Abstracts

Rationale: According to the National Association of Epilepsy Centers (NAEC) there are more than 50 specialized epilepsy programs in the United States treating the 2.7 million Americans who suffer from some form of epilepsy, of which 25 - 30 % are intractable. Epilepsy News reports that nearly 50 million people worldwide suffer from some form of epilepsy, and of those, 85% live in developing countries where it is estimated that 70 - 90% do not receive treatment. Methods: To support comprehensive epilepsy care in South America, a relationship between the Hospital de Clinicas in Montevideo, Uruguay and the Dartmouth-Hitchcock Medical Center in Lebanon, NH, based on professional exchange and friendship, was established. Results: Phase I of this project included selection of an existing publicly funded epilepsy program, and verification of access to neuroimaging and neuropsychology. A dedicated and competent local epilepsy team was crucial. Donations of modern epilepsy monitoring equipment were obtained. Nine candidates for monitoring were determined at this time. Phase II consisted of installing monitoring equipment and conducting scalp video - EEG monitoring in Uruguay. Seizures were recorded in six patients and a protocol for long - term monitoring was established. Phase III involved the collaboration of Uruguayan and Dartmouth - Hitchcock neurosurgeons who jointly performed five temporal lobectomies in Uruguay with excellent outcomes. Further neurosurgical training was provided at the Dartmouth - Hitchcock Medical Center. Phase IV completed this project when invasive EEG monitoring was established at the Hospital de Clinicas in 2010. One patient was monitored intracranially and went to surgery. Additional training in intracranial mapping and surgical techniques was provided at this time. Throughout this project each team benefitted from the abilities and experiences of the other. Conclusions: Comprehensive epilepsy surgery programs can be successfully established in emerging economies with determination and resourcefulness. Access to epilepsy surgery will benefit patients who otherwise would continue to suffer from the socio-economic impact of epilepsy. This encounter was sponsored by private contributions and the Dartmouth-Hitchcock Medical Center. Additional funding and equipment was provided by the Ad-Tech Medical Instrument Corporation and Grass Technologies. This project was initiated by Peter D. Williamson, MD.