Kwadwo Darko, Pearl Ohenewaa Tenkorang, Olivia Asiedu, W Elorm Yevudza, Salim Issah, Eyako Dzantor, Marjidah Tahiru, Andrew Awuah Wireko, Sean O'Leary, Umaru Barrie, Hannah Weiss, Teddy Totimeh, Mabel Banson
{"title":"非洲耐药癫痫的手术治疗：系统综述。","authors":"Kwadwo Darko, Pearl Ohenewaa Tenkorang, Olivia Asiedu, W Elorm Yevudza, Salim Issah, Eyako Dzantor, Marjidah Tahiru, Andrew Awuah Wireko, Sean O'Leary, Umaru Barrie, Hannah Weiss, Teddy Totimeh, Mabel Banson","doi":"10.1227/neu.0000000000003307","DOIUrl":null,"url":null,"abstract":"<p><strong>Background and objectives: </strong>Nearly one-third of individuals with epilepsy have drug-resistant epilepsy, treated most effectively with surgery. This study aims to discuss the demographic profile, surgical access, and strategies used in drug-resistant epilepsy in Africa.</p><p><strong>Methods: </strong>A systematic review was performed using PubMed, Google Scholar, Embase, and Web of Science in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines.</p><p><strong>Results: </strong>Nine studies encompassing 498 patients from 6 African countries (Egypt, Kenya, Morocco, South Africa, Tunisia, and Uganda) were included. The mean Methodological Index for Non-Randomized Studies score for these articles was 9.6 ± 1.6. The average patient age was 24.9 years (95% CI: 18.9-30.8 years), with a male predominance of 53.4%. The average age of seizure onset was 10.4 years (95% CI: 6.1-14.7 years). Most patients experienced focal onset seizures (73.1%), with head trauma (33.1%) being the most reported risk factor. The predominant etiologies were hippocampal sclerosis (66.8%, 95% CI: 42.7-91), microdysgenesis (26.7%, 95% CI: 20.7-32.7), and brain tumors (22.3%, 95% CI: 6.4-38.2). Lesions were primarily located in the left hemisphere (61.9%, 95% CI: 26.7-97.1), with temporal lobe involvement in 54.8% of cases (95% CI: 28.7-80.8). Temporal lobectomy was the most frequently performed surgery (59.6%), followed by lesionectomy (9.6%). Postoperatively, 80.6% of patients achieved Engel class I outcomes, indicating seizure freedom, and long-term follow-up (1 to 5 years) showed that 70.3% maintained Engel class I outcomes. Surgical complications were reported in 8.8% of cases.</p><p><strong>Conclusion: </strong>These findings demonstrate the efficacy and long-term benefits of epilepsy surgery in Africa, where epilepsy is a significant public health challenge. The high rates of seizure freedom and reduced seizure frequency from surgery highlight its potential to improve the quality of life for individuals with drug-resistant epilepsy in Africa.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":"704-712"},"PeriodicalIF":3.9000,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Epilepsy Surgery for Drug-Resistant Epilepsy in Africa: A Systematic Review.\",\"authors\":\"Kwadwo Darko, Pearl Ohenewaa Tenkorang, Olivia Asiedu, W Elorm Yevudza, Salim Issah, Eyako Dzantor, Marjidah Tahiru, Andrew Awuah Wireko, Sean O'Leary, Umaru Barrie, Hannah Weiss, Teddy Totimeh, Mabel Banson\",\"doi\":\"10.1227/neu.0000000000003307\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background and objectives: </strong>Nearly one-third of individuals with epilepsy have drug-resistant epilepsy, treated most effectively with surgery. This study aims to discuss the demographic profile, surgical access, and strategies used in drug-resistant epilepsy in Africa.</p><p><strong>Methods: </strong>A systematic review was performed using PubMed, Google Scholar, Embase, and Web of Science in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines.</p><p><strong>Results: </strong>Nine studies encompassing 498 patients from 6 African countries (Egypt, Kenya, Morocco, South Africa, Tunisia, and Uganda) were included. The mean Methodological Index for Non-Randomized Studies score for these articles was 9.6 ± 1.6. The average patient age was 24.9 years (95% CI: 18.9-30.8 years), with a male predominance of 53.4%. The average age of seizure onset was 10.4 years (95% CI: 6.1-14.7 years). Most patients experienced focal onset seizures (73.1%), with head trauma (33.1%) being the most reported risk factor. The predominant etiologies were hippocampal sclerosis (66.8%, 95% CI: 42.7-91), microdysgenesis (26.7%, 95% CI: 20.7-32.7), and brain tumors (22.3%, 95% CI: 6.4-38.2). Lesions were primarily located in the left hemisphere (61.9%, 95% CI: 26.7-97.1), with temporal lobe involvement in 54.8% of cases (95% CI: 28.7-80.8). Temporal lobectomy was the most frequently performed surgery (59.6%), followed by lesionectomy (9.6%). Postoperatively, 80.6% of patients achieved Engel class I outcomes, indicating seizure freedom, and long-term follow-up (1 to 5 years) showed that 70.3% maintained Engel class I outcomes. Surgical complications were reported in 8.8% of cases.</p><p><strong>Conclusion: </strong>These findings demonstrate the efficacy and long-term benefits of epilepsy surgery in Africa, where epilepsy is a significant public health challenge. The high rates of seizure freedom and reduced seizure frequency from surgery highlight its potential to improve the quality of life for individuals with drug-resistant epilepsy in Africa.</p>\",\"PeriodicalId\":19276,\"journal\":{\"name\":\"Neurosurgery\",\"volume\":\" \",\"pages\":\"704-712\"},\"PeriodicalIF\":3.9000,\"publicationDate\":\"2025-04-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Neurosurgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1227/neu.0000000000003307\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/12/12 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q1\",\"JCRName\":\"CLINICAL NEUROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Neurosurgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1227/neu.0000000000003307","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/12/12 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
Epilepsy Surgery for Drug-Resistant Epilepsy in Africa: A Systematic Review.
Background and objectives: Nearly one-third of individuals with epilepsy have drug-resistant epilepsy, treated most effectively with surgery. This study aims to discuss the demographic profile, surgical access, and strategies used in drug-resistant epilepsy in Africa.
Methods: A systematic review was performed using PubMed, Google Scholar, Embase, and Web of Science in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines.
Results: Nine studies encompassing 498 patients from 6 African countries (Egypt, Kenya, Morocco, South Africa, Tunisia, and Uganda) were included. The mean Methodological Index for Non-Randomized Studies score for these articles was 9.6 ± 1.6. The average patient age was 24.9 years (95% CI: 18.9-30.8 years), with a male predominance of 53.4%. The average age of seizure onset was 10.4 years (95% CI: 6.1-14.7 years). Most patients experienced focal onset seizures (73.1%), with head trauma (33.1%) being the most reported risk factor. The predominant etiologies were hippocampal sclerosis (66.8%, 95% CI: 42.7-91), microdysgenesis (26.7%, 95% CI: 20.7-32.7), and brain tumors (22.3%, 95% CI: 6.4-38.2). Lesions were primarily located in the left hemisphere (61.9%, 95% CI: 26.7-97.1), with temporal lobe involvement in 54.8% of cases (95% CI: 28.7-80.8). Temporal lobectomy was the most frequently performed surgery (59.6%), followed by lesionectomy (9.6%). Postoperatively, 80.6% of patients achieved Engel class I outcomes, indicating seizure freedom, and long-term follow-up (1 to 5 years) showed that 70.3% maintained Engel class I outcomes. Surgical complications were reported in 8.8% of cases.
Conclusion: These findings demonstrate the efficacy and long-term benefits of epilepsy surgery in Africa, where epilepsy is a significant public health challenge. The high rates of seizure freedom and reduced seizure frequency from surgery highlight its potential to improve the quality of life for individuals with drug-resistant epilepsy in Africa.
期刊介绍：
Neurosurgery, the official journal of the Congress of Neurological Surgeons, publishes research on clinical and experimental neurosurgery covering the very latest developments in science, technology, and medicine. For professionals aware of the rapid pace of developments in the field, this journal is nothing short of indispensable as the most complete window on the contemporary field of neurosurgery.
Neurosurgery is the fastest-growing journal in the field, with a worldwide reputation for reliable coverage delivered with a fresh and dynamic outlook.
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