Level 4 comprehensive epilepsy program in Malaysia, a resource-limited country

Background and Objective: There is a great challenge to establish a level 4 epilepsy care offering complete evaluation for epilepsy surgery including invasive monitoring in a resource-limited country. This study aimed to report the setup of a level 4 comprehensive epilepsy program in Malaysia and the outcome of epilepsy surgery over the past 4 years. Methods: This is a retrospective study analyzing cases with intractable epilepsy in a comprehensive epilepsy program in University Malaya Medical Center (UMMC), Kuala Lumpur, from January 2012 to August 2016. Results: A total of 92 cases had comprehensive epilepsy evaluation from January 2012 till August 2016. The mean age was 35.57 years old (range 15-59) and 54 (58.7%) were male. There were 17 cases having epilepsy surgery after stage-1 evaluation. Eleven cases had mesial temporal sclerosis and 81% achieved Engel class I surgical outcome. Six cases had lesionectomy and 60% had Engel class I outcome. A total of 16 surgeries were performed after stage-2 evaluation, including invasive EEG monitoring in 9 cases. Among those with surgery performed more than 12 months from the time of data collection, 5/10 (50%) achieved Engel I outcome, whereas 2 (20%) had worthwhile improvement (Engel class III) with 75% and 90% seizure reduction. Conclusion: Level 4 epilepsy care has an important role and is possible with joint multidisciplinary effort in a middle-income country like Malaysia despite resource limitation