Establishment of low cost epilepsy surgery centers in resource poor setting

Purpose: To prospectively assess the feasibility of establishing low cost epilepsy surgery programs in resource poor settings. Method: We started epilepsy surgery centers in Tier 2 and Tier 3 cities in India in private hospitals. This model is based on the identifying and operating ideal epilepsy surgery candidates on the basis of clinical history, interictal and ictal video-EEG data, and 1.5 T MRI without other investigations and without regular involvement of other specialists. Trained epileptologists formed the fulcrum of this program who identified ideal candidates, offered them counseling, and read video-EEG and MRI. We also spread epilepsy awareness among locals and physicians and established focused epilepsy clinics. The expenses were subsidized for deserving patients and policies were devised to keep video-EEG duration and staff requirement to minimum. Difficult epilepsy surgery cases were referred to established centers. Initial surgeries were performed by invited epilepsy surgeons and subsequently by local neurosurgeons. Results: A total of 125 epilepsy surgeries were performed at three centers since 2012. This included 81(64.8%)temporal lobe resections, 26 (20.8%)extratemporal focal resections, and 13 (10.4%)hemispherotomies. Of the 93 patients with more than 1 year of postoperative followup, 86 (92.5%)had Engel class IA outcome. There were minor complications in 5% patients. Average cost of presurgical evaluation and surgery was Rs. 92,707 (USD 1,324). Conclusions: It is possible to establish successful epilepsy surgery programs in resource poor setting with reasonable costs. This low cost model can be replicated in other parts of world to reduce the surgical treatment gap.