Surgery for Medication Refractory Epilepsy in Africa: A Review of Seizure Freedom Outcomes.

Abstract

Background: Epilepsy is a chronic condition that confers social stigma, reduced engagement in work and social activities, increased risks of comorbidities, and premature death. It is often treated with medications, but in about a third of patients, epilepsy may be refractory to medications. It is estimated that each year 211,456 new individuals across Africa meet criteria for surgically treatable epilepsy, and the current volume of surgically treatable epilepsy is 1,819,067 cases across the region. Here, we review previously published epilepsy surgery programs in Africa, noting their outcomes.

Method: Eligible studies reporting seizure freedom and/or quality of life outcomes after epilepsy surgeries conducted in Africa were identified through database searches on PubMed/MEDLINE, Google Scholar, and reviewing references in previously identified publications.

Results: While more than a thousand articles were retrieved in the database search, 17 full-length articles were reviewed for eligibility, and 8 articles (likely representing 7 unique patient cohorts) were ultimately included in this study. The reviewed studies demonstrated successful implementation of programs to evaluate patients with epilepsy for surgical treatment. 60-100% of patients in these cohorts achieved good seizure freedom outcomes within a year from surgery and secondarily had improved quality of life and reduced severity of depression.

Conclusion: This review demonstrates that it is feasible to establish and sustain epilepsy surgery programs in Africa, with seizure freedom outcomes comparable to those reported in studies conducted in parts of the world with higher income.