International conference and workshop "Hallmarks of Epileptic Brain Activity" in Tbilisi, Georgia, October 24-27, 2017.

Abstract

More than 50 million people worldwide suffer from epilepsy; 80% of them live in low- and middle-income countries where three-fourths of them have no access to appropriate treatment.1 Epilepsy surgery is currently not only the most effective,2 but also a cost-efficient treatment for a drug-resistant form of epilepsy,3 in particular for low- and middle-income countries.4, 5 Georgia is one of the low- to middle-income countries6 that still lacks some of the advanced presurgery diagnostic methods as well as an appropriate epilepsy surgery program. To improve this situation and foster the presurgical diagnosis and implementation of epilepsy neurosurgery, a German-Georgian cooperative project (EpilepCure) was initiated with the financial support of the German Federal Ministry of Education and Research. The launching event of this project took place in Tbilisi on October 24-27, 2017 and was structured as a 2-day scientific conference with 2-day case studies in a subsequent workshop (Figure 1). This event brought together 25 invited European and Georgian physicians and researchers to explore and discuss the current situation in Georgia, the potential to optimize diagnostic tools with a special focus on the presurgical evaluation, and the options for surgical interventions. Details of this public meeting can be found on the project homepage https://epilepcure.wordpress.com/. The broad spectrum of presurgical evaluation and treatment options were introduced in the conference series lectures (Drs. M. Holtkamp, T. Lehmann, and M. Cunningham). In the case studies, German colleagues (Drs. M. Holtkamp and T. Lehmann) emphasized that in patients with discordant indications based on seizure semiology, electroencephalography (EEG) and magnetic resonance imaging (MRI), more sophisticated diagnostic methods, such as intracranial EEG recordings, are required to substantiate the diagnosis and evaluate the potential of surgical intervention. Those methods are still missing in Georgia, but are routinely used in Germany. Therefore, as one aim of the project, the German colleagues offered to assist in their establishment in Georgia. Notable, epilepsy surgery is already feasible in Georgia, with the potential availability of good medical expertise to perform such interventions. In line with this state of the art, the case studies of Georgian colleagues (Drs. S. Kasradze, N. Tatishvili, G. Lomidze, and V. Tsikarishvili) revealed a high potential for surgical intervention with a relatively large proportion of patients with temporal lobe epilepsy and hippocampal sclerosis. Importantly, in contrast to high-income countries,7 these clear-cut cases are still common in Georgia due to the lack of surgical interventions so far.8 These patients with concordant indications have a very good outcome prognosis and do not require the implementation of additional diagnostic efforts, thus representing a favorable starting point to launch a coordinated epilepsy surgery program. The essential diagnostic workup for clear-cut cases, including neurological examination, standard video-EEG, and MRI, is readily available. Therefore, drug-resistant mesial temporal lobe epilepsy with hippocampal sclerosis will be a primary focus when starting the implementation of the neurosurgical epilepsy program. One of the most hotly debated themes of the meeting was the topic of high-frequency oscillations (HFOs) as a potential biomarker to localize the epileptogenic focus and to predict surgical outcome (Drs. T. Gloveli, T. Dugladze, P. Bäuerle, and I. Vida). An important conclusion on this discussion was the aim of linking clinical and experimental research to investigate this neural activity signature in human EEG recordings as well as in local field potential recordings in animal models of epilepsy. Having access to a large number of human patients with hippocampal sclerosis, Georgia provides a unique opportunity within the framework of this project to compare data from chronic human and animal model recordings and evaluate the potential of HFOs as a biomarker. Hence, HFOs will be examined by a close collaboration of clinicians and basic researchers. All participants admitted that given the generally favorable situation in the development of epilepsy treatment, the Georgian capital Tbilisi is well suited to establish a central epilepsy full-service cooperative health care unit, with the potential for a deep impact not only for the country, but also for the whole of the South Caucasus, where appropriate epilepsy surgery options are largely still lacking. Therefore, the first meeting in Tbilisi will be followed by the exchange of experts, conferences, and workshops in both countries, with the aim of optimizing presurgical epilepsy diagnostics by training Georgian physicians in advanced diagnostic and neurosurgical strategies and promoting surgical interventions in Georgia in the near future. The meeting in Georgia was financially supported by the German Federal Ministry of Education and Research. None of the authors has any conflict of interest to disclose. 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