Epilepsy care and outcome in low- and middle-income countries: A scoping review.

Objectives: Epilepsy is a common neurological condition in low- and middle-income countries (LMICs). This study aims to systematically review, analyze, evaluate, and synthesize information on the current state of medical and surgical management and outcomes of epilepsy in LMICs. Materials and Methods: Systematic searches were conducted on MEDLINE, EMBASE, World Health Organization Global Index Medicus, African Journals Online, WOS, and Scopus, covering the period from the inception of the databases to August 18th, 2021, focusing on studies reporting management and outcomes of epilepsy in LMICs. Results: A total of 2298 unique studies were identified, of which, 48 were included (38035 cases). The mean age was 20.1 ± 19.26 years with a male predominance in 60.92% of cases. The type of seizure commonly reported in most of the studies was absence seizures (n = 8302, 21.82%); partial focal seizure (n = 3891, 10.23%); and generalized tonic-clonic seizures (n = 3545, 9.32%) which were the next most common types of seizures. Mesiotemporal epilepsy was less frequently reported (n = 87, 0.22%). Electroencephalogram was commonly used (n = 2516, 6.61%), followed by computed tomography scan (n = 1028, 2.70%), magnetic resonance imaging (n = 638, 1.67%), and video telemetry (n = 484, 1.27%) in the care of patients with seizures. Primary epilepsy was recorded in 582 patients (1.53%) whereas secondary epilepsy was present in 333 patients (0.87%). Carbamazepine was the most used anti-epileptic drug (n = 2121, 5.57%). Surgical treatment was required for 465 (1.22%) patients. Conclusion: In LMICs, epilepsy is underreported. There is still a lack of adequate tools for the diagnosis of primary or secondary epilepsy as well as adequate access to medical management of those reported.

Care and three-year outcomes of children with Benign Epilepsy with Centro-Temporal Spikes in England.

PURPOSE: Benign Epilepsy with Centro-Temporal Spikes (BECTS) is a pediatric epilepsy with typically good seizure control. Although BECTS may increase patients' risk of developing neurological comorbidities, their clinical care and short-term outcomes are poorly quantified. METHODS: We retrospectively assessed adherence to National Institute for Health and Care Excellence (NICE) guidelines relating to specialist referral, electroencephalogram (EEG) conduct and annual review in the care of patients with BECTS, and measured their seizure, neurodevelopmental and learning outcomes at three years post-diagnosis. RESULTS: Across ten centers in England, we identified 124 patients (74 male) diagnosed with BECTS between 2015 and 2017. Patients had a mean age at diagnosis of 8.0 (95% CI = 7.6-8.4) years. 24/95 (25%) patients were seen by a specialist within two weeks of presentation; 59/100 (59%) received an EEG within two weeks of request; and 59/114 (52%) were reviewed annually. At three years post-diagnosis, 32/114 (28%) experienced ongoing seizures; 26/114 (23%) had reported poor school progress; 15/114 (13%) were diagnosed with a neurodevelopmental disorder (six autism spectrum disorder, six attention-deficit/hyperactivity disorder); and 10/114 (8.8%) were diagnosed with a learning difficulty (three processing deficit, three dyslexia). Center-level random effects models estimated neurodevelopmental diagnoses in 9% (95% CI: 2-16%) of patients and learning difficulty diagnoses in 7% (95% CI: 2-12%). CONCLUSIONS: In this multicenter work, we found variable adherence to NICE guidelines in the care of patients with BECTS and identified a notable level of neurological comorbidity. Patients with BECTS may benefit from enhanced cognitive and behavioral assessment and monitoring.

Management and Outcomes of Low-Grade Gliomas in Africa: A Scoping Review Protocol.

BACKGROUND: Over the last decade, many advancements have been made in the management of low-grade gliomas (LGGs). Overall survival outcomes are correlated with factors such as postoperative residual volumes and specific tumor biomolecular profiles such as IDH mutation status. It is unclear whether these advancements have benefited LGG patients in Africa. This scoping review protocol outlines how the authors will evaluate the epidemiology, presentations, management and outcomes of LGGs in Africa. METHODS: MEDLINE, Embase and African Journals Online will be searched from database inception to date in order to identify the relevant studies. Patients of all ages with histologically and/or radiologically confirmed LGGs that were managed in an African country will be included. Surgical and chemoradiation management of LGG tumours will be considered. Original research, reviews, commentaries, editorials and case reports will be included. RESULTS: Primary outcomes of the review will include LGG management, morbidity and mortality. Secondary outcomes include epidemiology and recurrence of LGGs. DISCUSSION: This scoping review will be the first to evaluate the current landscape of LGG management and outcomes in Africa, highlighting pertinent themes that may be used to guide further research as well as health system strengthening efforts by policymakers and stakeholders. SCOPING REVIEW REGISTRATION: The protocol has been registered on the Open Science Framework (OSF; registration link: https://doi.org/10.17605/OSF.IO/E732G). HIGHLIGHTS: LGGs account for 17% to 22% of total brain tumours and have a median survival time between 5.6 and 13.3 years.Despite many recent advancements in the management of LGGs, there is a paucity in the data within the African landscape.This scoping review will be the first to evaluate the current landscape of LGG management and outcomes in Africa, highlighting pertinent themes that may be used to guide further research and policymaking efforts.

Hosting an Educational Careers Day Within the Virtual Paradigm: The Neurology and Neurosurgery Interest Group Experience.

INTRODUCTION:  To explore our experience of hosting the 10th Annual Neurology and Neurosurgery Interest Group-Society of British Neurological Surgeons (NANSIG-SBNS) Neurosurgery Careers Day, held virtually for the first time. METHODS:  Reflective feedback and review of an international, virtual neurosurgery careers day. The authors reflect on the logistics of organizing the event, and the pre- and post-event feedback provided by delegates. Recommendations have been made on how to successfully host a virtual event. The key themes that permeated the event have been outlined and discussed in the context of the feedback received. RESULTS:  The event was attended by 231 delegates from 20 countries worldwide. Knowledge of neurosurgery as a career and the application process increased after attending the careers day (4.27/5 to 4.51/5, p=0.003 and 3.12/5 to 4.31/5, p<0.001 respectively). The key themes identified from the event include attendance, networking, and education. Qualitative feedback was positive and indicated a positive perception of the careers day. CONCLUSIONS:  The future of educational events is unclear, and a hybrid approach is recommended to retain the benefits of the online space when in-person events eventually return.

Management and outcomes of low-grade gliomas in Africa: A scoping review.

INTRODUCTION: Despite recent advancements in the management of low-grade gliomas (LGGs), there is a paucity in the data within the African landscape. We aim to evaluate the epidemiology, management, and outcomes of LGGs in Africa. METHODS: Systematic searches of MEDLINE, Embase and African Journals Online were performed from database inception to January 27, 2021, for studies reporting on LGGs in Africa. Pooled statistics were calculated using measures of central tendency and spread. RESULTS: 554 unique studies were identified, of which 25 were included. The mean age of patients was 15.7 years (95% confidence interval (CI): 11.8-19.6) and 56.4% were male (95% CI: 55.6-62.6%). Most patients had solitary lesions (86.0%, 95% CI: 82.8-89.1%) located in the infratentorial region (71.6%, 95% CI: 66.1-77.1%). Most LGGs received histopathological diagnosis (71.7%, 95% CI: 69.2-74.2%) and astrocytoma was the most common type (81.1%, 95% CI: 78.5-83.7%). 37 patients had awake surgery (3.1%, 95% CI: 2.0-4.0%) and there were no reports of molecular pathology testing, intraoperative neuroimaging, or 5-aminolevulinic acid. Gross total resection was achieved in 74.8% (95% CI: 69.6-80.0%) and there was a recurrence rate of 1.7% (95% CI: 0.9-2.4%), with a mean follow-up of 19.4 months (95% CI: 6.9-31.9). CONCLUSION: LGGs are underreported in Africa. We found a lag in the uptake of techniques established in high-income countries for improving patient outcomes. Future efforts will require further training and funding in molecular pathology testing and advanced surgical adjuncts.

Management and Outcomes of Paediatric Intracranial Suppurations in Low- and Middle-Income Countries: A Scoping Review.

Introduction: Intracranial suppurations account for a significant proportion of intracranial masses in low- and middle-income countries (LMICs), particularly among children. The development of better imaging equipment, antibiotics, and surgical techniques has enabled significant progress in detecting and treating intracranial abscesses. However, it is unclear whether these advances are accessible and utilised by LMICs. In this review, we aimed to describe the landscape of paediatric intracranial suppurations in LMICs. Methods: This scoping review was conducted using the Arksey and O'Malley framework. MEDLINE, EMBASE, WHO Global Index Medicus, AJOL and Google scholar were searched for relevant articles from database inception to January 18th, 2021. Publications in English and French were included. Results: Of the 1,011 records identified, 75 were included. The studies, on average, included 18.8 (95% CI = 8.4-29.1) children (mean age: 8.2 years). Most children were male (62.2%, 95% CI = 28.7-95.7%). Intracranial suppurations were most commonly (46.5%) located in the supratentorial brain parenchyma. The most prevalent causative mechanism was otitis (37.4%) with streptococcus species being the most common causative organism (19.4%). CT scan (71.2%) was most commonly used as a diagnostic tool and antibiotics were given to all patients. Symptoms resolved in 23.7% and improved in 15.3% of patients. The morbidity rate was 6.9%, 18.8% of patients were readmitted, and the mortality rate was 11.0%. Conclusion: Most intracranial suppurations were complications of preventable infections and despite MRI being the gold standard for detecting intracranial suppurations, CT scans were mostly used in LMICs. These differences are likely a consequence of inequities in healthcare and have resulted in a high mortality rate in LMICs.

Survey Fatigue During the COVID-19 Pandemic: An Analysis of Neurosurgery Survey Response Rates.

Background: The COVID-19 pandemic has caused a surge in research activity while restricting data collection methods, leading to a rise in survey-based studies. Anecdotal evidence suggests this increase in neurosurgical survey dissemination has led to a phenomenon of survey fatigue, characterized by decreased response rates and reducing the quality of data. This paper aims to analyze the effect of COVID-19 on neurosurgery surveys and their response rates, and suggest strategies for improving survey data collection. Methods: A search was conducted on March 20, 2021, on Medline and EMBASE. This included the terms "neurosurgery," "cranial surgery," "spine surgery," and "survey" and identified surveys written in English, on a neurosurgical topic, distributed to neurosurgeons, trainees, and medical students. Results were screened by two authors according to these inclusion criteria, and included articles were used for data extraction, univariable, and bivariable analysis with Fisher's exact-test, Wilcoxon rank-sum test, and Spearman's correlation. Results: We included 255 articles in our analysis, 32.3% of which were published during the COVID-19 pandemic. Surveys had an average of 25.6 (95% CI = 22.5-28.8) questions and were mostly multiple choice (78.8%). They were disseminated primarily by email (75.3%, 95% CI = 70.0-80.6%) and there was a significant increase in dissemination via social media during the pandemic (OR = 3.50, 95% CI = 1.30-12.0). COVID-19 surveys were distributed to more geographical regions than pre-pandemic surveys (2.1 vs. 1.5, P = 0.01) and had higher total responses (247.0 vs. 206.4, P = 0.01), but lower response rates (34.5 vs. 51.0%, P < 0.001) than pre-COVID-19 surveys. Conclusion: The rise in neurosurgical survey distribution during the COVID-19 pandemic has led to survey fatigue, reduced response rates, and data collection quality. We advocate for population targeting to avoid over-researching, collaboration between research teams to minimize duplicate surveys, and communication with respondents to convey study importance, and we suggest further strategies to improve response rates in neurosurgery survey data collection.

Educating the Next Generation of Global Neurosurgeons: Competencies, Skills, and Resources for Medical Students Interested in Global Neurosurgery.

BACKGROUND: Global neurosurgery operates at the intersection of neurosurgery and public health. Although most global neurosurgery initiatives have targeted neurosurgeons and trainees, medical students represent the future of global neurosurgery. METHODS: A narrative review of the literature regarding research methodology, education, economics, health policy, health advocacy, relevant to global neurosurgery was conducted. RESULTS: We summarize pearls that all medical students interested in global neurosurgery should know. DISCUSSION: To become effective agents of change within global neurosurgery, medical students must master competencies of motivation, organization, collaborativeness, dependability, flexibility, resilience, creative problem-solving, ethical thinking, cultural humility, and global awareness and gain knowledge and skills regarding research, education, policy making, and advocacy. Discussions with neurosurgeons and trainees, neurosurgery interest groups, conferences, university global neurosurgery initiatives, and student organizations represent opportunities for learning and becoming involved in global neurosurgery.