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Tran VD, Nguyen BT, Van Dong H, Lieber BA, Bista J, Van Vu H, Bui TN, Chu HT, Nguyen PX, Nguyen TA, Ono T, Trieu ST, Nhu SD. Temporal Lobe Surgery for Epilepsy in a Resource-Limited Vietnamese Cohort. World Neurosurg 2023; 178:e559-e565. [PMID: 37532017 DOI: 10.1016/j.wneu.2023.07.119] [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: 07/04/2023] [Revised: 07/22/2023] [Accepted: 07/24/2023] [Indexed: 08/04/2023]
Abstract
BACKGROUND Epilepsy surgery is traditionally difficult to pursue in resource-limited countries but is nevertheless essential in the treatment of medication-refractory, surgically amenable epilepsy. METHODS With the help of international collaboration, a successful epilepsy program was started in Vietnam. This article comprises a retrospective chart review, combined with prospective longitudinal follow-up of 35 cases of unilateral drug-resistant epilepsy in the temporal lobe who underwent temporal lobectomy, in Viet Duc University Hospital from May 2018 to September 2022. RESULTS The female/male ratio was 0.6:1, and focal seizures with impaired awareness accounted for 97.14% of patients. Of patients with focal awareness seizures, 51.41% were localized and detected by electroencephalography. Postoperatively, 80% of patients were seizure free (Engel I) at 1 year, and the remaining 20% had worthwhile seizure improvement (Engel II). Postoperative temporal lobe pathology was categorized as follows: mesial temporal sclerosis (48.57%), focal cortical dysplasia (25.71%), and low-grade neoplasms (25.71%). Of patients, 17.14% had postoperative complications (5 infections and 1 transient extremity paresis), and there were no deaths. CONCLUSIONS Even in low-resource environments, effective and safe surgical care can be provided for drug-resistant epilepsy caused by temporal lobe disease. This study serves as a model of international collaboration and support for future hospitals in low-resource environments to replicate.
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Affiliation(s)
- Van Dinh Tran
- Vietnam Military Medical University, Hanoi, Vietnam; Neurosurgery Center of Viet Duc Hospital, Hanoi, Vietnam
| | | | - He Van Dong
- Neurosurgery Center of Viet Duc Hospital, Hanoi, Vietnam
| | - Bryan A Lieber
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, Louisiana, USA; Department of Neurosurgery, Dr. Kiran C. Patel College of Allopathic Medicine, Davie, Florida, USA.
| | - Jehan Bista
- The University of Queensland-Ochsner Clinical School, New Orleans, Louisiana, USA
| | - Hoe Van Vu
- Vietnam Military Medical University, Hanoi, Vietnam
| | - Tien Ngoc Bui
- Neurosurgery Center of Viet Duc Hospital, Hanoi, Vietnam
| | - Hung Thanh Chu
- Department of Neurological Surgery, Hanoi Medical University, Hanoi, Vietnam
| | | | | | - Tomonori Ono
- Epilepsy Center, Department of Neurosurgery, National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan
| | | | - Son Dinh Nhu
- Vietnam Military Medical University, Hanoi, Vietnam
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Tran VD, Nguyen BT, Van Dong H, Nguyen TA, Nguyen PX, Van Vu H, Chu HT. Microsurgery for drug resistance epilepsy due to temporal lobe lesions in a resource limited condition: a cross-sectional study. Ann Med Surg (Lond) 2023; 85:3852-3857. [PMID: 37554863 PMCID: PMC10406011 DOI: 10.1097/ms9.0000000000001021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 06/15/2023] [Indexed: 08/10/2023] Open
Abstract
UNLABELLED Epilepsy is a prevalent neurological condition that affects individuals of all ages and genders worldwide. Surgical intervention for drug-resistant epilepsy has been found to improve quality of life, with patient independence being of utmost importance. METHODS The study was a retrospective and prospective cross-sectional study of 35 cases of drug-resistant temporal lobe epilepsy. All patients were operated on by the primary author between May 2018 and September 2022. The study evaluated various factors including clinical characteristics, electroencephalogram, magnetic resonance imaging, surgical outcomes, and histopathology. RESULTS The success rate of the surgeries (74.3%) is similar to those reported in high-income countries. 51.4% underwent selective amygdalohippocampectomy for cases that localized to the mesial temporal lobe. Lateral/neocortical lesions underwent lesionectomy (48.6%). Our study found a complication rate of 17.1%: meningitis (8.5%), trainset focal paralysis (2.9%), and soft tissue infection (5.7%). There were no mortalities. CONCLUSIONS The article showcases an international collaborative effort that demonstrates the possibility of providing highly effective and safe surgical care for temporal lobe epilepsy even in low-resource environments. The authors hope that this model can be replicated in other areas with similar resource limitations.
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Affiliation(s)
- Van Dinh Tran
- Vietnam Military Medical University, Hanoi, Vietnam
- Neurosurgery Center of Vietduc University Hospital, Hanoi, Vietnam
| | | | - He Van Dong
- Neurosurgery Center of Vietduc University Hospital, Hanoi, Vietnam
| | - Tuan Anh Nguyen
- Neurosurgery Center of Vietduc University Hospital, Hanoi, Vietnam
| | | | - Hoe Van Vu
- Vietnam Military Medical University, Hanoi, Vietnam
| | - Hung Thanh Chu
- Neurosurgery Center of Vietduc University Hospital, Hanoi, Vietnam
- Hanoi Medical University, Hanoi, Vietnam
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Le V, Thuy Le M, Nguyen DH, Tang LNP, Pham TA, Nguyen AM, Nguyen MK, Van Ngo T, Tran TT, Van Le T, Jallon P, Lim K. Epilepsy surgery program in a resource-limited setting in Vietnam: A multicentered collaborative model. Epilepsia Open 2022; 7:710-717. [PMID: 36136063 PMCID: PMC9712473 DOI: 10.1002/epi4.12650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 09/18/2022] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE Although epilepsy surgery is more effective than medical therapy for drug-resistant patients, it is underutilized in both high-income and low- and middle-income countries. In light of our efforts to establish an epilepsy surgery program in a resource-limited setting, this study aimed to determine the outcome of the epilepsy surgery program in Ho Chi Minh City (HCMC), Vietnam. METHODS In 2018, we developed the HCMC epilepsy core multidisciplinary team with members from various hospitals and centers. The team typically included neurologists, neurosurgeons, neuropsychologists, psychiatrists, and nursing specialists. Presurgical evaluations were performed for patients with drug-resistant epilepsy, fulfilling the ILAE criteria, with an epileptogenic lesion (mesial temporal sclerosis, low-grade gliomas, or focal cortical dysplasia). All epilepsy surgeries were performed in two epilepsy surgery centers in HCMC between 2018 and 2021. The patients were followed up for at least 12 months. RESULTS Fifty-two patients with drug-resistant epilepsy underwent presurgical evaluation, of which 35 underwent surgery. Among the 52 patients, 20 (38.5%) underwent surgery after showing concordance among the results of standard presurgical assessments such as semiology, scalp interictal or ictal electroencephalography, and brain imaging. Among the 26 people with epilepsy who required more advanced evaluations, 15 underwent surgery with intraoperative electrocorticography to delineate the optimal resection borders. The outcomes of Engel Class I and Class II were achieved in 29/35 (82.8%) and 6/35 (17.2%) patients, respectively. SIGNIFICANCE The epilepsy surgery program with a multicentered collaborative model in a resource-limited setting showed favorable outcomes in HCMC, Vietnam.
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Affiliation(s)
- Viet‐Thang Le
- Department of NeurosurgeryUniversity Medical Center at Ho Chi Minh CityHo Chi Minh CityVietnam,Department of NeurosurgeryUniversity of Medicine and Pharmacy at Ho Chi Minh CityHo Chi Minh CityVietnam
| | - Minh‐An Thuy Le
- Department of NeurologyUniversity of Medicine and Pharmacy at Ho Chi Minh CityHo Chi Minh CityVietnam,Department of NeurologyNguyen Tri Phuong HospitalHo Chi Minh CityVietnam
| | - Duc Hue Nguyen
- Department of NeurosurgeryNguyen Tri Phuong HospitalHo Chi Minh CityVietnam
| | - Loc Ngoc Phuong Tang
- Department of NeurologyNguyen Tri Phuong HospitalHo Chi Minh CityVietnam,Department of NeurologyPham Ngoc Thach University of MedicineHo Chi Minh CityVietnam
| | - Tuan Anh Pham
- Department of NeurosurgeryUniversity of Medicine and Pharmacy at Ho Chi Minh CityHo Chi Minh CityVietnam,Department of NeurosurgeryNguyen Tri Phuong HospitalHo Chi Minh CityVietnam
| | - Anh Minh Nguyen
- Department of NeurosurgeryUniversity Medical Center at Ho Chi Minh CityHo Chi Minh CityVietnam
| | - Minh Kien Nguyen
- Department of Infection DiseaseChildren Hospital 1Ho Chi Minh CityVietnam
| | - Tan Van Ngo
- Division of PET‐CT and Cyclotron, Nuclear Medicine DepartmentCho Ray hospitalHo Chi Minh CityVietnam
| | - Thanh Trung Tran
- Department of NeurologyNguyen Tri Phuong HospitalHo Chi Minh CityVietnam
| | - Tuan Van Le
- Department of NeurologyUniversity of Medicine and Pharmacy at Ho Chi Minh CityHo Chi Minh CityVietnam
| | - Pierre Jallon
- Department of NeurologyUniversity of Medicine and Pharmacy at Ho Chi Minh CityHo Chi Minh CityVietnam
| | - Kheng‐Seang Lim
- Division of Neurology, Faculty of MedicineUniversity of MalayaKuala LumpurMalaysia
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Vaughan KA, Lopez Ramos C, Buch VP, Mekary RA, Amundson JR, Shah M, Rattani A, Dewan MC, Park KB. An estimation of global volume of surgically treatable epilepsy based on a systematic review and meta-analysis of epilepsy. J Neurosurg 2018:1-15. [PMID: 30215556 DOI: 10.3171/2018.3.jns171722] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Accepted: 03/12/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVEEpilepsy is one of the most common neurological disorders, yet its global surgical burden has yet to be characterized. The authors sought to compile the most current epidemiological data to quantify global prevalence and incidence, and estimate global surgically treatable epilepsy. Understanding regional and global epilepsy trends and potential surgical volume is crucial for future policy efforts and resource allocation.METHODSThe authors performed a systematic literature review and meta-analysis to determine the global incidence, lifetime prevalence, and active prevalence of epilepsy; to estimate surgically treatable epilepsy volume; and to evaluate regional trends by WHO regions and World Bank income levels. Data were extracted from all population-based studies with prespecified methodological quality across all countries and demographics, performed between 1990 and 2016 and indexed on PubMed, EMBASE, and Cochrane. The current and annual new case volumes for surgically treatable epilepsy were derived from global epilepsy prevalence and incidence.RESULTSThis systematic review yielded 167 articles, across all WHO regions and income levels. Meta-analysis showed a raw global prevalence of lifetime epilepsy of 1099 per 100,000 people, whereas active epilepsy prevalence is slightly lower at 690 per 100,000 people. Global incidence was found to be 62 cases per 100,000 person-years. The meta-analysis predicted 4.6 million new cases of epilepsy annually worldwide, a prevalence of 51.7 million active epilepsy cases, and 82.3 million people with any lifetime epilepsy diagnosis. Differences across WHO regions and country incomes were significant. The authors estimate that currently 10.1 million patients with epilepsy may be surgical treatment candidates, and 1.4 million new surgically treatable epilepsy cases arise annually. The highest prevalences are found in Africa and Latin America, although the highest incidences are reported in the Middle East and Latin America. These regions are primarily low- and middle-income countries; as expected, the highest disease burden falls disproportionately on regions with the fewest healthcare resources.CONCLUSIONSUnderstanding of the global epilepsy burden has evolved as more regions have been studied. This up-to-date worldwide analysis provides the first estimate of surgical epilepsy volume and an updated comprehensive overview of current epidemiological trends. The disproportionate burden of epilepsy on low- and middle-income countries will require targeted diagnostic and treatment efforts to reduce the global disparities in care and cost. Quantifying global epilepsy provides the first step toward restructuring the allocation of healthcare resources as part of global healthcare system strengthening.
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Affiliation(s)
- Kerry A Vaughan
- 1Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.,5Global Neurosurgery Initiative/Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
| | - Christian Lopez Ramos
- 2University of California San Diego School of Medicine, La Jolla, California.,5Global Neurosurgery Initiative/Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
| | - Vivek P Buch
- 1Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rania A Mekary
- 3Department of Pharmaceutical Business and Administrative Sciences, School of Pharmacy, MCPHS University, Boston.,4Cushing Neurosurgical Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School
| | - Julia R Amundson
- 5Global Neurosurgery Initiative/Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts.,6Miller School of Medicine, University of Miami, Florida
| | - Meghal Shah
- 5Global Neurosurgery Initiative/Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts.,7Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Abbas Rattani
- 5Global Neurosurgery Initiative/Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts.,8Meharry Medical College, School of Medicine, Nashville; and
| | - Michael C Dewan
- 5Global Neurosurgery Initiative/Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts.,9Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kee B Park
- 5Global Neurosurgery Initiative/Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
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Beghi E, Hesdorffer D. Prevalence of epilepsy--an unknown quantity. Epilepsia 2014; 55:963-7. [PMID: 24966095 DOI: 10.1111/epi.12579] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2014] [Indexed: 11/27/2022]
Abstract
The incidence, prevalence, and mortality of epilepsy vary across countries with different economies. Differences can be explained by methodological problems, premature mortality, seizure remission, socioeconomic factors, and stigma. Diagnostic misclassification-one possible explanation-may result from inclusion of patients with acute symptomatic or isolated unprovoked seizures. Other sources of bias include age and ethnic origin of the target population, definitions of epilepsy, retrospective versus prospective ascertainment, sources of cases, and experienced and perceived stigma. Premature mortality is an issue in low-income countries (LICs), where treatment gap, brain infections, and traumatic brain injuries are more common than in high-income countries (HICs). Death rates may reflect untreated continued seizures or inclusion of acute symptomatic seizures. Lack of compliance with antiepileptic drugs has been associated with increased risk for death, increased hospital admissions, motor vehicle accidents, and fractures in poor communities. Epilepsy is a self-remitting clinical condition in up to 50% of cases. Studies in untreated individuals from LICs have shown that the proportion of remissions overlaps that of countries where patients receive treatment. When the identification of patients is based on spontaneous reports (e.g., door-to-door surveys), patients in remission may be less likely to disclose the disease for fear of stigmatization with no concurrent benefits. This might lead to underascertainment of cases when assessing the lifetime prevalence of epilepsy. In LICs, the proportion of people living in poverty is greater than in HICs. Poverty is associated with risk factors for epilepsy, risk for developing epilepsy, and increased mortality. The high incidence and prevalence of epilepsy found in LICs is also observed in low income individuals from HICs. Epileptogenic conditions are associated with an increased mortality. This may partly explain the difference between incidence and lifetime prevalence of epilepsy in LICs. Poverty within LICs and HICs could be a preventable cause of mortality in epilepsy.
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Affiliation(s)
- Ettore Beghi
- Department of Neurosciences, IRCCS Mario Negri Institute for Pharmacological Research, Milano, Italy
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Neligan A, Hauser WA, Sander JW. The epidemiology of the epilepsies. HANDBOOK OF CLINICAL NEUROLOGY 2012; 107:113-133. [PMID: 22938966 DOI: 10.1016/b978-0-444-52898-8.00006-9] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Aidan Neligan
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, UK
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