Initiating an epilepsy surgery program with limited resources in Indonesia

Area of Science:

• Neurosurgery
• Epileptology
• Medical Program Development

Background:

• Epilepsy surgery programs require careful organization and evaluation.
• Indonesia's epilepsy surgery program evolved over two distinct periods.
• Advancements in presurgical evaluation techniques impacted patient outcomes.

Purpose of the Study:

• To document the organizational experiences of establishing an epilepsy surgery program in Indonesia.
• To compare patient outcomes between different eras of presurgical evaluation.
• To highlight the importance of selective surgical criteria in resource-limited settings.

Main Methods:

• Retrospective analysis of epilepsy surgery patients from 1999-2017.
• Categorization into two periods based on presurgical evaluation methods: EEG/MRI confirmation vs. video-EEG.
• Outcome assessment using the Engel scale up to December 2019.

Main Results:

• The second period (2005-2017) showed improved outcomes (89.4% Engel Class I) compared to the first (76.8% Engel Class I).
• Temporal lobe epilepsy (TLE) was the primary focus in the first period (65 patients), with a larger cohort in the second (524 patients).
• Median survival times varied among seizure types, with focal impaired awareness seizures (FIAS) having the shortest median survival (9 years).

Conclusions:

• Enhanced presurgical evaluation, including long-term video-EEG, significantly improved epilepsy surgery outcomes.
• Stringent and selective criteria for surgery are vital for successful program implementation, particularly in resource-constrained environments.
• The findings underscore the need for careful resource allocation and patient selection in developing epilepsy surgery programs.