Speaker Biography

Biography:

Zainal Muttaqin is a Starting Epilepsy Surgery in Indonesia in July 1999, and since then developing Epilepsy Centers and Epilepsy Monitoring Unit at Diponegoro University/ Dr. Kariadi Hospital in Semarang, Indonesia. In cooperation with Hiroshima University, Kagoshima University, and Shizuoka National Epilepsy Center in Japan, Dr. Muttaqin’s Epilepsy Team is develops all kind of surgery for Epilepsy, from intracranial electrode placement, anterior temporal lobectomy, callosotomy, hemispherotomy to the selective amygdalo-hippocampectomy. There are about 50 epilepsy surgery cases each year for the past 19 years, and the patients comes from all over Indonesia. 

Abstract:

Background: Even with optimized medications, 30% of epilepsy patients will be refractory and this condition leads to cognitive and psychosocial decline. With 0,75% prevalence, there are more than 2.0 million epileptic in Indonesia, about 700.000 will be refractory, and half of them are potential candidates for epilepsy surgery (ES). After 19 years, number of ES increases every year reaching around 50 cases/year. By the end of 2018,  the total number reached 671 and most was temporal lobe epilepsy (TLE). Pre-surgical investigations were compared in relation to the seizure free results between the first five-year and the recent fourteen-year. Despite the excellent result shown, there are so many countries in Asia without any ES program yet while others such as Japan and Korea had a very well run ES program. To improve treatment for refractory epilepsy cases elsewhere, new centers capable of performing ES are urgently needed in many countries with limited resources in Asia.

Material and methods: Until the end of 2018, there were 671 ES cases, including 514 Temporal Lobe Epilepsies (TLEs). Pre-surgical investigations were grouped as Simple (MRI with specific protocol and routine EEG), Difficult (needs long-term ictal EEG, and/or PET CT), and Complex (needs invasive or intracranial/ subdural grid EEG, and or Electrocorticography/ ECoG during the surgery). For the first five year-period, besides seizure semiology, decision to operate were based on MRI and routine EEG (Simple) in 54 out of 56 (96,4%) TLE cases. One patient had long-term ictal EEG and another had subdural grid EEG implanted, both patients showed visually normal MRI. But for the recent fourteen-year, Simple TLEs occupy only 234 out of 458 (51%) TLE cases. Long-term ictal EEG were performed in 161 patients (35,2%), PET study in 39 patients (8,5%), subdural grid EEG in 30 patients (6,5%), and ECoG in 61 patients (13,3%).

Results: As a new ES center performing only simple TLE cases, our surgical results were Class I: 82%, Class II: 11%, and Class III: 7%. As a semi advance ES center (after more than 5 years, and only half were simple ES cases), the Class I or seizure free results were 78,7% for simple TLEs, 73,4% for Difficult TLEs, and 65,2% for Complex TLEs.            

Conclusion: For the first five year, -as a basic ES center- we relay most on good MRI besides detailed study on seizure semiology and routine EEG. The Class I or Seizure Free result was best in the Simple TLEs with MRI showing discrete unilateral temporal lesion. With 18 years experiences of structured ES program, together with those countries with advanced ES program, we should encourage countries with limited resources in Asia to initiate a new Basic ES Center, so that ES services may become available to PWEs in all part of Asia.