Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK; Chalfont Centre for Epilepsy, Chalfont St Peter SL9 0RJ, UK; Neurology Unit, Department of Medicine, University of Maiduguri Teaching Hospital, PMB 1414, Maiduguri, Borno State, Nigeria.
Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK; Department of Neurology, West China Hospital of Sichuan University, Chengdu, Sichuan, China; Magnetic Resonance Imaging Unit, Epilepsy Society, Gerrards Cross, UK.
Epilepsy Behav. 2019 Mar;92:311-326. doi: 10.1016/j.yebeh.2019.01.001. Epub 2019 Feb 6.
Epilepsy surgery is an important treatment option for people with drug-resistant epilepsy. Surgical procedures for epilepsy are underutilized worldwide, but it is far worse in low- and middle-income countries (LMIC), and it is less clear as to what extent people with drug-resistant epilepsy receive such treatment at all. Here, we review the existing evidence for the availability and outcome of epilepsy surgery in LMIC and discuss some challenges and priority.
We used an accepted six-stage methodological framework for scoping reviews as a guide. We searched PubMed, Embase, Global Health Archives, Index Medicus for South East Asia Region (IMSEAR), Index Medicus for Eastern Mediterranean Region (IMEMR), Latin American & Caribbean Health Sciences Literature (LILACS), African Journal Online (AJOL), and African Index Medicus (AIM) to identify the relevant literature.
We retrieved 148 articles on epilepsy surgery from 31 countries representing 22% of the 143 LMIC. Epilepsy surgery appears established in some of these centers in Asia and Latin America while some are in their embryonic stage reporting procedures in a small cohort performed mostly by motivated neurosurgeons. The commonest surgical procedure reported was temporal lobectomies. The postoperative seizure-free rates and quality of life (QOL) are comparable with those in the high-income countries (HIC). Some models have shown that epilepsy surgery can be performed within a resource-limited setting through collaboration with international partners and through the use of information and communications technology (ICT). The cost of surgery is a fraction of what is available in HIC.
This review has demonstrated the availability of epilepsy surgery in a few LMIC. The information available is inadequate to make any reasonable conclusion of its existence as routine practice. Collaborations with international partners can provide an opportunity to bring high-quality academic training and technological transfer directly to surgeons working in these regions and should be encouraged.
癫痫手术是治疗耐药性癫痫患者的重要手段。全球范围内癫痫手术的应用不足，但在中低收入国家（LMIC）的情况更差，而且对于耐药性癫痫患者接受此类治疗的程度，目前还不太清楚。在这里，我们回顾了 LMIC 中癫痫手术的可及性和结果的现有证据，并讨论了一些挑战和优先事项。
我们使用公认的六阶段方法学框架进行了范围综述。我们在 PubMed、Embase、全球健康档案、东南亚医学索引（IMSEAR）、东地中海医学索引（IMEMR）、拉丁美洲和加勒比健康科学文献（LILACS）、非洲在线期刊（AJOL）和非洲医学索引（AIM）上进行了搜索，以确定相关文献。
我们从代表 22%的 143 个 LMIC 的 31 个国家检索到 148 篇关于癫痫手术的文章。在这些中心中的一些亚洲和拉丁美洲国家，癫痫手术似乎已经建立，而其他一些国家则处于萌芽阶段，仅报告了少数由有动力的神经外科医生进行的小队列手术。报告的最常见手术是颞叶切除术。术后无癫痫发作率和生活质量（QOL）与高收入国家（HIC）相当。一些模型表明，通过与国际合作伙伴合作以及使用信息和通信技术（ICT），可以在资源有限的环境中进行癫痫手术。手术费用只是 HIC 可用费用的一小部分。
本综述证明了少数 LMIC 中存在癫痫手术。目前获得的信息不足以得出其作为常规实践存在的任何合理结论。与国际合作伙伴的合作可以为在这些地区工作的外科医生提供直接获得高质量学术培训和技术转让的机会，应该予以鼓励。
