Silvia Oddo#, Brenda Giagante# and Silvia Kochen*
Neuroscience Service, Video-EEG Unit, High Complexity Hospital, Argentina #These authors contributed equally to this workFulltext PDF
Introduction: In this work we present the evidence that in a developing country, it is possible to perform surgical treatment for drug resistant temporal lobe epilepsy patients, including those cases that require SEEG, with a similar outcome than in developed countries. Methods: We selected 19 consecutive drug resistant temporal lobe epilepsy patients, who underwent SEEG evaluation at El Cruce Hospital from 2014 to 2019. SEEG is performed due to failure to localize the Epileptogenic Zone (EZ) with non-invasive methods, when the hypothesis of EZ are suspected to involve extra temporal areas, negative MRI, suspected bilateral onset, bilateral hippocampal lesion, or with discrepancies between MRI findings and scalp Video-EEG monitoring. The implantation scheme was planned based on the EZ hypothesis, based on scalp Video-EEG, especially ictal clinical semiology, neuroimaging data and neuropsychological results. Between 6 and 12 multilead electrodes per patient were implanted, in temporal and extra temporal areas. Results: Thirteen patients (68.4%) with unilateral EZ were found eligible for surgery after SEEG. Seven patients underwent a mesial temporal region resection (left N=3, right n=4). One patient underwent a frontotemporal corticectomy, one patient an insulectomy. Because of the pandemic situation, four patients are on a list for surgery. Six patients were formally excluded from surgery because of the bilateral (seizures originating independently or concomitantly in both temporal lobes) or multifocal origin of their seizures. Conclusion: According to the results obtained in this case analysis, we consider SEEG to be an appropriate method to define EZ in patients with drug-resistant temporal epilepsy and the subsequent indication for surgery. We hope to encourage the multiplication of epilepsy surgery centers in the region that have specialist staff and financial resources. Despite the high costs, it is achievable development with the same quality as that carried out in developed countries.
Temporal lobe epilepsy; Stereoelectroencephalography; Epilepsy surgery; Ictal clinical semiology; Ictal electrical semiology
Oddo S, Giagante B, Kochen S. Surgical Strategies for Epilepsy in Developing Countries: Experience with SEEG in Temporal Lobe Epilepsy. Ann Epilepsy Seizure. 2021; 3(1):1014..