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.