Temporal lobe epilepsy surgery with limited resources: Results and economic considerations

被引:22
作者
Campos, MG
Godoy, J
Mesa, MT
Torrealba, G
Gejman, R
Huete, I
机构
[1] Pontificia Univ Catolica Chile, Dept Neurosurg, Santiago, Chile
[2] Pontificia Univ Catolica Chile, Dept Neurol, Santiago, Chile
[3] Pontificia Univ Catolica Chile, Dept Pediat, Santiago, Chile
[4] Pontificia Univ Catolica Chile, Dept Pathol, Santiago, Chile
[5] Pontificia Univ Catolica Chile, Dept Radiol, Santiago, Chile
关键词
temporal lobe epilepsy; noninvasive evaluation; epilepsy surgery; outcome; direct cost; developing country;
D O I
10.1111/j.1528-1157.2000.tb01540.x
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
This study evaluates the surgical outcome of patients with medically refractory temporal lobe epilepsy (TLE) who underwent anterior temporal lobe lobectomy (ATL) based on data derived from noninvasive studies and assesses the economic costs entailed at a newly created epilepsy program in Chile. Seventeen ATL candidates underwent a presurgical evaluation. This included outpatient brain MRI and neuropsychological testing and inpatient scalp/sphenoidal prolonged video-EEG monitoring. There were 10 females and 7 males, with a mean age of 23.8 years and a mean duration of seizure disorder of 12 years. Patients with congruent data localizing the seizure focus to one anterotemporal region underwent ATL. Seven patients underwent a left-side ATL and 10 patients a right-side ATL. The histopathological findings showed a low-grade tumor in six patients, hippocampal sclerosis in five, neuronal migration disorder in four, and cavernous angiomas in two patients. The mean follow-up period was 29.1 months. Seizure outcome was assessed with Engel's classification: class I, no seizures or only auras; class II, rare seizures; class III, >90% seizure reduction; class IV, <90% seizure reduction. Fifteen patients are now in class I, one patient in class II, and one in class IV. The total cost, including evaluation and surgery, was equivalent to US$ 5,020. Thus, well-selected TLE patients can derive maximal benefit from ATL after a noninvasive presurgical evaluation. This finding is of great significance for the creation of epilepsy surgery programs in developing countries.
引用
收藏
页码:S18 / S21
页数:4
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