2015 AESC Lecture

Epilepsy surgery care in Taiwan

Taiwan is an island with a population of 24 million. Over 95% have been covered by National Health Insurance. The ageadjusted prevalence was 5.85 per 1000, and incidence was 97 per 100,000 person-years. Taiwan may be divided in 4 regions geographically, namely north, central, south and east. There were excessive epilepsy patients in east Taiwan, predominantly in the young and middle aged group.

The total expense for epilepsy treatment was NT 1.6 billion ($ 52 millions). OPD visit was 8.4/year per patient with expense of NT 2159 ($ 72) per OPD. The anti-epileptic drug (AED) expensewas NT 900 millions in year 2007, and increased up to 2 billion in year 2009. AED expensed was NT 1145 ($35) per OPD, about 53% of OPD expense.

Epilepsy surgery program was started by Professor His YS in 1987, followed by Professor Chang CN in 1988. Until now, there are only 5 epilepsy surgery programs among 19 medical centers in Taiwan, Taipei Veteran General Hospital (both adult and pediatric), Chang Gung Memorial Hospital, Tzu-Chi General Hospital and Taichung Veterans General Hospital (mainly VNS).

The epilepsy surgery includes awake craniotomy, intraoperative cortical functional mapping, epilepsy with lesion, Temporal lobe epilepsy, Frontal lobe epilepsy, implantation of subdural grid and strip, depth electrodes, foramen ovale electrodes, Callosotomy, Multiple sub-pial trans-section, vagus nerve stimulation, deep brain stimulation and cortical stimulation.

In the past ten years, about 50–60 cases of epilepsy surgery were done annually in Taiwan. As compared to the other developing or developed countries, it is slightly under performed after such a long history of over 20 year’s development. There is still a tremendous space for us to continue more hardly.