Overview: epilepsy surgery in developing countries.

Epilepsy surgery (ES) is addressed in relation to economic classifications of national resources and welfare in developing countries. A decade ago, ten developing countries conducted ES; now 26 such countries have reported results of ES. A number of international authorities define indicators of national economic welfare. Adopting the economic classification of the International Monetary Fund. we find that ES is nonexistent in 98% of African countries, 76% of Asian countries, 58% of European countries, 82% of Middle East countries, and in 86% of countries of the Western Hemisphere. The 1980-1990 global ES survey conducted by the International League Against Epilepsy identified ten developing countries reporting ES (DCRES): Brazil, China, Czechoslovakia, Hungary, Mexico, Poland, Taiwan, the U.S.S.R., Yugoslavia, and Viet Nam. The present survey based on the proceedings of the 19th-23rd International Epilepsy Congresses and Medline reports from 1991 to November 1999 revealed at least 26 (18.3%) DCRES of 142 developing countries: Argentina, Brazil, Chile, China, Colombia, Czech Republic, Egypt, Estonia, Hungary, India, Iran, Israel, Korea, Lithuania, Mexico, P.R.China, the U.S.S.R., Singapore, Slovenia, South Africa, South Korea, Taiwan, Turkey, Ukraine, Uruguay, and former Yugoslavia. National vital statistics expose the hardships of developing countries. The population ratio of developed countries to developing countries is approximately 1:5. The reverse per capita Gross Domestic Product ratio is 20:1. Great disparities exist in vital statistics, all to the disadvantage of the DCRES. The World Health Organization defines health-related sectors geographically, then divides developing countries into several subgroups. Disability caused by length of disease and years lived with disability can be quantified monetarily for epilepsy, and the total health expenditures of developed and developing countries can be compared. The DCRES are short of technology, and their ES teams must choose from an excess of surgical candidates, investigating with computed tomography, magnetic resonance imaging, noninvasive video-electroencephalography, and neuropsychology. The surgical outcomes achieved are similar to those in the developed world, but at a fractional cost. To internationalize ES, outcome, cost, and savings from care, evolution of assessment methodology is needed. Also needed is general support from the developed world.