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Development and results of the epilepsy surgery in Armenia: hope for a better future
Biayna Sukhudyan1, Krasimir Minkin2, Sevak Badalyan1
1Arabkir Joint Medical Center, Yerevan, Armenia.
Insights
Epilepsy surgery in Armenia successfully treated drug-resistant epilepsy in pediatric patients. Most patients became seizure-free, with many reducing or eliminating anti-seizure medications.
Area of Science:
- Neurology
- Neurosurgery
- Pediatric Medicine
Background:
- Epilepsy surgery programs are crucial for managing drug-resistant epilepsy.
- Developing such programs in resource-limited settings presents unique challenges.
Purpose of the Study:
- To describe the establishment and outcomes of a national epilepsy surgery program in Armenia.
- To highlight the collaborative effort between Armenian and Bulgarian medical centers.
Main Methods:
- Evaluation of 28 pediatric patients with lesional drug-resistant epilepsy.
- Utilized 3T MRI, Video-EEG monitoring, and 18FDG-PET (in some cases).
- Preoperative neuropsychological assessments were performed in 53% of patients.
Main Results:
- 89% of patients achieved seizure freedom (Engel class I) post-surgery.
- 43% of patients had their anti-seizure medication (ASM) reduced or withdrawn.
- 39% of patients became ASM-free, and 14% were on monotherapy.
Conclusions:
- Epilepsy surgery can be successfully implemented in resource-limited countries.
- This experience provides a model for developing similar programs.
- Collaboration is key to advancing epilepsy surgery initiatives.
Purpose:
We present our experience with the national epilepsy surgery program in Armenia by tracing the development of epilepsy surgery in the largest pediatric neurology department at "Arabkir" Medical Center. This development was possible on the basis of a strong collaboration with the Epilepsy Surgery center at the University Hospital "Sofia St. Ivan Rilski," Sofia, Bulgaria.
Materials And Methods:
Our material included 28 consecutive patients with lesional drug-resistant epilepsy evaluated. All patients underwent 3 T MRI and Video-EEG monitoring. Brain 18FDG-PET was done in 13 patients in St. Petersburg. Fifteen patients (53%) had preoperative neuropsychological examination before surgery. All operations were done by the same neurosurgical team on site in Arabkir Hospital.
Results:
The majority of the patients in our cohort benefited from the epilepsy surgery as 25 (89%) are free of disabling seizures (Engel class I) and three patients (11%) did not improve substantially (Engel class IV). Eleven patients (39%) are already ASM-free after surgery, 4 (14%) are on monotherapy, 11(39%) get two drugs, and 2(7%) are on polytherapy, one of them still continues having seizures. In 12 patients (43%), we were able either to withdraw therapy or to decrease one of the ASM.
Conclusion:
We believe that, although small, yet encompassing patients along the usual age spectrum and with the most frequent pathologies of drug-resistant epilepsies, our experience can serve as a model to develop epilepsy surgery in countries with limited resources.
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