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Nugroho AW. The start-up of a neurosurgical service in an East Indonesian archipelagic province: The first 2-year experience of North Maluku Database in Neurosurgery (NOMADEN). Surg Neurol Int 2024; 15:53. [PMID: 38468665 PMCID: PMC10927227 DOI: 10.25259/sni_1026_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 01/31/2024] [Indexed: 03/13/2024] Open
Abstract
Background Despite encouraging developments after its initial founding in Indonesia more than seven decades ago, inequity in access and availability of neurosurgical services throughout the country continues to pose a challenge. We aimed to elaborate on the start-up of a previously inactive neurosurgical service in North Maluku, an archipelagic province in East Indonesia, and describe cases managed within the first two years of service. Methods In the North Maluku Database in the Neurosurgery register, demographic and clinical information of neurosurgical patients admitted to Chasan Boesoirie General Hospital, Ternate, from January 2021 to December 2022, were analyzed. Surgically managed patients were rendered visually according to their decades of life and districts of events. Results There were 998 new patients (mean age ± standard deviation [SD]: 34.7 ± 19.6 years, 60.3% male) managed and 216 neurosurgical procedures (mean age ± SD: 33 ± 20.4 years, 67.1% male) performed. The majority of patients operated were within the 1st decade of life (18.5%), presented to the emergency room (56.5%), covered by national health insurance (69.4%), from outside Ternate (62.5%), diagnosed with neurotrauma (40.7%), and discharged alive (80.1%). Ternate was the only district where all seven types of neurological diseases were encountered. No surgeries were performed for patients from Taliabu, the farthest district from Ternate. Conclusion A large portion of neurosurgical patients in North Maluku were those young and at productive age who were transported from outside Ternate with acute neurological disease (particularly neurotrauma). Distance and geographical circumstances may have a profound effect on access to neurosurgical services.
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Hamdi H, Kishk N, Shamloul R, Moawad MK, Baghdadi M, Rizkallah M, Nawito A, Mohammad ME, Nazmi H, Nasr YM, Waly SH, Elshahat M, Magdy R, Othman AS, Nafea H, Fouad AM, Elantably I, Rizk H, Elsayyad E, Morsy AA. Resective epilepsy surgery in a limited-resource settings: A cohort from a multi-disciplinary epilepsy team in a developing country. Surg Neurol Int 2023; 14:240. [PMID: 37560561 PMCID: PMC10408623 DOI: 10.25259/sni_1081_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 04/20/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Multidisciplinary pre-surgical evaluation is vital for epilepsy surgery decision and outcomes. Resective epilepsy surgery with assisted monitoring is currently a standard treatment for focal drug resistant epilepsy (DRE). In resource-limited countries, lack of epilepsy surgery center is a huge challenge. We presented and illustrated how to create a multidisciplinary protocol with resource-limited settings in a developing country and epilepsy surgery outcome using brain mapping and monitoring techniques for ensuring satisfactory resection. METHODS We created multicentric incomplete but complementary units covering all epilepsy-related sub-specialties and covering a wide geographical area in our country. Then, we conducted a prospective and multicentric study with low resource settings on patients with focal DRE, who underwent resective epilepsy surgery and were followed up for at least 12 months and were evaluated for postoperative seizure outcome and complications if present. Preoperative comprehensive clinical, neurophysiological, neuropsychological, and radiological evaluations were performed by multidisciplinary epilepsy team. Intraoperative brain mapping including awake craniotomy and direct stimulation techniques, neurophysiological monitoring, and electrocorticography was carried out during surgical resection. RESULTS The study included 47 patients (18 females and 29 males) with mean age 20.4 ± 10.02 years. Twenty-two (46.8%) patients were temporal epilepsy while 25 (53.2%) were extra-temporal epilepsy. The epilepsy surgery outcome at the last follow up was Engel Class I (seizure free) in 35 (74.5%), Class II (almost seizure free) in 8 (17%), Class III (worthwhile improvement) in 3 (6.4%), and Class IV (no worthwhile improvement) in 1 patient (2.1%). CONCLUSION With low resource settings and lack of single fully equipped epilepsy center, favorable outcomes after resective surgery in patients with focal DRE could be achieved using careful presurgical multidisciplinary selection, especially with using intraoperative brain mapping and electrocorticography techniques.
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Affiliation(s)
- Hussein Hamdi
- Department of Neurosurgery, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Nirmeen Kishk
- Department of Neurology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Reham Shamloul
- Department of Neurology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mona K. Moawad
- Department of Neurology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | | | - Mina Rizkallah
- Department of Radiology, Ministry of Health, Cairo, Egypt
| | - Amani Nawito
- Department of Clinical Neurophysiology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | | | - Hatem Nazmi
- Department of Anesthesia, Surgical Intensive Care and Pain Management, Zagazig, Egypt
| | - Yasser Mohamed Nasr
- Department of Anesthesia, Surgical Intensive Care and Pain Management, Zagazig, Egypt
| | - Salwa Hassan Waly
- Department of Anesthesia, Surgical Intensive Care and Pain Management, Zagazig, Egypt
| | - Mo’men Elshahat
- Department of Neurosurgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Rehab Magdy
- Department of Neurology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Alshimaa S. Othman
- Department of Neurology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Hesham Nafea
- Department of Clinical Neurophysiology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Amro M Fouad
- Department of Neurology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ismail Elantably
- Department of Neurosurgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Haytham Rizk
- Department of Neurology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Enas Elsayyad
- Department of Neurology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed A. Morsy
- Department of Neurosurgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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Asadi-Pooya AA, Damabi NM, Fazelian K, Moshfeghinia R, Niknam N. How to successfully establish an epilepsy care center in resource-limited countries: A scoping systematic review. Seizure 2023; 109:92-96. [PMID: 37290225 DOI: 10.1016/j.seizure.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/15/2023] [Accepted: 06/03/2023] [Indexed: 06/10/2023] Open
Abstract
PURPOSE The aim of the current study was to systematically review the literature on establishing epilepsy care centers in resource-limited nations in the world and to provide a comprehensive roadmap on this significantly needed endeavor. This work may provide guidance on how to develop an epilepsy care center in other resource-limited places in the world. METHODS Web of science, Science Direct, and MEDLINE (accessed from PubMed) from inception to March 2023 were systematically searched for relevant published manuscripts. In all electronic databases, the following search strategy was implemented and these key words were used (title/abstract): epilepsy AND resource. The inclusion criteria were all original studies and articles written in English. RESULTS We could identify nine manuscripts on how to successfully establish an epilepsy care center in resource-limited countries. Two models were identified for such an endeavor: developing a team of trained healthcare professionals (e.g., in Iran, India, China, Vietnam) or a twin affiliation between an advanced epilepsy surgery program in a developed country and a starting program in a developing country (e.g., in Georgia, Tunisia). CONCLUSION In order to successfully establish an epilepsy care center in resource-limited countries four pillars are needed: presence of skillful healthcare professionals, having access to basic investigative technologies (i.e., MRI and EEG), a careful planning, and raising awareness.
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Affiliation(s)
- Ali A Asadi-Pooya
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA.
| | | | - Khatereh Fazelian
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Reza Moshfeghinia
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nafise Niknam
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Bakhtiar Y, Pratama Brilliantika S, Bunyamin J, Arifin MT, Hardian H, Bintoro AC, Muttaqin Z. Postoperative Evaluation of the Quality of Life, Depression, and Anxiety of Temporal Lobe Epilepsy Cohort: A Single Institute Experience in Indonesia. Front Neurol 2021; 12:708064. [PMID: 34594295 PMCID: PMC8477026 DOI: 10.3389/fneur.2021.708064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 08/09/2021] [Indexed: 11/24/2022] Open
Abstract
Background: Besides seizure control, quality of life (QoL) should be considered as an equally important outcome for epilepsy surgery service providers. The paucity of QoL reports from developing countries has enlarged the representation gap between wealthy countries and countries with fewer resources. In this study, we evaluated postoperative QoL in the Indonesian drug-resistant epilepsy cohort where the epilepsy surgery service faces limited resource availability. Methods: We evaluated the QoL in patients with temporal lobe epilepsy who underwent surgery in our epilepsy surgery center in Semarang, Indonesia, from 2001 until 2015. The follow–up period started in 2018 through 2019. Postoperative QoL, depression, and anxiety were evaluated with self-reporting questionnaires including the Quality of Life in Epilepsy Inventory-31, Beck Depression Inventory-II, and Zung Self-Rating Anxiety Scales. Results: Forty returned questionnaires were included in the analysis (male 25, 62.5%; mean age 27.6 ± 9.05 years). The seizure-free cohort (n = 22, 55.0%) reported higher scores in most QoL dimensions particularly adjustment, overall QoL, and seizure worry compared to those with persistent seizures. The overall QoL level was correlated with seizure freedom and surgery type. QoL dimensions were negatively correlated with anxiety and depression levels. Conclusions: Postoperative seizure freedom was a major factor of postoperative QoL level. Besides seizure freedom, anxiety and depression levels were also negatively correlated with QoL levels in the Indonesian population.
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Affiliation(s)
- Yuriz Bakhtiar
- Department of Neurosurgery, Faculty of Medicine Diponegoro University/Dr Kariadi Hospital, Semarang, Indonesia.,Department of Physiology, Faculty of Medicine, Diponegoro University, Semarang, Indonesia
| | - Surya Pratama Brilliantika
- Department of Neurosurgery, Faculty of Medicine Diponegoro University/Dr Kariadi Hospital, Semarang, Indonesia
| | - Jacob Bunyamin
- Department of Neurosurgery, Faculty of Medicine Diponegoro University/Dr Kariadi Hospital, Semarang, Indonesia
| | - Muhammad Thohar Arifin
- Department of Neurosurgery, Faculty of Medicine Diponegoro University/Dr Kariadi Hospital, Semarang, Indonesia
| | - Hardian Hardian
- Department of Physiology, Faculty of Medicine, Diponegoro University, Semarang, Indonesia
| | - Aris Catur Bintoro
- Department of Neurology, Faculty of Medicine Diponegoro University/Dr Kariadi Hospital, Semarang, Indonesia
| | - Zainal Muttaqin
- Department of Neurosurgery, Faculty of Medicine Diponegoro University/Dr Kariadi Hospital, Semarang, Indonesia
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