Is epilepsy surgery possible in countries with limited resources?

This study illustrates the outcome and cost-effectiveness of anterior tempo ral lobectomy (ATL) among patients with medically refractory temporal lobe epilepsy (TLE) treated in an epilepsy center in Kerala, South India. Patien ts for ATL were selected on the basis of a noninvasive protocol comprising clinical, interictal scalp electroencephalogram (EEG), magnetic resonance i maging, and ictal video-EEG data. The authors compared the outcome and dire ct cost of 119 patients (mean age, 25.6 years; mean duration of epilepsy be fore ATL, 16.1 years) who have completed at least 1 year follow-up after AT L with 71 refractory TLE patients (mean age, 27.1 years; mean duration of e pilepsy, 15.4 years) who did not undergo ATL. Patients in the study who und erwent ATL had a 70% likelihood of becoming seizure-free after ATL and a 30 % chance of being completely off of antiepileptic drug treatment within 3 y ears after ATL. The out-of-pocket one-time payment for ATL (including presu rgical evaluation) in this setup is Indian Rupees (INR) 47,000 (US$ 1,200). The total direct medical cost of caring for TLE patients aged 26 to 60 yea rs would be INR 200,000 (US$ 5,000). Patients freed from seizures often can be better employed and achieve an improved quality of life. It is conclude d that ATL for refractory TLE is a more cost-effective option than continue d medical treatment. Epilepsy surgery is not only possible in a developing country but can also be undertaken in a cost-effective way.