Presurgical evaluation in epilepsy surgery in Viet Nam

Presurgical evaluation in epilepsy surgery in Viet Nam

Minh An Thuy Le, MD, MSc
University of Medicine and Pharmacy at Hcmc

Abstract
Epilepsy is one of the most common neurological diseases affecting more than 50 million people worldwide. Despite anti-seizure medication (ASM) being the most popular treatment, about one-third of people with epilepsy (PWE) have not achieved seizure freedom with optimal medicines. Epilepsy surgery showed effectiveness in drug-resistant epilepsy. Presurgical evaluation is an essential step in performing a successful surgery. In Viet Nam, a limited resource country, we chose candidates showing suspected lesional MRI with surgically remediable epilepsy syndromes, such as mesial temporal sclerosis, low-grade gliomas (LGGs), or focal cortical dysplasia (FCD). Trained neurologists evaluated PWE diagnosed with drug-resistant epilepsy based on clinical information, including age at onset, semiology, number of ASMs, medical history, and primary modalities such as long-term video EEG and brain MRI. MRI was performed with an epilepsy protocol, while long-term video EEG with a duration of 1 to 3 days was conducted to capture interictal discharges and/or clinical seizures. In cases showing concordant findings for at least three examinations, including semiology, interictal EEG, ictal EEG, and brain MRI, and lesions that did not affect the eloquent cortex, the surgical plan was anterior temporal lobectomy for hippocampal sclerosis or lesionectomy for FCD or LGGs. The decision to perform surgery was also made if the potential epileptogenic zone was confirmed.