Pediatric epilepsy surgery in Latin-America

Abstract

OBJECTIVE: The classical concept is that pediatric epilepsy surgery (PES) is still underused in developing countries. Accurate information about the amount of PES programs and procedures in Latin-American is still lacking. MATERIAL AND METHODS: We included information from 80 epilepsy surgical programs from 18 Latin American countries. We tabulated the duration of each program, types of surgery (curative, palliative, and diagnostic), and procedures in the pediatric population. Then, we estimated the number of procedures per capita for each country. RESULTS: We registered a total of 25,333 procedures. Temporal lobe resection was the most frequent procedure (42,3%), followed by extratemporal resection (27,1%), callosotomy (8,7%), VNS (8,4%), hemispherectomy (5%), DBS (0,7%) and other procedures (0,2%). An invasive presurgical evaluation was performed in 7,5% of cases, including 827 patients with SEEG. The pediatric population was 36,3% of the cases. The estimated ES per capita was between 1 per 207,571 habitants (Colombia) to 1 per 3,353,333 habitants (Honduras), with an overall Latin-American average of 1 case per 484,248 inhabitants. CONCLUSION: Latin America performs all epilepsy surgical procedures except laser ablation or responsive cortical stimulation (RNS). The wide diference in the procedures per country depends on the amount of PES centers, resources, medical training, and governmental investment in health. There is an unmet need to improve ES access, especially in low-income Latin American countries and an evident need to standardize the access and complexity of epilepsy surgery procedures across the Latin American region which can be attained with increased awareness by stakeholders as well as development of educational resources and logistics which enable these techniques to be available to a broader range of patients, particularly during infancy.