title: Epilepsy surgery in Argentina: long-term results in a comprehensive epilepsy centre.
abstract: BACKGROUND
  Epilepsy surgery procedures started in Argentina more than 50 years ago. This is the first comprehensive and systematic survey of epilepsy surgery long-term outcome from our country.
  
  
  METHODS
  A descriptive cohort study was conducted between 1998 and 2008 for drug-resistant epilepsy surgery with a minimum of 12 months follow-up (n=110). In 84 cases (76.36%) resective surgery was performed, and outcome periodically assessed using the Engel score. Patients were stratified into groups: 12, 13-36, 37-60 and over than 60 months of follow-up. Video-EEG with and without intracranial electrode implants, intraoperative electrocorticograms, Wada tests, pathology reports, use of antiepileptic drugs (AEDs), and surgical complication rates were evaluated.
  
  
  RESULTS
  Surgical techniques included: 69 lobectomies (62.7%), 15 lesionectomies (13.6%), 6 callosotomies (5.4%), 6 multiple subpial transection (5.4%), 11 vagus nerve stimulations (10%), 3 hemispherectomies (2.7%). Male: female ratio: 1/1.44. Mean age at time of surgery: 26.2 years. Mean duration of epilepsy: 14 years. Age at seizure onset: 11.5 years. Mean follow-up: 46 months. Pathology findings: mesial temporal sclerosis 32 (35.1%); dual pathology 17 (18.7%); cortical dysplasia 15 (16.4%); non-specific inflammatory changes 11 (12.1%); tumors 7 (7.7%); other 6 (6.8%). Engel scores at 12 months follow-up: 72.6% (61) class I, 16.6% (14) class II and 15.5% (13) class III-IV; 13-36 months after surgery: 68.1% of cases were class I, 15.9% class II and 15.5% class III-IV. After 37-60 months, 74% class I, 14% class II, 14% class III-IV. Over 60 months (n=45) 78% class I, 13.5% class II and 8.1% class III-IV.
  
  
  CONCLUSIONS
  Conducting a successful epilepsy surgery program in a developing country is challenging. These results should encourage specialists in these countries. Long-term outcome results comparable to centres in developed countries can be achieved.
authors.affiliation: Comprehensive Epilepsy Programme. Institute for Neurological Research, FLENI, Montañeses 2325, Buenos Aires, Argentina, Zip C1428AQK, Buenos Aires, Argentina.
authors.forename: Martín
authors.initials: M
authors.lastname: Donadío
authors.forename: Carlos
authors.initials: C
authors.lastname: D'Giano
authors.forename: Mauricio
authors.initials: M
authors.lastname: Moussalli
authors.forename: Leonardo
authors.initials: L
authors.lastname: Barrios
authors.forename: Gabriela
authors.initials: G
authors.lastname: Ugarnes
authors.forename: Mónica
authors.initials: M
authors.lastname: Segalovich
authors.forename: Juan
authors.initials: J
authors.lastname: Pociecha
authors.forename: Claudio
authors.initials: C
authors.lastname: Vázquez
authors.forename: Cesar
authors.initials: C
authors.lastname: Petre
authors.forename: Hugo
authors.initials: H
authors.lastname: Pomata
mesh_terms: D000293:Adolescent; D000328:Adult; D000927:Anticonvulsants / Q000627:therapeutic use; D001118:Argentina; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D016208:Databases, Factual; D004185:Disability Evaluation; D004351:Drug Resistance; D004569:Electroencephalography; D004827:Epilepsy / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D009493:Neurosurgery / Q000639:trends*; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000706:statistics & numerical data / Q000639:trends*; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000927:Anticonvulsants