Epileptic surgery a first in Indonesia

Epileptic surgery a first in Indonesia

By Bengawan

SEMARANG (JP): The parents were ecstatic when their second
child, Maria, was born 34 years ago. She looked just like other
healthy babies. They had no inkling that Maria would be afflicted
with epilepsy.

"When she was about one year old, Maria started having
frequent spasms, at least four times a month. A medical checkup
found that she had epilepsy," her sister Lee Hwa said at
Telogorejo Hospital in Semarang last Sunday.

Despite the epilepsy, Maria graduated from Dharma Putra high
school in her hometown of Salatiga in Central Java. She did not
pursue a higher education, instead helping out at the family's
bakery.

Lee Hwa said her sister was examined at a Bangkok hospital 10
years ago, and three years ago she was examined in Singapore. But
there was no improvement in her condition.

"In March 1999, Maria sought treatment with neurosurgeon Dr.
Zainal Muttaqin at Telogorejo Hospital. He suggested an
operation," Lee Hwa said.

A preoperation examination with a video electroencephalograph
(EEG) and magnetic resonance imaging (MRI) showed a stain on one
of the nerves in the left side of the brain. "The stain will be
removed by the operation," said Lee Hwa.

The operation was successfully carried out last Sunday thanks
to the cooperation between the Association of Neurosurgeons and
the Association of Neurologists in Semarang. In fact, it was the
first operation of its kind in Indonesia.

"In Europe such operations were being performed 10 years ago,"
Dr. Zainal said. "Indonesia has only 56 neurosurgeons and they
are overworked. Besides, they are not evenly distributed
throughout Indonesia. However, I hope this operation will spread
information on epilepsy to all the neurosurgeons here," he said.

The operation on Maria was indeed an educational forum for 15
prospective neurosurgeons from Jakarta, Bandung and Surabaya.
Professor Kazunori Arita of Hiroshima University in Japan, Dr.
Zainal Muttaqin's mentor, came to Semarang to lead the operation,
which began at 3 p.m. and lasted some four hours.

A workshop on epilepsy surgery was held at the hospital before
the operation. Dr. R.B. Wirawan, a neurologist at Diponegoro
University's School of Medicine in Semarang, said epilepsy was
not a hereditary disease.

"Possibly only 8 percent of epilepsy cases are hereditary," he
said.

According to Dr. Wirawan, there are several types of epilepsy,
a disorder which causes the patient to lose consciousness,
experience spasms, bleeding from the mouth, incontinence and
comma. Some patients might suffer confusion and frequently drop
objects. Other patients might exhibit strange behavior, babble or
run around. Hallucinations can also occur.

Dr. Zainal said epileptics' intellect was hampered as a result
of the disorder. "Epilepsy disturbs the working of the nerves in
the brain. Each spasm will add to the number of damaged brain
cells and disturb the brain's function."

If the patient often suffers convulsions, their intellect will
be seriously impaired and they may be committed to a mental
hospital, he said.

Dr. Zainal said, however, epilepsy could be effectively
treated, adding that treatment can be considered a failure if
standard antiepilepsy drugs have been given individually or in
combination for two years and convulsions still occur or drug
toxicity takes place. Seventy percent of epilepsy cases can be
overcome by drugs; the remainder can only be cured by an
operation, he said.

Dr. Zainal said the operation removed brain tissue which had
been damaged by continual convulsions. After the operation, the
patient is not entirely cured and will continue to receive
antiepilepsy drugs for six more months. The dosage is gradually
reduced over a period of three years. "In that period it will be
known whether the patient is cured of epilepsy. Medication will
only be completely stopped after three years if the patient is
declared cured."

When asked about the cost of the operation, Dr. Zainal said it
was not prohibitive. "It does not cost much. It is nearly the
same as other neurosurgeries, including brain operations
necessitated by accidents. The cost for third-class patients is
about Rp 3 million for drugs, the operating room and the doctors.
First-class patients pay twice or three times as much."

The MRI costs Rp 1 million and can only be taken in Jakarta
and Surabaya. The EEG is only Rp 10,000.

Maria spends Rp 1.2 million a month on drugs. Before the
monetary crisis the drugs cost Rp 400,000.

Data presented by Dr. Zainal showed that generally 50 to 60
people from a population of 100,000, or 0.05 percent, suffered
from epilepsy. Of that number, 20 percent to 40 percent cannot be
cured by standard antiepilepsy drugs. The United States has
150,000 new cases of epilepsy every year and two thousand to five
thousand of these patients must be operated on to cure their
epilepsy. Statistically, there must be a large number of epilepsy
cases in Indonesia, with a population of more than 200 million.