Epilepsy Surgery for Drug-Resistant Epilepsy in Africa: A Systematic Review

Kwadwo Darko; Pearl Ohenewaa Tenkorang; Olivia Asiedu; W Elorm Yevudza Jr; Salim Issah; Eyako Dzantor; Marjidah Tahiru; Andrew Awuah Wireko; Sean O'Leary; Umaru Barrie; Hannah Weiss; Teddy Totimeh; Mabel Banson

doi:10.1227/neu.0000000000003307

Epilepsy Surgery for Drug-Resistant Epilepsy in Africa: A Systematic Review

Neurosurgery. 2024 Dec 12. doi: 10.1227/neu.0000000000003307. Online ahead of print.

Authors

Affiliations

¹ Department of Neurosurgery, Korle Bu Teaching Hospital, Accra, Ghana.
² University of Ghana Medical School, Accra, Ghana.
³ Columbia University Vagelos College of Physicians and Surgeons, New York City, New York, USA.
⁴ Faculty of Medicine, Sumy State University, Sumy, Ukraine.
⁵ Department of Neurosurgery, University of Texas Medical Branch, Galveston, Texas, USA.
⁶ Department of Neurosurgery, NYU Grossman School of Medicine, New York City, New York, USA.
⁷ Accra Medical College, Accra, Ghana.

PMID: 39665528
DOI: 10.1227/neu.0000000000003307

Abstract

Background and objectives: Nearly one-third of individuals with epilepsy have drug-resistant epilepsy, treated most effectively with surgery. This study aims to discuss the demographic profile, surgical access, and strategies used in drug-resistant epilepsy in Africa.

Methods: A systematic review was performed using PubMed, Google Scholar, Embase, and Web of Science in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines.

Results: Nine studies encompassing 498 patients from 6 African countries (Egypt, Kenya, Morocco, South Africa, Tunisia, and Uganda) were included. The mean Methodological Index for Non-Randomized Studies score for these articles was 9.6 ± 1.6. The average patient age was 24.9 years (95% CI: 18.9-30.8 years), with a male predominance of 53.4%. The average age of seizure onset was 10.4 years (95% CI: 6.1-14.7 years). Most patients experienced focal onset seizures (73.1%), with head trauma (33.1%) being the most reported risk factor. The predominant etiologies were hippocampal sclerosis (66.8%, 95% CI: 42.7-91), microdysgenesis (26.7%, 95% CI: 20.7-32.7), and brain tumors (22.3%, 95% CI: 6.4-38.2). Lesions were primarily located in the left hemisphere (61.9%, 95% CI: 26.7-97.1), with temporal lobe involvement in 54.8% of cases (95% CI: 28.7-80.8). Temporal lobectomy was the most frequently performed surgery (59.6%), followed by lesionectomy (9.6%). Postoperatively, 80.6% of patients achieved Engel class I outcomes, indicating seizure freedom, and long-term follow-up (1 to 5 years) showed that 70.3% maintained Engel class I outcomes. Surgical complications were reported in 8.8% of cases.

Conclusion: These findings demonstrate the efficacy and long-term benefits of epilepsy surgery in Africa, where epilepsy is a significant public health challenge. The high rates of seizure freedom and reduced seizure frequency from surgery highlight its potential to improve the quality of life for individuals with drug-resistant epilepsy in Africa.