Epilepsy Surgery: A Case Series from Bolivia Highlighting Global Health Collaboration
Abstract number :
2.073
Submission category :
13. Health Services (Delivery of Care, Access to Care, Health Care Models)
Year :
2025
Submission ID :
438
Source :
www.aesnet.org
Presentation date :
12/7/2025 12:00:00 AM
Published date :
Authors :
Presenting Author: Tori Greaves, MD – Ann & Robert H. Lurie Children's Hospital of Chicago
Rebecca Garcia-Sosa, MD – Lurie Children’s Hospital
Nicole Arvanitis, MD – Lurie Children's Hospital
Giovanna Flores, MD – Hospital de Niños Dr. Mario Ortiz Suárez
Victor Cuellar, MD – Hospital de Niños Dr. Mario Ortiz Suárez,
Shirley Martinez, MD – Hospital de Niños Dr. Mario Ortiz Suárez
Felix Pacheco, MD – Hospital de Niños Dr. Mario Ortiz Suárez
Jose Cuiza, MD – Hospital de Niños Dr. Mario Ortiz Suárez
Jose Ferrufino, MD – Hospital de Niños Dr. Mario Ortiz Suárez
Limber Milpa, MD – Hospital de Niños Dr. Mario Ortiz Suárez
Mauricio Puch, MD – Hospital de Niños Dr. Mario Ortiz Suárez
Juan Gabriel Salgueiro, MD – Hospital de Niños Dr. Mario Ortiz Suárez
Miguel Saenz, MD – Hospital de Niños Dr. Mario Ortiz Suárez
Arthur DiPatri, MD – Comer Children’s Hospital, University of Chicago Medicine
Raheel Ahmed, MD – UW Health, UW School of Medicine and Public Health
David Hsu, MD – UW Health, UW School of Medicine and Public Health
Patricia Vargas, n/a – Fundación Puente de Solidaridad
Lindsay Doucette, n/a – Neurosurgery and Neurology Institute, Solidarity Bridge
Maria Eugenia Brockmamn, n/a – Neurosurgery and Neurology Institute, Solidarity Bridge
Rationale: Epilepsy affects 1 in 26 people over a lifetime. About 80% of individuals with epilepsy live in low- and middle-income countries (LMICs), where premature mortality from epilepsy is highest. Treatment gaps in LMICs such as Bolivia can reach 75% due to limited healthcare infrastructure and access to specialized care. Bolivia, with minimal access to epilepsy surgery, exemplifies this disparity. This case series describes the collaborative efforts of Solidarity Bridge and Bolivian clinicians, to evaluate and perform epilepsy surgery for pediatric patients in Santa Cruz, Bolivia. The initiative highlights the role of cross-border collaboration in reducing the global epilepsy treatment gap.
Methods: Solidarity Bridge/Fundación Puente de Solidaridad collaborated with U.S. based clinicians and Hospital de Niños in Santa Cruz. In 2023, Bolivian and U.S. pediatric neurologists and neurosurgeons arranged virtual meetings nearly every month to discuss refractory epilepsy patients and identify good surgical candidates. Over two trips, 4 pediatric patients with medically refractory epilepsy were selected. A multidisciplinary team of American epileptologists and neurosurgeons traveled to Bolivia in August 2023 and November 2024 to assist in intraoperative and perioperative support. All patients underwent video-EEG monitoring, brain MRI, and neurological evaluation prior to the interventions. Surgeries were conducted at Hospital de Niños with the support of local and visiting surgical teams. Surgical procedures included complete callosotomy (n=1), temporal lobectomy (n=3), tailored to the individual’s presumed seizure focus and imaging findings.
Results: All patients have had positive outcomes in seizure frequency and severity (Table 1). Patient 1 and 2 remains seizure-free on monotherapy. Patient 3 experienced worthwhile improvement (Engel Class IIIA) and remains on polytherapy with three medications, now with improvement in sleep and development. Patient 4 remains seizure-free on dual therapy. Surgical outcomes were favorable in all patients, despite having scarce resources such as limited access to prolonged video-EEG for spell capture, functional imaging and neurosurgical equipment.
Conclusions: These were the first pediatric epilepsy surgeries ever performed in the Bolivian public health system. Despite limited access to advanced technologies and specialized resources, meaningful improvements in patient outcomes can be realized through sustained engagement in educational conferences and multidisciplinary discussions focused on epilepsy surgical management. The collaboration between U.S.-based specialists and Bolivian healthcare providers enabled effective surgical intervention for children with intractable epilepsy while fostering long-term capacity-building. There is critical need for investment in local neurosurgical systems and comprehensive epilepsy care models. Addressing the global epilepsy treatment gap in LMICs requires ongoing international partnerships and policy initiatives that prioritize neurologic health equity. Expanding initiatives like this collaboration represents a promising pathway toward increasing access to epilepsy surgery for underserved populations worldwide.
Funding: N/A
Health Services (Delivery of Care, Access to Care, Health Care Models)