Epilepsy surgery program in Tunisia: an example of a Tunisian French collaboration.
OBJECTIVE
To describe the first Tunisian epilepsy surgery program establishment and to emphasize on its originality that is an exchange and surgery decision taken by two Mediterranean neurophysiological teams, via the Internet.


METHODS
Patients with mesial temporal lobe epilepsy (MTLE) and refractory to antiepileptic drugs were included. A noninvasive protocol evaluation including a detailed history, neurological evaluation, brain imaging, scalp video-EEG monitoring and neuropsychological evaluation were performed. The different findings were discussed between the Neurophysiological Department of Charles Nicolle Hospital of Tunis and Rouen through the EUMEDCONNECT Internet network project. If cases of concordance of clinical, neuropsychological, neuroimaging data and video-EEG recordings, surgery was indicated.


RESULTS
15 patients (7 women and 8 men) with mean age of 30 years were included. 10 patients had right hippocampal sclerosis (HS) and 5 had left HS. MRI findings were concordant with the ictal EEG in 12 patients. One patient had bitemporal ictal EEG abnormalities and right HS on MRI. One patient had contralateral ictal clinical and EEG patterns to the side of HS. One patient had temporal 'plus' epilepsy. Surgery was performed in 10 cases. After surgery, all patients are seizure free, with no operative mortality or major surgery complications.


CONCLUSIONS
Our model of twin affiliations between advanced epilepsy surgery programs in a developed country and starting programs in a developing country, using Internet technology, can be a model for collaboration in other countries.
Mrabet Khiari
Hela
H
Department of Neurology, Charles Nicolle Hospital, Boulevard 9 Avril, Tunis 1006, Tunisia. helamrabet@yahoo.com
Khemiri
Emna
E
Parain
Dominique
D
Hattab
Nejib
N
Proust
Franois
F
Mrabet
Amel
A
D000328:Adult; D003299:Cooperative Behavior; D004569:Electroencephalography / Q000379:methods; D004833:Epilepsy, Temporal Lobe / Q000150:complications / Q000601:surgery*; D005260:Female; D005602:France; D006624:Hippocampus / Q000473:pathology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D009493:Neurosurgery / Q000379:methods* / Q000458:organization & administration*; D012598:Sclerosis / Q000209:etiology / Q000473:pathology; D013223:Statistics as Topic; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D014416:Tunisia / Q000453:epidemiology; D014741:Video Recording / Q000379:methods; D055815:Young Adult