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ORIGINAL ARTICLE
Year : 2022  |  Volume : 10  |  Issue : 1  |  Page : 5-18

Telecollaboration: Telementorship for epilepsy surgery services in resource: Challenged lower-middle-income countries environs – A model and proof of concept


1 Department of Neurosurgery; R. Madhavan Nair Centre for Comprehensive Epilepsy Care, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
2 R. Madhavan Nair Centre for Comprehensive Epilepsy Care, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
3 Global Centre for Excellence in Neurosciences, Aster Hospital, Bengaluru, Karnataka, India
4 Epilepsy Centre, Institute of Neurology, National Hospital of Sri Lanka, Colombo, Sri Lanka
5 Department of Neurosurgery, National Institute of Neurosciences and Hospital, Dhaka, Bangladesh
6 Department of Neurosurgery, Narayana Medical College, Nellore, Andhra Pradesh, India
7 Department of Neuroimaging and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
8 Department of Neurosurgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India

Correspondence Address:
Prof. George Chandy Vilanilam
Department of Neurosurgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram - 695 011, Kerala
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/amhs.amhs_105_22

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Background and Aim: Although 80% of people with epilepsy live in low and lower-middle-income countries (LMIC), epilepsy surgery (ES) has reached very few of its potential beneficiaries in these nations. This imbalance could be overcome by telecollaboration ES, aided by the burgeoning digital penetration in LMIC. We aimed to propose a telecollaboration-mentorship model for resource-limited LMIC environs to initiate, sustain, and expand ES centers. We also aimed to assess the model's feasibility and provide a proof of concept. Materials and Methods: Five mentee centers (level 3 epilepsy centers) across three LMIC under the mentorship of a tertiary comprehensive epilepsy care center (level 4) were part of the telecollaboration-mentorship model. This model was used for surgical candidacy selection, intraoperative surgical support, and postoperative outcome assessment at the mentee centers, using both asynchronous and synchronous telecollaboration exchanges. Results: Nineteen patients across five centers and three LMIC underwent ES as part of the telecollaboration-mentorship program from 2018 to 2021. Sixty-eight telemedicine exchanges (average 3.5/patient), 42 asynchronous (email, text message, multimedia message), and 26 synchronous (phone call, video call, video conference) were made in the preoperative, intraoperative, and postoperative period. Worthwhile seizure outcome (Engel Class I, II) was achieved in 17 patients (89.4%) at a mean duration of follow-up of 13.5 months (standard deviation 10.9). Conclusion: The telecollaboration-mentorship model is a feasible, sustainable scalable, and replicable mechanism to expand the outreach of surgical care in epilepsy, especially in resource-constrained LMIC environs. It holds the potential to overcome the “ES divide” between LMIC and high-income countries and reduce the surgical treatment gap with acceptable surgical outcomes.


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