Underutilization of epilepsy surgery in ASEAN countries

Thuy Le MA 1 , Fong SL 2 , Lim KS 3 , Gunadharma S 4 , Sejahtera DP 5 , Visudtibhan A 6 Show all authors , Chan D 7 , Vorachit S 8 , Chan S 9 , Ohnmar 10 , Chua AE 11 , Cabral-Lim L 11 , Yassin N 12 , Le VT 13 , Tan CT 2

Affiliations 

  • 1 Department of Neurology, Faculty of Medicine, University of Medicine and Pharmacy of Ho Chi Minh city, Ho Chi Minh City, Viet Nam
  • 2 Division of Neurology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
  • 3 Division of Neurology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia. Electronic address: kslimum@gmail.com
  • 4 Faculty of Medicine, Padjadjaran University, Hasan Sadikin Hospital, Bandung, Indonesia
  • 5 Department of neurology, Sardjito general hospital, Yogyakarta, Indonesia; Epilepsy subdivision, department of neurology, faculty of medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia
  • 6 Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
  • 7 Division of Neurology, Department of Paediatric Medicine, KK Women's and Children's Hospital, Singapore, Singapore
  • 8 Faculty of Medicine, University of Health Sciences, Vientiane, Laos
  • 9 University of Health Sciences, Phnom Penh, Cambodia
  • 10 Department of Neurology, University of Medicine 1, Yangon, Myanmar
  • 11 Department of Neurosciences, College of Medicine-Philippine General Hospital, The Health Sciences Center, University of the Philippines Manila, Manila, Philippines
  • 12 Neurology Unit, Department of Internal Medicine. Raja Isteri Pengiran Anak Saleha (RIPAS) Hospital, Brunei; Brunei Neurosciences, Stroke and Rehabilitation Centre (BNSRC), Brunei
  • 13 Department of Neurosurgery, Faculty of Medicine, University of Medicine and Pharmacy of Ho Chi Minh city, Ho Chi Minh city, Viet Nam
Seizure, 2019 Jul;69:51-56.
PMID: 30974407 DOI: 10.1016/j.seizure.2019.04.002

Abstract

PURPOSE: This survey was performed to determine the availability of epilepsy surgery, and understand the limiting factors to epilepsy surgery in ASEAN countries with total of 640 million population.

METHOD: A cross-sectional survey was completed by national representatives in all ASEAN countries (Brunei, Cambodia, East Timor, Indonesia, Laos, Malaysia, Myanmar, Philippines, Singapore, Thailand, and Vietnam).

RESULTS: Overall facilities for initial epilepsy pre-surgical evaluation are available in most countries, but further non-invasive and invasive investigations are limited. Three countries (Brunei, Cambodia, and East Timor) have no epilepsy center, and 2 countries (Laos, Myanmar) have level 2 centers doing tumor surgery only. Level-3 epilepsy centers are available in 6 countries (Indonesia, Malaysia, Philippine, Singapore, Thailand, Vietnam); only 5 countries (Indonesia, Malaysia, Philippine, Singapore, Thailand) has at least one level-4 epilepsy care facility. Indonesia with 261 million population only has one level 3 and another level 4 center. The costs of presurgical evaluation and brain surgery vary within and among the countries. The main barriers towards epilepsy surgery in ASEAN include lack of expertise, funding and facilities.

CONCLUSIONS: Epilepsy surgery is underutilized in ASEAN with low number of level 3 centers, and limited availability of advanced presurgical evaluation. Lack of expertise, facilities and funding may be the key factors contributing to the underutilization.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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