MORGANTOWN, W.Va. – In West Virginia and other parts of the Western world, epilepsy is a serious – but treatable – disease. Most patients can control their seizures with medication, and many others are cured with surgery. In the past 50 years, rapid advances in imaging technology have allowed doctors to pinpoint the parts of the brain that trigger seizures and perform life-saving surgery with no disruption to other brain functions.

In the developing world, where 85% of the 40 million people with epilepsy live, the story is far less positive. Surgery for epilepsy is uncommon, expensive imaging equipment is scarce or nonexistent, and drug therapy is limited because of costs, medication availability, lack of medical infrastructure, and other factors. “In East Africa, epilepsy is ten times as common as in the United States, and death rates are two to three times higher. Medically intractable epilepsy – epilepsy that does not respond to drug treatment -- is a major health problem throughout the developing world,” says WVU epilepsy neurosurgeon Warren W. Boling. M.D.

The epilepsy program at West Virginia University has formed a partnership with CURE Children’s Hospital of Uganda to develop a comprehensive epilepsy evaluation and treatment center for patients for the developing countries of Uganda and sub-Saharan Africa. As a part of the program, the Mbale, Uganda, facility is introducing the first epilepsy surgery program for medically intractable epilepsy in East Africa.

In July, Dr. Boling traveled to Uganda with his wife, Nicoletta Longoni, R.N., a WVU neurosurgery nurse, and performed the first three epilepsy surgeries in the region. WVU is working with the hospital’s pediatric neurosurgeons to establish permanent capabilities for this surgery among their staff, and create a treatment program that can be continued in other under developed regions. In addition, WVU neurologists are participating in this project by reviewing brain waves recordings to make recommendations and decisions about epilepsy surgery...

Benjamin Warf, M.D., originally from Pikesville, Ky., and former leader of the University of Kentucky’s pediatric neurosurgery program, is medical director and chief of surgery at CURE Children’s Hospital, operated by CURE International, a Christian non-profit organization.

(Quote from Dr. Warf here - importance of work, value added by WVU link)

Over the last several years, WVU has developed a strong epilepsy program that has brought relief to hundreds of patients from throughout West Virginia and the surrounding region.

“We’re now evaluating 400 to 450 patients a year in our Epilepsy Monitoring Unit,” says Adriana Palade, M.D., a WVU neurologist who has consulted regularly with Dr. Warf and other CURE physicians on cases seen in Mbale.

WVU’s epilepsy program is certified at level four – the highest classification – by the National Association of Epilepsy Centers. The diagnostic protocol here – as in most American hospitals – relies heavily on MRI studies, along with EEG and video monitoring of patients.

“With a combination of viedo monitoring, surgery and medication changes, we’ve been able to make major improvements in our patients’ lives,” Dr. Palade says. “People who have been limited for years are holding down jobs, going to school and overcoming the depression and isolation that sometimes result from years of uncontrolled seizures.”

Translating that success to East Africa won’t be easy, Boling admits. The CURE hospital doesn’t have an MRI. But he, Palade and Warf are convinced that they have designed an epilepsy protocol that takes full advantage of resources that are more common in developing countries. “We want to build a program that’s sustainable – not do a ‘hit-and-run’ intervention,” he said.

The protocol is based on the use of the CT scan the CURE hospital owns. They determined that they needed a more sophisticated EEG unit, and one dedicated Ugandan medical resident traveled to Montreal in the past year to train in EEG at the Montreal Neurological Institute and at the Sellate company headquarters to learn on the EEG system the hospital was able to obtain.

Staff at the CURE hospital copy medical images onto CDs and DVDs and send them to Palade at WVU for interpretation. She reviews the EEG record and the videotape of the patient during a seizure – the same technology used at WVU – and determines where in the brain seizures arise. The hospital has applied for grant funding to establish a high-speed Internet link that would allow instant transmission of images and live teleconferencing with WVU faculty.

“WVU’s experience as a leader in rural telemedicine throughout West Virginia has prepared us well for this task,” Boling says. “Our doctors are comfortable working as partners with physicians in distant locations. And in fact, telemedicine and teleconferencing will be key to bringing advanced treatments for epilepsy to the developing world.”

Successful epilepsy treatment can be even more life-changing in Africa than it is here, Palade says. “Here, we make it possible for patients to hold a job, go to school and drive a car. There, we’re talking about survival in a tough environment.”

In addition to treating patients, the project will improve opportunities for medical education in East Africa. Trainees will learn the techniques of seizure classification, localization and treatment. American Board of Neurological Surgeons has authorized the CURE hospital as a training site for American neurosurgical residents, and it is a certified African training center for pediatric neurosurgery in the newly founded College of Surgeons of East Central and Southern Africa (COSECSA).. There is also a research component to the program; data and tissue from patients will be analyzed to try and determine the causes of the high incidence of epilepsy in the area.

Links

CURE Children’s Hospital Uganda:
http://www.cureinternational.org/locations.jsp?pageId=0690200091781078763448878

WVU Neurosurgery:
http://www.hsc.wvu.edu/som/neurosurgery/

WVU Neurology:
http://www.hsc.wvu.edu/som/neurology/