International collaboration on epilepsy surgery in Tunisia - a

model for the future

Introduction Epilepsy is a frequent neurological disorder Medication does not always workIf seizures> 2 years and 2 drug trials then the chanceof long term control of epilepsy with medication is

~10% Epilepsy have an adverse impact upon

Work Education Driving Mariage Life expectancy

Introduction

Epilepsy surgery : effective treatment for medically refractory seizures.

60–80% of patients with temporal epilepsybecome seizure free after resective surgery This technique, although effective, remainslimited in developing countries, creating asignificant ‘‘surgical treatment gap’’

Presurgical evaluation of epilepsy

Identification of candidates eligible for surgery : crucial step before surgery

Established at the Neurological Department of Charles Nicolle Hospital (Tunis)

Includes : detailed history, neurological exam, brain MRI, scalp video-EEG monitoring and neuropsychological tests

Video-EEG Monitoring

Seizure focus

•Continuous EEG recording with simultaneous video recording of the patient clinical manifestations

•Objective: localization seizure origin and propagation

•Requires technical and medical competencies

Contribution of EUMEDCONNECT

EUMEDCONNECT network project

Length of video-EEG Combination of Video and EEG

large files causing problems in data transfer

Using in real time the high speed NECT backbonenetwork, a rapid access transfer of the video-EEGrecordings from Tunis to France was performed

Video-EEG recordings were then discussedbetween the two Neurophysiological teams. In cases of concordance of clinical,neuropsychological, neuroimaging data andvideo-EEG recording, the surgery indicationwas then considered