PRACTICE OF EPILEPSY SURGERY IN EMERGING AND DEVELOPING COUNTRIES: FOCUS IN SUBSAHARAN AFRICA: A brief literature review

More than 85% of the total global burden of epilepsy is found in population of lowor middle-income countries. In the vast majority of these are African countries that however are less equipped to handle this disease and especially in his surgical component. Until recently the epilepsy surgery was been considered as treatment using expensive technology and therefore reserved for developed countries. Currently programs of this treatment are becoming common in Brazil, China and India. It is also introduced in many other developing countries including those in North Africa. In sub-Saharan Africa, epilepsy surgery is still very little practiced. This literature review aims to address some results of the practice of epilepsy surgery in emerging and developing countries in general. In the other hand, to describe what is the practice of this surgery in the subSaharan African countries and explore solutions proposed in literature to start this surgery in low-income countries. Keyswords: Epilepsy Developing countriesSub-Saharan Africa surgical treatment Introduction: Over 85% of the overall weight of epilepsy is found in the world's population living in middleand low-income countries. In the vast majority, it is African countries where annual health expenditures are below $ 50 per individual. The population of developing countries is 5 times greater than that of developed countries, but has at its disposal less than 5% of the total domestic capital production. These countries are thus the least prepared to support epilepsy patients1,2,3,4,5. The estimated mortality based on age, sex and cause of death in 1990 showed 127,000 deaths related to epilepsy in developed countries and 1.025 million in developing countries. The gap of epilepsy in the latter group of countries is alarming. Indeed, over 60% of patients with epilepsy in developing countries have no access to medical treatment or do not adhere to the treatment regimen1,6,7,8,9. Epileptic patients have a higher risk of premature death than the general population. In Ethiopia, a 1997 study showed that 6.3% of epileptics die within 2 years following the onset of the disease and one third in 20 years. Causes of death include status epilepticus, falls, drowning, burns and sudden death10. Symptomatic epilepsy can reduce the life expectancy of over 18 years. The results of the projection of the demographic and epidemiological trends suggest that with the population growth, the number of epilepsy will continue to increase especially in the pediatric population in developing countries. This augurs the need for development of comprehensive management strategies for this pathology especially in African countries by including his surgical component1,2,3,11. This literature review aims to address some results of the practice of epilepsy surgery in emerging and developing countries in general. In the other hand, to describe what is the practice of this surgery in the African subSaharan countries and explore solutions proposed in literature to start this surgery in low-income countries. 1. Epilepsy Surgery in emerging and developing countries in general It was considered that the epilepsy surgery does not exist in many developing countries because of its cost and the lack of infrastructure in these countries to get up to the technological advances. At this infrastructure problem, the additional is the lack of qualified personnel in this field. It is true that the role of technology must be carefully assessed in the context of these countries. The tools used in assessing seizures must meet the cost-effectiveness balance criteria. The results of some studies from China and India suggested that the monitoring of EEG and MRI are adequate tools for identifying candidates for surgical treatment of epilepsy. Thus the lack of invasive investigative techniques should not be a handicap for surgery in patients who require4,5,11,12,13.