Research Article| Volume 142, 109209, May 2023

Download started.


Evaluation of epilepsy surgery scope and training in Latin America


      • There is high variability of surgical procedures performed throughout Latin America.
      • Advanced surgical interventions are performed throughout Latin America.
      • Laser ablation procedures are not widely available.
      • There are areas to improve training and exposure in surgical epilepsy internationally.



      To describe the variety of surgical epilepsy procedures offered in Latin America and characterize the training in surgical management for epilepsy and neurophysiology fellows.

      Materials & Methods

      A 15-question survey was sent to Spanish-speaking epilepsy specialists in Latin America (members of the International Consortium in Epilepsy Surgery Education) to characterize their epilepsy surgery practices and formal training programs when present, including fellowship program characteristics, trainee involvement, and assessment of trainee performance. Epilepsy surgery procedures included resective/ablative interventions and neuromodulation therapies approved for drug-resistant epilepsy. Associations between categorical variables were evaluated using the Fisher Exact test.


      There were 42 responses from a total of 57 survey recipients (73% response rate). Most surgical programs performed either 1 to 10 procedures (36%) or 11 to 30 procedures (31%) per year. Most centers (88%) performed resective procedures, while none of the surveyed institutions performed laser ablations. Most of the centers performing intracranial EEG (88%) and advanced neuromodulation (93%) were in South America. Centers with formal fellowship training programs were more likely to perform intracranial EEG procedures compared to centers without fellows (92% vs 48%, respectively, OR = 12.2 [95% CI 1.45–583], p = 0.007).


      There is significant variability in surgical procedures performed across epilepsy centers in a Latin American educational consortium. Advanced surgical diagnostic procedures and interventions are performed in a fair number of surveyed institutions. Strategies to enhance access to epilepsy surgery procedures and facilitate formal training in surgical management are necessary.



      DRE (drug-resistant epilepsy), CNP (clinical neurophysiology), ACGME (Accreditation Council for Graduate Medical Education), EMG (electromyography), LITT (laser interstitial thermal therapy), RNS (responsive neurostimulator), DBS (deep brain stimulator implantation), EEG (electroencephalography), VNS (vagus nerve stimulation)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Epilepsy & Behavior
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Brodie M.J.
        • Barry S.J.
        • Bamagous G.A.
        • Norrie J.D.
        • Kwan P.
        Patterns of treatment response in newly diagnosed epilepsy.
        Neurology. 2012; 78: 1548-1554
        • Wiebe S.
        • Blume W.T.
        • Girvin J.P.
        • Eliasziw M.
        A randomized, controlled trial of surgery for temporal-lobe epilepsy.
        N Engl J Med. 2001; 345: 311-318
        • Engel Jr., J.
        • McDermott M.P.
        • Wiebe S.
        • Langfitt J.T.
        • Stern J.M.
        • Dewar S.
        • et al.
        Early surgical therapy for drug-resistant temporal lobe epilepsy: a randomized trial.
        J Am Med Assoc. 2012; 307: 922-930
      1. Ali M. The Epilepsy Milestone Project. In; 2015.

      2. (ACGME) ACGME. ACGME Program Requirements for Graduate Medical Education in Epilepsy. In; 2022.

      3. Albert Dea. Clinical Neurophysiology Milestones. In; 2022.

        • Thio L.L.
        • Edgar L.
        • Ali I.
        • Farooque P.
        • Holland K.D.
        • Mizrahi E.M.
        • et al.
        Epilepsy Milestones 2.0: An updated framework for assessing epilepsy fellowships and fellows.
        Epilepsia. 2022;
      4. Neurophysiology TUSoC. European Training Requirements (ETR) for Clinical Neurophysiology. In; 2017.

        • Watila M.M.
        • Xiao F.
        • Keezer M.R.
        • Miserocchi A.
        • Winkler A.S.
        • McEvoy A.W.
        • et al.
        Epilepsy surgery in low- and middle-income countries: A scoping review.
        Epilepsy Behav. 2019; 92: 311-326
        • Wieser H.G.
        • Silfvenius H.
        Overview: epilepsy surgery in developing countries.
        Epilepsia. 2000; 41: S3-S9
        • Martínez-Juárez I.E.
        • Del Carmen G.M.
        • Camilo-Cotuá U.J.
        • Paredes-Aragón E.
        • Chang-Segura J.L.
        • Guzmán-Sánchez K.E.
        • et al.
        An international consortium in epilepsy surgery education: Clinical case-based discussions between Latin-American and Canadian Epilepsy Centers.
        Epilepsy Behav. 2022; 133108803
        • Lemus H.N.
        • Dworetzky B.A.
        • Bubrick E.J.
        • Cosgrove G.R.
        • Tobochnik S.
        Education Research: Evaluation of Epilepsy Surgery Education in Epilepsy and Clinical Neurophysiology Fellowship Programs.
        Neurology: Education. 2022; 1: e200018
        • Engel Jr., J.
        Evolution of concepts in epilepsy surgery.
        Epileptic Disord. 2019; 21: 391-409
        • Amaral L.C.
        • Portela E.
        • Oliveira M.
        • Lara M.
        • Sousa-Pereira S.
        • Seabra L.
        • et al.
        Tratamento cirúrgico da epilepsia refratária: análise de 34 casos atendidos no Hospital das Clínicas da UFMG.
        Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery. 2014; 33: 112-114
        • Hemb M.
        • Palmini A.
        • Paglioli E.
        • Paglioli E.B.
        • Costa da Costa J.
        • Azambuja N.
        • et al.
        An 18-year follow-up of seizure outcome after surgery for temporal lobe epilepsy and hippocampal sclerosis.
        J Neurol Neurosurg Psychiatry. 2013; 84: 800-805
        • Campos M.G.
        • Godoy J.
        • Mesa M.T.
        • Torrealba G.
        • Gejman R.
        • Huete I.
        Temporal lobe epilepsy surgery with limited resources: results and economic considerations.
        Epilepsia. 2000; 41: S18-S21
        • Fandiño-Franky J.
        • Torres M.
        • Nariño D.
        • Fandiño J.
        Corpus callosotomy in Colombia and some reflections on care and research among the poor in developing countries.
        Epilepsia. 2000; 41: S22-S27
        • Tureczek I.E.
        • Fandiño-Franky J.
        • Wieser H.G.
        Comparison of the epilepsy surgery programs in Cartagena, Colombia, and Zürich, Switzerland.
        Epilepsia. 2000; 41: S35-S40
        • Benedetti-Isaac J.C.
        • Torres-Zambrano M.
        • Fandiño-Franky J.
        • Dussán-Ordóñez J.
        • Herrera-Trujillo A.
        • Guerra-Olivares R.
        • et al.
        Long-term surgical outcomes in patients with drug-resistant temporal lobe epilepsy and no histological abnormalities.
        Neurologia. 2013; 28: 543-549
        • Mejía-Tupa M.A.
        • Pérez-Galdos P.
        • Tori-Murgueytio A.
        • Del Solar-Tafur M.
        • Anicama-Lima W.E.
        • Campos-Puebla M.G.
        Cirugía de epilepsia en el Hospital Nacional Guillermo Almenara: primeros siete casos.
        Acta Médica Peruana. 2014; 31: 199-212
        • Fandino J.
        • Tejada S.K.
        • Suarez M.M.
        • Rocha J.L.
        • de León K.
        • Dorado M.T.
        • et al.
        Hemisferectomía: experiencia institucional y revisión sistemática de la literatura.
        Neurologia Argentina. 2020; 12: 90-97
        • Donadío M.
        • D'Giano C.
        • Moussalli M.
        • Barrios L.
        • Ugarnes G.
        • Segalovich M.
        • et al.
        Epilepsy surgery in Argentina: long-term results in a comprehensive epilepsy centre.
        Seizure. 2011; 20: 442-445
        • Alonso-Vanegas M.A.
        • Austria-Velásquez J.
        • López-Gómez M.
        • Brust-Mascher E.
        Chronic intermittent vagal nerve stimulation in the treatment of refractory epilepsy: experience in Mexico with 35 cases.
        Cir Cir. 2010; 78 (15–23, 24)
        Cirugía de epilepsia: Experiencia en el Hospital de Clínicas de Montevideo.
        Revista Médica del Uruguay. 2006; 22: 36-45
        • Fernández-Concepción O.
        • López Jiménez M.
        • Valencia-Calderón C.
        • Calderón-Valdivieso A.
        • Recasén-Linares A.
        • Reyes-Haro L.
        • et al.
        Safety and effectiveness of surgery for epilepsy in children. Experience of a tertiary hospital in Ecuador.
        Neurologia (Engl Ed). 2021; 36: 271-278
        • Caraballo R.
        • Bartuluchi M.
        • Cersósimo R.
        • Soraru A.
        • Pomata H.
        Hemispherectomy in pediatric patients with epilepsy: a study of 45 cases with special emphasis on epileptic syndromes.
        Childs Nerv Syst. 2011; 27: 2131-2136
        • Pomata H.B.
        • Bartuluchi M.
        • Lubieniecki F.
        • Pociecha J.
        • Caraballo R.
        • Cáceres E.
        • et al.
        Malformación del desarrollo cortical: nuestra experiencia acerca de 150 casos.
        Rev Argent Neurocir. 2010; 24: 93-103
      5. Vázquez C, Cuello M, Rubino P, Prosen A, Tanriover N, Perasolo M, et al. Esclerosis temporal mesial: Paradigma de la epilepsia de resolución quirúrgica. Revista argentina de neurocirugía 2008;22.

        • Oddo S.
        • Solis P.
        • Consalvo D.
        • Seoane E.
        • Giagante B.
        • D'Alessio L.
        • et al.
        Postoperative neuropsychological outcome in patients with mesial temporal lobe epilepsy in Argentina.
        Epilepsy Res Treat. 2012; 2012370351
        • Velasco Monroy A.L.
        • Aguado Carrillo G.
        • Sandoval Olivares L.
        • Vázquez Barrón D.
        Intracranial electrode recording prognostic value in anterior temporal lobectomy and hypocampectomy.
        Gac Med Mex. 2013; 149: 143-151
        • Meneses M.S.
        • Rocha S.F.
        • Simão C.
        • Santos H.N.
        • Pereira C.
        • Kowacs P.A.
        Vagus nerve stimulation may be a sound therapeutic option in the treatment of refractory epilepsy.
        Arq Neuropsiquiatr. 2013; 71: 25-30
        • Benedetti-Isaac J.C.
        • Torres-Zambrano M.
        • Vargas-Toscano A.
        • Perea-Castro E.
        • Alcalá-Cerra G.
        • Furlanetti L.L.
        • et al.
        Seizure frequency reduction after posteromedial hypothalamus deep brain stimulation in drug-resistant epilepsy associated with intractable aggressive behavior.
        Epilepsia. 2015; 56: 1152-1161
        • Sakas D.E.
        • Krauss J.K.
        • Schramm J.
        • Scerrati M.
        • Reulen H.J.
        • Cunha E.S.M.
        • et al.
        Training charter in epilepsy surgery added competence.
        Acta Neurochir (Wien). 2013; 155 (discussion 1729): 1725-1729
      6. Epilepsy IILA. European Project on Development of Epilepsy Surgery (EPODES). In; 2022.

        • Williamson P.D.
        • Jobst B.C.
        Epilepsy surgery in developing countries.
        Epilepsia. 2000; 41: S45-S50
      7. Fund UNP. World Population Dashboard. In; 2022.

        • Karakis I.
        • Liu L.
        • Bensalem-Owen M.
        • LaRoche S.M.
        • Lopez J.R.
        • Schmitt S.E.
        • et al.
        Clinical Neurophysiology Fellowship Program Directors Survey on a Standardized Fellowship Match Process: A Call for Action.
        J Clin Neurophysiol. 2021;
        • Hamberger M.J.
        • Williams A.C.
        • Schevon C.A.
        Extraoperative neurostimulation mapping: results from an international survey of epilepsy surgery programs.
        Epilepsia. 2014; 55: 933-939
      8. Epilepsy ILA. ILAE-LATIN AMERICA Chapters. In; 2023.