Overview: Epilepsy surgery in developing countries

Epilepsy surgery (ES) is addressed in relation to economic classifications of national resources and welfare in developing countries. A decade ago, te n developing countries conducted ES; now 26 such countries have reported re sults of ES. A number of international authorities define indicators of nat ional economic welfare. Adopting the economic classification of the Interna tional Monetary Fund, we find that ES is nonexistent in 98% of African coun tries, 76% of Asian countries, 58% of European countries, 82% of Middle Eas t countries, and in 86% of countries of the Western Hemisphere. The 1980-19 90 global ES survey conducted by the International League Against Epilepsy identified ten developing countries reporting ES (DCRES): Brazil, China, Cz echoslovakia, Hungary, Mexico, Poland, Taiwan, the U.S.S.R., Yugoslavia, an d Viet Nam. The present survey based on the proceedings of the 19th-23rd In ternational Epilepsy Congresses and Medline re ports from 1991 to November 1999 revealed at least 26 (18.3%) DCRES of 142 developing countries: Argent ina, Brazil, Chile, China, Colombia, Czech Republic, Egypt, Estonia, Hungar y, India, Iran, Israel, Korea, Lithuania, Mexico, P.R.China, the U.S.S.R., Singapore, Slovenia, South Africa, South Korea, Taiwan, Turkey, Ukraine, Ur uguay, and former Yugoslavia. National vital statistics expose the hardship s of developing countries. The population ratio of developed countries to d eveloping countries is similar to 1:5. The reverse per capita Gross Domesti c Product ratio is 20:1. Great disparities exist in vital statistics, all t o the disadvantage of the DCRES. The World Health Organization defines heal th-related sectors geographically, then divides developing countries into s everal subgroups. Disability caused by length of disease and years lived wi th disability can be quantified monetarily for epilepsy, and the total heal th expenditures of developed and developing countries can be compared. The DCRES are short of technology, and their ES teams must choose from an exces s of surgical candidates, investigating with computed tomography, magnetic resonance imaging, noninvasive video-electroencephalography, and neuropsych ology. The surgical outcomes achieved are similar to those in the developed world, but at a fractional cost. To internationalize ES, outcome, cost, an d savings from care, evolution of assessment methodology is needed. Also ne eded is general support from the developed world.