Pioneering Epilepsy Surgery in Cameroon: Outcomes from the First Prospective Cohort of Surgical Patients with Drug-Resistant Epilepsy.

OBJECTIVE

This study aimed to assess the quality of life and cognitive well-being of patients operated on for drug resistant epilepsy (DRE) in Cameroon.

METHODS

We conducted a single-center, prospective single-arm cohort of 31 patients with DRE who underwent epilepsy surgery between January 2018 and March 2024. Primary endpoints were seizure freedom (Engel IA-IB), cognitive change, and quality of life (QoL) improvement. Survival estimates were computed using Kaplan-Meier analysis and assessed time from surgery to disabling seizure (Engel II-IV).

RESULTS

In this cohort, female was predominant (74%), the median age at surgery was 21 years (IQR 14-29), and the median disease duration was 8 years (IQR 5-13). Anterior temporal lobectomy was performed in 61%; hippocampal sclerosis was the most common pathology (61%). At 12-month follow-up, 71% achieved seizure freedom. Postoperative complications were uncommon: 13% experienced transient neurologic deficits, and 3.2% had wound infections. Cognitive outcomes varied by laterality: left-side resections showed declines in most domains, whereas right-side surgeries demonstrated improvement in several measures. Seizure-free patients maintained better QoL and neuropsychological performance across all domains (p<0.05) except for energy level and medication effects. Overall QoL and sum QoL scores rose from a mean of 6.4 to 9.1 (p<0.001) and 49 to 63 (p<0.001), respectively, with significantly greater gains among seizure-free individuals. Kaplan-Meier analysis showed estimated freedom from disabling seizures of 74% (95% CI 55.0-86.2%) at 3 and 6 months and 71% (95% CI 51.6-83.7%) at 12 months. Median seizure-free survival was not reached.

CONCLUSION

Epilepsy surgery was feasible in our resource-limited setting and was associated with encouraging short-term seizure and quality-of-life outcomes in carefully selected patients with MRI-visible, electroclinically concordant DRE who were able to complete presurgical evaluation. Larger multicentre studies with longer follow-up are needed to determine the durability and generalizability of these findings.