RESUMO
Epilepsy prevalence in the developing world is many fold that found in developed countries. For individuals whose conditions failed to respond to pharmacotherapy, surgery is the only opportunity for cure. In Uganda, we developed a center for treatment of intractable temporal lobe epilepsy (iTLE) that functions within the technologic and expertise constraints of a severely low resource area. Our model relies on partnership with epilepsy professionals and training of local staff. Patients were prescreened at regional clinics for iTLE. Individuals meeting inclusion criteria were referred to the treating Ugandan hospital (CURE Children's' Hospital of Uganda, CCHU) for video-EEG (electroencephalography), computed tomography (CT) imaging, and neuropsychological evaluation. Data were transferred to epilepsy experts for analysis and treatment recommendations. Ten patients were diagnosed with iTLE and surgically treated at CCHU. Six (60%) were seizure free, and there was no neurologic morbidity or mortality. Our model for surgical treatment of pharmacoresistant TLE has functioned successfully in a true developing world low resource setting.
Assuntos
Epilepsia do Lobo Temporal/cirurgia , Procedimentos Neurocirúrgicos/métodos , Adolescente , Eletroencefalografia/métodos , Epilepsia do Lobo Temporal/diagnóstico , Epilepsia do Lobo Temporal/epidemiologia , Feminino , Humanos , Masculino , Testes Neuropsicológicos , Projetos Piloto , Tomografia Computadorizada por Raios X , Uganda/epidemiologia , Adulto JovemRESUMO
Intractable epilepsy is a debilitating disease with significant associated morbidity and mortality. Uncontrolled epilepsy is socially disabling causing stigma, social exclusion, and often preventing employment. After an individual has tried and failed three or four of the standard anticonvulsants, it is very unlikely any further medications or combinations of medications will control the epilepsy. The major Neurology, Neurosurgery, and Epilepsy medical societies recommend all individuals with medically intractable epilepsy be evaluated in a comprehensive epilepsy program. In selected individuals, surgery for epilepsy has tremendous potential to cure or control intractable epilepsy. At West Virginia University Health Sciences Center, 48 individuals underwent surgery for intractable temporal lobe epilepsy over a 2.5 year period. Thirty-five (73%) of individuals were seizure free after surgery, and 96% were seizure free or significantly improved. Surgery for epilepsy has a high likelihood for success in medically intractable temporal lobe epilepsy, and is superior to medical treatment alone.
