Current status of epilepsy surgery in Nepal

ABSTRACT

Epilepsy surgery could not be started in Nepal till recently because we lacked know-how on epileptic zone localization. With the guidance of Prof. K Arita and Prof. T Hori we could start this surgery from 2002. Now we are performing surgery on our own but still have limitation in regards to case selection. At present Kathmandu Model Hospital is the only institute providing surgery for non-lesional cases. We have operated on 11 cases of non-lesional epilepsy of which 9 were temporal lobe epilepsy and 2 were drop attacks. Engel class I result could be achieved in 7 and class II in 2 cases. Both of the drop attack cases underwent complete corpus callosotomy and had no further atonic seizure. One patient had transient hemiparesis and there was no mortality or permanent morbidity. Achieving good result especially in the initial phase is important to convince the medical community to accept this treatment modality. Initial failure will lead to lack of enthusiasm, referral and even restriction on the program. In this regards we have been able to prepare groundwork for future development of epilepsy surgery. Epilepsy surgery can be an acceptable and cost-effective method of treatment for intractable seizure in countries having similar socio-economic scenario.