title: Epilepsy surgery in a developing  country (Lebanon):  ten years experience  and predictors of outcome.
abstract: We present our 10-year experience and preoperative predictors of outcome in 93 adults and children who underwent epilepsy surgery at the American University of Beirut. Presurgical evaluation included video-EEG monitoring, MRI, neuropsychological assessment with invasive monitoring, and other tests (PET, SPECT, Wada). Surgeries included temporal (54%), extratemporal (22%), and multilobar resections (13%), hemispherectomy (4%), vagal nerve stimulation (6%), and corpus callosotomy (1%). Mesial temporal sclerosis was the most common aetiology (37%). After resective surgery, 70% had Engel class I, 9% class II, 14% class III, and 7% class IV. The number of antiepileptic drugs before surgery was the only preoperative factor associated with Engel class I (p=0.005). Despite the presence of financial and philanthropic aid, many patients could not be operated on for financial reasons. We conclude that advanced epilepsy presurgical workups, surgical procedures, and favourable outcomes, comparable to those of developed countries, are achievable in developing countries, but that issues of financial coverage remain to be addressed.
authors.affiliation: Department of Pediatrics, American University of Beirut Medical Center.
authors.forename: Mohamad A
authors.initials: MA
authors.lastname: Mikati
authors.forename: Nour
authors.initials: N
authors.lastname: Ataya
authors.forename: Jessica
authors.initials: J
authors.lastname: El-Ferezli
authors.forename: Alhan
authors.initials: A
authors.lastname: Shamseddine
authors.forename: Amal
authors.initials: A
authors.lastname: Rahi
authors.forename: Aline
authors.initials: A
authors.lastname: Herlopian
authors.forename: Rana
authors.initials: R
authors.lastname: Kurdi
authors.forename: Saleh
authors.initials: S
authors.lastname: Bhar
authors.forename: Abeer
authors.initials: A
authors.lastname: Hani
authors.forename: Youssef G
authors.initials: YG
authors.lastname: Comair
mesh_terms: D003906:Developing Countries; D004827:Epilepsy / Q000601:surgery; D004833:Epilepsy, Temporal Lobe / Q000601:surgery; D006801:Humans; D007861:Lebanon; D012189:Retrospective Studies