Northwell Health Epilepsy Program, Zucker Hofstra School of Medicine, Lennox Hill Hospital, New York, New York.
Hospital del Niño Jose R. Esquivel, Panama City, Panama.
Epilepsia. 2018 Nov;59(11):2137-2144. doi: 10.1111/epi.14571. Epub 2018 Oct 19.
The majority of the 65 million people worldwide with epilepsy live in low- and middle-income countries. Many of these countries have inadequate resources to serve the large patient population affected by epilepsy. Panama is a middle-income country that currently has only 2 facilities that can provide basic epilepsy services and no epilepsy surgery services. To address this need, a group of Panamanian physicians partnered with U.S. epilepsy health care providers to test a hybrid epilepsy surgery program, combining resources and expertise.
From 2011 to 2017, a multidisciplinary team of neurologists, neurosurgeons, and an electroencephalography (EEG) technician from the United States traveled to Panama 6 times and, in collaboration with the local team, performed surgical procedures for intractable epilepsy at the national children's hospital. Resective surgeries were performed with intraoperative electrocorticography and/or implantation of subdural and depth electrodes and extra-operative monitoring. Cost was calculated using Panama government data.
Twenty-seven children with intractable epilepsy were surgically treated. Fifteen children are seizure-free (Engle class I), 11 children are Engel II, and one child is Engel III. No major morbidity or mortality occurred, with only one postoperative infection. The average cost of treatment was calculated at $9850 per patient.
This program is a model for creating a multinational and multi-institutional collaboration to provide surgical epilepsy treatment in a middle-income country without an adequate infrastructure. To be successful, this collaboration needed to address medical, technical, and cultural challenges. This partnership helps to alleviate some of the present need for surgical epilepsy services while laying the groundwork for the development of a future local independent epilepsy surgery program.
全球有 6500 万癫痫患者，其中大多数生活在中低收入国家。许多这些国家的资源不足，无法为大量癫痫患者提供服务。巴拿马是一个中等收入国家，目前只有 2 家机构能够提供基本的癫痫服务，没有癫痫手术服务。为了解决这一需求，一群巴拿马医生与美国癫痫医疗保健提供者合作，测试了一种结合资源和专业知识的混合癫痫手术方案。
从 2011 年到 2017 年，一个由美国神经科医生、神经外科医生和脑电图（EEG）技术人员组成的多学科团队六次前往巴拿马，与当地团队合作，在国家儿童医院为难治性癫痫患者进行手术。切除术在术中皮层电图和/或植入硬膜下和深部电极和术中监测下进行。成本使用巴拿马政府数据计算。
27 名难治性癫痫患儿接受了手术治疗。15 名患儿无癫痫发作（Engle Ⅰ级），11 名患儿为 Engel II 级，1 名患儿为 Engel III 级。没有发生重大并发症或死亡，只有 1 例术后感染。治疗的平均费用为每位患者 9850 美元。
该方案是在中低收入国家建立跨国和多机构合作以提供手术性癫痫治疗的模式，而这些国家没有足够的基础设施。为了取得成功，这种合作需要解决医疗、技术和文化方面的挑战。这种合作关系有助于缓解目前对手术性癫痫服务的一些需求，同时为未来建立一个独立的当地癫痫手术项目奠定基础。
