Ali A Asadi-Pooya1,2,3, Seyed M Rakei4, Ahmad Kamgarpour4, Mousa Taghipour5,4, Nahid Ashjazadeh5,6, Ali Razmkon5,4, Zahra Zare7, Mohammad H Bagheri8. 1. Neurosciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran - aliasadipooya@yahoo.com. 2. Department of Neurology, Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, Iran - aliasadipooya@yahoo.com. 3. Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA - aliasadipooya@yahoo.com. 4. Department of Neurosurgery, Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, Iran. 5. Neurosciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran. 6. Department of Neurology, Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, Iran. 7. Department of Radiology, Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, Iran. 8. Medical Imaging Research Center, Department of Radiology, Namazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.
Abstract
BACKGROUND: Epilepsy surgery has been proved to be feasible and cost-effective in developing countries. In the current paper, we discussed the outcome of patients with mesial temporal lobe epilepsy (MTLE) and medically-refractory seizures who had surgery at our center in Shiraz, Iran. METHODS: Patients aged 18 years and older with refractory MTLE and mesial temporal sclerosis operated at Namazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran from May 2009 through December 2011 were enrolled. Presurgical evaluation included clinical history, neurological examination, 2-hour video-EEG recording, and 1.5-T MRI. All patients were submitted to standard temporal lobectomy at the side determined by MRI and video-EEG. RESULTS: Twenty-two patients (12 women and 10 men) underwent surgery between May 2009 and December 2011. All patients were followed postoperatively for at least 12 months (mean=24.8±7.7 months; minimum=12 months; maximum=36 months). At the last follow-up visit, 18 patients (81.8%) had a good outcome (15 patients [68.2%] had Engel class 1 and three others had Engel class 2). The total cost of presurgical evaluation and epilepsy surgery at our center was less than $500. CONCLUSIONS: Resources are limited for the vast majority of medically-refractory patients with epilepsy who live in the developing countries. However, it is feasible to select good surgical candidates for anterior temporal lobectomy relying on the clinical history and examination, MRI and interictal EEG. Broader application of epilepsy surgery should be encouraged in countries with limited financial resources.
BACKGROUND:Epilepsy surgery has been proved to be feasible and cost-effective in developing countries. In the current paper, we discussed the outcome of patients with mesial temporal lobe epilepsy (MTLE) and medically-refractory seizures who had surgery at our center in Shiraz, Iran. METHODS:Patients aged 18 years and older with refractory MTLE and mesial temporal sclerosis operated at Namazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran from May 2009 through December 2011 were enrolled. Presurgical evaluation included clinical history, neurological examination, 2-hour video-EEG recording, and 1.5-T MRI. All patients were submitted to standard temporal lobectomy at the side determined by MRI and video-EEG. RESULTS: Twenty-two patients (12 women and 10 men) underwent surgery between May 2009 and December 2011. All patients were followed postoperatively for at least 12 months (mean=24.8±7.7 months; minimum=12 months; maximum=36 months). At the last follow-up visit, 18 patients (81.8%) had a good outcome (15 patients [68.2%] had Engel class 1 and three others had Engel class 2). The total cost of presurgical evaluation and epilepsy surgery at our center was less than $500. CONCLUSIONS: Resources are limited for the vast majority of medically-refractory patients with epilepsy who live in the developing countries. However, it is feasible to select good surgical candidates for anterior temporal lobectomy relying on the clinical history and examination, MRI and interictal EEG. Broader application of epilepsy surgery should be encouraged in countries with limited financial resources.
Authors: Lilia Maria Morales Chacón; Ivan Garcia Maeso; Margarita M Baez Martin; Juan E Bender Del Busto; María Eugenia García Navarro; Nelson Quintanal Cordero; Bárbara Estupiñan Díaz; Lourdes Lorigados Pedre; Ricardo Valdés Yerena; Judith Gonzalez; Randy Garbey Fernandez; Abel Sánchez Coroneux Journal: Behav Sci (Basel) Date: 2018-02-01