Epilepsy surgery in Argentina: Long-term results in a comprehensive epilepsy centre

• Published in: Seizure (London, England) England), 2011-07, Vol.20 (6), p.442-445
• Main Authors: Donadío, Martín, D’Giano, Carlos, Moussalli, Mauricio, Barrios, Leonardo, Ugarnes, Gabriela, Segalovich, Mónica, Pociecha, Juan, Vázquez, Claudio, Petre, Cesar, Pomata, Hugo
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Anticonvulsants - therapeutic use; Argentina; Argentinean epilepsy surgery series; Child; Child, Preschool; Cohort Studies; Databases, Factual; Disability Evaluation; Drug Resistance; Electroencephalography; Epilepsy - mortality; Epilepsy - surgery; Female; Follow-Up Studies; Humans; Infant; Long-term outcome; Male; Middle Aged; Neurology; Neurosurgery - trends; Neurosurgical Procedures - adverse effects; Neurosurgical Procedures - statistics & numerical data; Neurosurgical Procedures - trends; Pathology outcome; Retrospective Studies; Treatment Outcome; Young Adult
• ISSN: 1059-1311; 1532-2688
• DOI: 10.1016/j.seizure.2011.02.002

Abstract Rationale Epilepsy surgery procedures started in Argentina more than 50 years ago. This is the first comprehensive and systematic survey of epilepsy surgery long-term outcome from our country. Methods A descriptive cohort study was conducted between 1998 and 2008 for drug-resistant epilepsy surgery with a minimum of 12 months follow-up ( n = 110). In 84 cases (76.36%) resective surgery was performed, and outcome periodically assessed using the Engel score. Patients were stratified into groups: 12, 13–36, 37–60 and over than 60 months of follow-up. Video-EEG with and without intracranial electrode implants, intraoperative electrocorticograms, Wada tests, pathology reports, use of antiepileptic drugs (AEDs), and surgical complication rates were evaluated. Results Surgical techniques included: 69 lobectomies (62.7%), 15 lesionectomies (13.6%), 6 callosotomies (5.4%), 6 multiple subpial transection (5.4%), 11 vagus nerve stimulations (10%), 3 hemispherectomies (2.7%). Male: female ratio: 1/1.44. Mean age at time of surgery: 26.2 years. Mean duration of epilepsy: 14 years. Age at seizure onset: 11.5 years. Mean follow-up: 46 months. Pathology findings: mesial temporal sclerosis 32 (35.1%); dual pathology 17 (18.7%); cortical dysplasia 15 (16.4%); non-specific inflammatory changes 11 (12.1%); tumors 7 (7.7%); other 6 (6.8%). Engel scores at 12 months follow-up: 72.6% (61) class I, 16.6% (14) class II and 15.5% (13) class III–IV; 13–36 months after surgery: 68.1% of cases were class I, 15.9% class II and 15.5% class III–IV. After 37–60 months, 74% class I, 14% class II, 14% class III–IV. Over 60 months ( n = 45) 78% class I, 13.5% class II and 8.1% class III–IV. Conclusion Conducting a successful epilepsy surgery program in a developing country is challenging. These results should encourage specialists in these countries. Long-term outcome results comparable to centres in developed countries can be achieved.