Abstract
AB076. Underutilization of epilepsy surgery in Pakistan: 10-year experience from the only comprehensive epilepsy center in the country
Saqib Kamran Bakhshi1, Rabeet Tariq1, Muhammad Usman Khalid2, Saman Hamid1, Namra Qadeer Shaikh1, Farhan Arshad Mirza2, Syed Ather Enam1
1Section of Neurosurgery, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan;
2Department of Neurosurgery, Kentucky Neuroscience Institute (KNI), University of Kentucky, Lexington, KY, USA
Correspondence to: Syed Ather Enam, MD, PhD, FRCSI, FRCSC, FRCSG, FACS. Section of Neurosurgery, Department of Surgery, Aga Khan University Hospital, Sadium Road, Karachi, Pakistan. Email: ather.enam@aku.edu.
Background: Eighty percent of the global epilepsy burden is borne by developing countries, and 30% of these patients have drug-resistant epilepsy (DRE). Epilepsy surgery (ES) can significantly improve the cognition and quality of life in DRE. A comprehensive epilepsy center was established in Pakistan in 2010, the only facility for ES in a country of 231 million people. Hundreds of epilepsy patients are medically managed at the center each year. We aimed to study seizure control in all ES cases performed at the only comprehensive epilepsy center in the country during last 10 years.
Methods: It was a retrospective cohort study. Medical records of all cases of ES performed at our center from 2012 to 2021 were retrieved, through the Hospital’s Information Management System. Patients were also contacted via phone calls where needed, to collect information about their seizure control as per Engel Classification. Data was analyzed using SPSSv21.
Results: Thirty-three surgeries including 10 temporal lobectomies with amygdalohippocampectomy, 11 selective amygdalohippocampectomies, 9 corpus callosotomies, 1 callosotomy with lesionectomy, 1 lesionectomy and 1 temporal lobectomy were performed. The median age of patients was 23: [18–31] years. Complex partial seizures were most common (14; 42.4%), followed by generalized seizures (10; 30.3%). The median duration of AEDs before surgery was 6 (IQR: 3.25–13.75) years. Eighteen (54.5%) patients had complete freedom from disabling seizures (Engel Class IA) at a median follow-up of 3.25 (IQR: 1.12–6) years. All patients continued to receive antiepileptic drugs after surgery, and all procedures had nearly 50% optimum seizure control outcomes.
Conclusions: The clinical outcomes of ES performed at our center are consistent with evidence. However, the small volume highlights the underutilization of this extremely important service. More studies are needed to identify the factors responsible for this disparity, so that all DRE patients have access to ES.
Keywords: Epilepsy surgery (ES); treatment gaps; low-middle-income countries; global neurosurgery
Acknowledgments
Funding: None.
Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://cco.amegroups.com/article/view/10.21037/cco-24-ab076/coif). The authors have no conflicts of interest to declare.
Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. The study was conducted in accordance with the Declaration of Helsinki (as revised in 2013) and approved by the Ethical Review Board of the Aga Khan University Hospital, Karachi, Pakistan (2022-7942-23287). Because of the retrospective nature of the research, the requirement for informed consent was waived.
Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the noncommercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.
Cite this abstract as: Bakhshi SK, Tariq R, Khalid MU, Hamid S, Shaikh NQ, Mirza FA, Enam SA. AB076. Underutilization of epilepsy surgery in Pakistan: 10-year experience from the only comprehensive epilepsy center in the country. Chin Clin Oncol 2024;13(Suppl 1):AB076. doi: 10.21037/cco-24-ab076
