Abstracts

Rationale: Epilepsy is an important public health problem in the developing world (DW) with a prevalence over 10 fold and mortality 3 times in developed countries. Despite initiatives to improve medication access in the DW, at least 30% of epilepsy patients will be pharmacoresistant with associated risks of morbidity, mortality, and stigmatization. Experience in the developed world has demonstrated that surgery for temporal epilepsy is a highly effective treatment with very low morbidity. The difficulty is overcoming the obstacles inherent in DW to bring this highly effective treatment to a population at need. Methods: A consortium of epilepsy professionals has established a comprehensive epilepsy program in East Africa at CURE Children’s Hospital of Uganda (CHU). The objective was to create a safe, practical, effective, and sustainable evaluation and treatment model for intractable epilepsy in a severely underserved setting. The model must function adequately within the technology and personnel limitations of the region being served. Patient recruitment and prescreening is accomplished at regional clinics (Fig 1) (candidates failed at least 2 anticonvulsants and have seizure features consistent with temporal lobe epilepsy). CT and video EEG are performed at CHU by trained Ugandans. Data is transferred to epilepsy experts in the developed world for analysis. Individuals with temporal lobe epilepsy determined by a multidisciplinary committee to be candidates have an opportunity for epilepsy surgery performed at CHU. This protocol was IRB approved.Results: >100 video EEG recordings have been accomplished in 70 patients within a dedicated epilepsy monitoring unit at CHU. Forty-nine individuals participated in the presurgical evaluation protocol. Ten have undergone surgery for temporal lobe epilepsy at CHU. There were 7 female and 3 male. Ages ranged from 12 to 24 years. Seizure frequencies ranged from 3/day to 2/month. Imaging revealed hippocampal sclerosis in 5 (Fig 2). Surgery consisted of corticoamygdalohippocampectomy on the left in 8 and right in 2. There was 1 complication of scalp infection. 80% are seizure free after surgery. In the 2 with persisting seizures, 1 has >90% reduction in seizure frequency and the other has no change in frequency but now less severe.Conclusions: >80% of the world’s population lives in the DW, and these individuals with pharmacoresistant epilepsy currently have no additional treatment options available. We have demonstrated a successful model for the diagnosis and surgical treatment of medically intractable temporal lobe epilepsy in a severely underserved setting. The treatment model utilizes technology and personnel that are reasonably available at the DW site. The model is based on screening at regional clinics, trained EEG and imaging technicians at the local site, and IT linkage between the local site and epilepsy experts in the developed world for data analysis and treatment recommendations.