Building a Pediatric Epilepsy Surgery Program in a Limited Resources Country. a Multi-center Collaborative Model
Abstract number :
2.449
Submission category :
9. Surgery / 9B. Pediatrics
Year :
2024
Submission ID :
507
Source :
www.aesnet.org
Presentation date :
12/8/2024 12:00:00 AM
Published date :
Authors :
Presenting Author: Manuel Vides-Rosales, MD, MSc – Centro Medico Escalon
Rebeca Figueroa, - – Fundacion Compasion Purpura
Mauricio Palacios, MD – Instituto de Neurociencias
Rene Silva, MD – Centro Medico Nuestra Señora de la Paz, San Miguel
Eduardo Lovo, MD – Centro Internacional del Cancer - Hospital de Diagnostico
Roberto Quintanilla, PhD – Clinica Insight Neuropsicologia
Luis Rodriguez, MD – Johns Hopkins All Children´s Hospital, Johns Hopkins University School of Medicine
Jorge Vidaurre, MD – Nationwide Children's Hospital, The Ohio State University
Angel Hernandez, MD – Johns Hopkins All Children´s Hospital, Johns Hopkins University School of Medicine
Rationale: Incidence of epilepsy is about 61.4/100 000 person‐years, being three times higher in low and middle‐income countries than HIC1.2 About 1/3 of patients with epilepsy have drug-resistant epilepsy (DRE)3. Epilepsy surgery is an effective treatment for these patients. Limited-resources countries (LRC), usually lack the human and infrastructure resources2 required to build a pediatric epilepsy surgery program.
Methods: A multidisciplinary team (MDT) formed by 2 pediatric epileptologists, 1 pediatric epilepsy neurosurgeon from different US academic level 4 epilepsy centers and 2 local child neurologists was assembled to start a pediatric epilepsy surgical program in El Salvador. Patients received support from local epilepsy NPO Fundación Compasión Purpura (FCP).
Children meeting ILAE´s criteria for DRE were selected by local team and evaluated by MDT. 40-50 pediatric DRE cases were evaluated per yearly visit. For each case, EEG and neuroimaging data were reviewed. Data was reviewed by MDT for surgical candidates selection. Treatment options were discussed with patients and families. Cases were then operated in a short term or at a follow visit.
Results: The MDT met for patients evaluation, from 2019-2024 with a hiatus during the pandemic. Educational activities were also planned for local health workers. In 2024, MDT met with local health government officials to discuss the need to continue to train personnel and equip public hospitals with the resources needed to build an epilepsy surgical program, including a 3T MRI, vEEG, and neuronavigation.
Since the project started, MDT has completed a limited number of surgeries and FCP has strengthened its outreach efforts. (Table 1, Table 2) The team started with lesional cases and palliative procedures, with plans to increase the number of surgeries as the teams continue to integrate
Conclusions: 80% of patients with epilepsy live in rural areas and LRC, where treatment gap is more than 75%4. These regions lack resources, including properly trained personnel and infrastructure. Multi-center collaboration between level 4 centers, local physicians and medical facilities in LRC is important to develop epilepsy programs. Involvement of local government, public and private hospitals, and local NPO is also crucial to create a long-term sustainable project. We demonstrated that building a pediatric epilepsy surgical program takes time and effort.
1. Fiest KM, Sauro KM, Wiebe S, et al. Prevalence and incidence of epilepsy: a systematic review and meta‐analysis of international studies. Neurology. 2017;17(88):296–303
2. Le VT, Thuy Le MA, Nguyen DH, et al. Epilepsy surgery program in a resource-limited setting in Vietnam: A multicentered collaborative model. Epilepsia Open. 2022 Dec;7(4):710-717
3. Kwan P, Brodie MJ. Early identification of refractory epilepsy. NEJM. 2000 Feb 3;342(5):314–9
4. Meyer AC, Dua T, Ma J, Saxena S, Birbeck G. Global disparities in the epilepsy treatment gap: a systematic review. Bull World Health Organ. 2010 Apr;88(4):260-6
Funding: No fundings were received for this project.
Surgery