Epilepsy surgery in developing countries

Epilepsy surgery (ES) is a well-accepted treatment for medically intractabl e epilepsy patients in developed countries, but it is highly technology dep endent. Such technology is not usually available in developing countries. F or presurgical evaluation, magnetic resonance imaging (MRI) and electroence phalogram recording while videotaping the patient have been important. High technology equipment will, in conjunction with MRI, identify similar to 70 % of ES candidates. Introducing ES into developing countries will require d etermining the candidates that are appropriate for the existing medical inf rastructure. This article reviews ES and its possible introduction into con ditions existing in developing countries. The authors address (a) the types of patients to be considered for resective ES (some patients require a fai rly standard series of noninvasive studies others will require extensive in vasive studies), (b) ways to determine which patients might be appropriate for the existing situation (unilateral mesial temporal lobe epilepsy detect ed with MRI, epilepsy with a circumscribed MRI lesion, hemi-spheric lesions , circumscribed MRT detected neuronal migration, and development disorders) , (c) surgical procedures (local resection, functional hemispherectomy, mul tiple subpial transections, corpus callosotomy, and implantation of a vagal nerve stimulator), (d) special considerations for introducing ES into deve loping countries (medical infrastructure, technology, seizure monitoring sy stems, selective intracarotid/carotid Amytal testing, and surgical equipmen t), and (e) the limitations, realistic expectations, personnel requirements , and educational function for selected professionals. Delivery of the tech nology and expertise to perform ES in developing regions of the world is a realizable project, but it would be limited by available technology and exi sting medical infrastructure. It should be possible in most areas to train local personnel and thereby leave a lasting legacy.