Initiating an epilepsy surgery program with limited resources in Indonesia

Muhamad Thohar Arifin,Jacob Bunyamin,Kazunori Arita,Novita Ikbar Khairunnisa,Kaoru Kurisu,Koji Iida,Surya Pratama Brilliantika,Yuriz Bakhtiar,Ryosuke Hanaya,Rofat Askoro,Zainal Muttaqin,Aris Catur Bintoro

doi:10.1038/s41598-021-84404-5

Muhamad Thohar Arifin, Jacob Bunyamin + Show 10 more

Open Access

https://doi.org/10.1038/s41598-021-84404-5

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Abstract

To share the experiences of organizing the epilepsy surgery program in Indonesia. This study was divided into two periods based on the presurgical evaluation method: the first period (1999–2004), when interictal electroencephalogram (EEG) and magnetic resonance imaging (MRI) were used mainly for confirmation, and the second period (2005–2017), when long-term non-invasive and invasive video-EEG was involved in the evaluation. Long-term outcomes were recorded up to December 2019 based on the Engel scale. All 65 surgical recruits in the first period possessed temporal lobe epilepsy (TLE), while 524 patients were treated in the second period. In the first period, 76.8%, 16.1%, and 7.1% of patients with TLE achieved Classes I, II, and III, respectively, and in the second period, 89.4%, 5.5%, and 4.9% achieved Classes I, II, and III, respectively, alongside Class IV, at 0.3%. The overall median survival times for patients with focal impaired awareness seizures (FIAS), focal to bilateral tonic–clonic seizures and generalized tonic–clonic seizures were 9, 11 and 11 years (95% CI: 8.170–9.830, 10.170–11.830, and 7.265–14.735), respectively, with p = 0.04. The utilization of stringent and selective criteria to reserve surgeries is important for a successful epilepsy program with limited resources.

Highlights

To share the experiences of organizing the epilepsy surgery program in Indonesia
We introduced selective amygdalohippocampectomy (SAH) for patients with unilateral dominant mesial temporal lobe surgery (TLE)
The majority of the aetiologies were associated with hippocampal sclerosis, with three tumours diagnosed through magnetic resonance imaging (MRI) findings: two dysembryoplastic neuroepithelial tumours (DNTs) and one of unknown aetiology

Summary

Introduction

To share the experiences of organizing the epilepsy surgery program in Indonesia. This study was divided into two periods based on the presurgical evaluation method: the first period (1999–2004), when interictal electroencephalogram (EEG) and magnetic resonance imaging (MRI) were used mainly for confirmation, and the second period (2005–2017), when long-term non-invasive and invasive video-EEG was involved in the evaluation. 50 million people worldwide suffer from this disorder, and 80% among them reside in developing countries with limited available resources[3]. The remainder of these million people are unable to obtain appropriate treatment and, as a result, experience significant morbidity owing to s eizures[4]. They still face psychosocial implications from stigma and prejudice due to stereotypes and negative attitudes towards epilepsy, especially in developing c ountries[5]. Resources are limited for the vast majority of patients with drug-resistant epilepsy (DRE), who live mostly in developing countries

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