Andrew Siyoon Ham1, Damber K Nirola2, Neishay Ayub3, Lhab Tshering4, Ugyen Dem2, Nathalie Jette5, Chencho Dorji4, Farrah J Mateen6. 1. Harvard University, Cambridge, MA, USA. 2. Khesar Gyalpo University of Medical Sciences of Bhutan, Thimphu, Bhutan. 3. Massachusetts General Hospital, Boston, MA, USA. 4. Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan. 5. Icahn School of Medicine at Mount Sinai, New York, NY, USA. 6. Massachusetts General Hospital, Boston, MA, USA. Electronic address: fmateen@partners.org.
Abstract
OBJECTIVE: To quantify the missed opportunities for epilepsy surgery referral and operationalize the Canadian Appropriateness of Epilepsy Surgery (CASES) tool for use in a lower income country without neurologists. METHODS: People with epilepsy were recruited from the Jigme Dorji Wangchuck National Referral Hospital from 2014-2016. Each participant was clinically evaluated, underwent at least one standard EEG, and was invited to undergo a free 1.5 T brain MRI. Clinical variables required for CASES were operationalized for use in lower-income populations and entered into the free, anonymous website tool. FINDINGS: There were 209 eligible participants (mean age 28.4 years, 56 % female, 179 with brain MRI data). Of the 179 participants with brain MRI, 43 (24.0 %) were appropriate for an epilepsy surgery referral, 21 (11.7 %) were uncertain, and 115 (64.3 %) were inappropriate for referral. Among the 43 appropriate referral cases, 36 (83.7 %) were "very high" and 7 (16.3 %) were "high" priorities for referral. For every unit increase in surgical appropriateness, quality of life (QoL) dropped by 2.3 points (p-value <0.001). Among the 68 patients who took >1 antiepileptic drug prior to enrollment, 42 (61.8 %) were appropriate referrals, 14 (20.6 %) were uncertain, and 12 (17.6 %) were inappropriate. CONCLUSION: Approximately a quarter of Bhutanese epilepsy patients who completed evaluation in this national referral-based hospital should have been evaluated for epilepsy surgery, sometimes urgently. Surgical services for epilepsy are an emerging priority for improving global epilepsy care and should be scaled up through international partnerships and clinician support algorithms like CASES to avoid missed opportunities.
OBJECTIVE: To quantify the missed opportunities for epilepsy surgery referral and operationalize the Canadian Appropriateness of Epilepsy Surgery (CASES) tool for use in a lower income country without neurologists. METHODS:People with epilepsy were recruited from the Jigme Dorji Wangchuck National Referral Hospital from 2014-2016. Each participant was clinically evaluated, underwent at least one standard EEG, and was invited to undergo a free 1.5 T brain MRI. Clinical variables required for CASES were operationalized for use in lower-income populations and entered into the free, anonymous website tool. FINDINGS: There were 209 eligible participants (mean age 28.4 years, 56 % female, 179 with brain MRI data). Of the 179 participants with brain MRI, 43 (24.0 %) were appropriate for an epilepsy surgery referral, 21 (11.7 %) were uncertain, and 115 (64.3 %) were inappropriate for referral. Among the 43 appropriate referral cases, 36 (83.7 %) were "very high" and 7 (16.3 %) were "high" priorities for referral. For every unit increase in surgical appropriateness, quality of life (QoL) dropped by 2.3 points (p-value <0.001). Among the 68 patients who took >1 antiepileptic drug prior to enrollment, 42 (61.8 %) were appropriate referrals, 14 (20.6 %) were uncertain, and 12 (17.6 %) were inappropriate. CONCLUSION: Approximately a quarter of Bhutanese epilepsypatients who completed evaluation in this national referral-based hospital should have been evaluated for epilepsy surgery, sometimes urgently. Surgical services for epilepsy are an emerging priority for improving global epilepsy care and should be scaled up through international partnerships and clinician support algorithms like CASES to avoid missed opportunities.
Authors: Nathalie Jette; Hude Quan; Jose F Tellez-Zenteno; Sophia Macrodimitris; Walter J Hader; Elisabeth M S Sherman; Lorie D Hamiwka; Elaine C Wirrell; Jorge G Burneo; Amy Metcalfe; Peter D Faris; Lizbeth Hernandez-Ronquillo; Churl-Su Kwon; Andrew Kirk; Samuel Wiebe Journal: Neurology Date: 2012-08-15 Impact factor: 9.910
Authors: Kate Brizzi; Sonam Deki; Lhab Tshering; Sarah J Clark; Damber K Nirola; Bryan N Patenaude; Erica D McKenzie; Hannah C McLane; Sydney S Cash; Chencho Dorji; Farrah J Mateen Journal: Int Health Date: 2016-05-08 Impact factor: 2.473
Authors: Musa M Watila; Fenglai Xiao; Mark R Keezer; Anna Miserocchi; Andrea S Winkler; Andrew W McEvoy; Josemir W Sander Journal: Epilepsy Behav Date: 2019-02-06 Impact factor: 2.937