Epilepsy surgery in Africa: state of the art and challenges.

Komi Assogba, Musa Watila, John N Jabang, Ansuya Naidoo, Jo Wilmshurst, Julien Razafimahefa, Amany Hussein Ragab, Callixte Kuate Tegueu, Ndiaga Matar Gaye, Najib Kissani, Gams Massi Daniel, Mendinatou Agbetou, Eetedal Ahmed A Ibrahim, Youssouf Sogoba, Youssoufa Maiga, Noureddine Bengamara, Abdelaati El Khiat, Sanaa Nafia

Journal: Epilepsy & behavior : E&B 2021;118():107910

PMID: 33744795

Full Text on Elsevier Science View on PubMed

Abstract

OBJECTIVE

Epilepsy is an important public health problem representing 0.6% of the global burden of disease that particularly impacts people living in the lowest income countries where epilepsy incidence may be 10 fold more than in the developed world. The battery of treatments designed to counteract the clinical manifestations of this disease are various and range from a wide spectrum of antiseizure medicationand specific diets, to surgical techniques for resection of the epileptogenic focus. The aim of our study was to describe the State of the art of Epilepsy Surgery (ES) in Africa and examine ways to deal with the high surgical treatment gap.

METHODOLOGY

In an observational study, we prospectively disseminated questionnaires via email or directly administered to main epileptologists and neurologists involved in epilepsy care, in key African countries. We also conducted a literature search using PubMed, Google scholar on ES in all the African countries.

RESULTS

We received responses from the majority of African countries, which allowed us to identify 3 levels of care for ES in African countries, a first level that uses ES with invasive presurgical evaluation, a second level that uses ES but without invasive presurgical evaluation, and a third level that does not use ES, and we summarized these results on a map.

DISCUSSION

This paper studied the availability of ES as a treatment modality in several African countries. We aimed to establish optimal pathways for initiating ES with noninvasive Electroencephalography and readily available investigations. This could be achieved through collaboration with epilepsy programs in developed countries directly or by using telemedicine.

Address: Laboratory of Clinical and Experimental Neuroscience. Faculty of Medicine, Cadi Ayyad University, Marrakech, Morocco; Department of Neurology. University Teaching, Hospital Mohammed VI, Marrakesh, Morocco. Electronic address: [email protected].; Laboratory of Clinical and Experimental Neuroscience. Faculty of Medicine, Cadi Ayyad University, Marrakech, Morocco.; Privat Neurology Clinic, Oran, Algeria.; Neurology Department, Hospital Gabriel Touré, Bamako, Mali.; Neurosurgery Department, Hospital Gabriel Touré, Bamako, Mali.; Neurology Department. Alneelain University, National Centre for Neurological Centre, Khartoum, Sudan.; Neurology Department, University of Parakou, Benin.; Neurology Unit, Douala General Hospital, Cameroon.; Neurology Department, University Hospital, Campus of Lome, Togo.; Neurology Department of Fann Teaching Hospital, Dakar, Senegal.; Neurology Department, Laquintinie Hospital of Douala, Cameroun.; Neurology Department, Cairo University, Egypt.; Neurology Unit of Befelatanana Hospital, Antananarivo, Madagascar.; Head of Paediatric Neurology, Red Cross War Memorial Children's Hospital, University of Cape Town, South Africa.; Head of Clinical Unit and Consultant Neurologist (Greys Academic Hospital) Clinical Lecturer, South Africa.; Neurosurgery Unit, Department of Surgery, Edward Francis Small Teaching Hospital, Banjul, Gambia.; Neurology Unit, Department of Medicine, University of Maiduguri Teaching Hospital, PMB 1414, Maiduguri, Borno State, Nigeria.

DOI: 10.1016/j.yebeh.2021.107910