Hamdi Hussein, Kishk Nirmeen, Shamloul Reham, Moawad Mona K, Baghdadi Micheal, Rizkallah Mina, Nawito Amani, Mohammad Mohammad Edrees, Nazmi Hatem, Nasr Yasser Mohamed, Waly Salwa Hassan, Elshahat Mo'men, Magdy Rehab, Othman Alshimaa S, Nafea Hesham, Fouad Amro M, Elantably Ismail, Rizk Haytham, Elsayyad Enas, Morsy Ahmed A
Department of Neurosurgery, Faculty of Medicine, Tanta University, Tanta, Egypt.
Department of Neurology, Faculty of Medicine, Cairo University, Cairo, Egypt.
Surg Neurol Int. 2023 Jul 14;14:240. doi: 10.25259/SNI_1081_2022. eCollection 2023.
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.
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.
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%).
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.
多学科术前评估对于癫痫手术的决策和预后至关重要。辅助监测下的切除性癫痫手术是目前局灶性药物难治性癫痫（DRE）的标准治疗方法。在资源有限的国家，缺乏癫痫手术中心是一个巨大的挑战。我们展示并说明了如何在发展中国家资源有限的环境中创建多学科方案，以及使用脑图谱和监测技术确保满意切除的癫痫手术结果。
我们创建了多中心不完整但互补的单元，涵盖所有癫痫相关亚专业，并覆盖我国广阔的地理区域。然后，我们对资源有限环境下的局灶性DRE患者进行了一项前瞻性多中心研究，这些患者接受了切除性癫痫手术，并至少随访12个月，评估术后癫痫发作结果和并发症（如有）。术前由多学科癫痫团队进行全面的临床、神经生理、神经心理和放射学评估。手术切除期间进行术中脑图谱，包括清醒开颅和直接刺激技术、神经生理监测和皮质脑电图。
该研究纳入了47例患者（18例女性和29例男性），平均年龄20.4±10.02岁。22例（46.8%）患者为颞叶癫痫，25例（53.2%）为颞叶外癫痫。最后一次随访时的癫痫手术结果为：Engel I级（无癫痫发作）35例（74.5%），II级（几乎无癫痫发作）8例（17%），III级（有价值的改善）3例（6.4%），IV级（无价值的改善）1例（2.1%）。
在资源有限且缺乏单一设备齐全的癫痫中心的情况下，通过仔细的术前多学科选择，特别是使用术中脑图谱和皮质脑电图技术，可以使局灶性DRE患者在切除性手术后获得良好的预后。
