Comparison of the epilepsy surgery programs in Cartagena, Colombia, and Zurich, Switzerland

The organization, financing, productivity, quality of work, and cost-effect iveness of the Epilepsy Center in Cartagena, Colombia, were studied and com pared with the epilepsy surgery program at the University Hospital Zurich, Switzerland. During a 2-month visit, one of the authors (I.T.) evaluated th e center in Cartagena as a welfare institution and evaluated its epilepsy s urgery program. The postoperative results of the Cartagena program were com pared with those reported at the Second International Palm Desert Conferenc e 1992, which revealed a similar rate of postoperative seizure control in t emporal lobe epilepsy, slightly inferior results with hemispherectomy , and slightly better results with anterior callosotomy. A comparison between th e two epilepsy centers showed that pre- and postoperative antiepileptic dru g treatment is more restricted in Colombia because of high costs. Although important diagnostic tools such as electroencephalography, seizure monitori ng, neuropsychology, computed tomography, and magnetic resonance imaging ar e available in both centers, the Zurich program also has access to positron emission tomography, single photon emission computed tomography, magnetic resonance spectroscopy, and intracarotid and selective amobarbital tests. T he postoperative seizure outcome is similar in surgical temporal lobe epile psy patients (temporal lobectomy series, Cartagena; selective amygdalohippo campectomy series, Zurich). The comparison of direct costs of epilepsy surg ery in Cartagena and Zurich showed that for the average patient undergoing epilepsy surgery in Cartagena, the cost is 5.5% of that in Zurich. This stu dy presents evidence that epilepsy surgery is an inexpensive and efficient treatment option for epilepsy patients in developing countries. Epilepsy su rgery in developing countries may even be considered at an early stage in p atients who cannot afford the costs of lifetime medical treatment but can a fford the one-time cost of a surgical treatment.