Access to Epilepsy Surgery in Latin America and the Caribbean: A Scoping Review
Arantxa Sanchez Boluarte1, Nathalie Zacarias2, Wagner Rios Garcia3, Fabiana Gibu2, Carolina Bonilla2, Niels Pacheco4, Sofia Sanchez Boluarte5, Jorge Burneo6
1University of Washington, 2Universidad Peruana Cayetano Heredia, 3NATIONAL UNIVERSITY SAN LUIS GONZAGA, 4Harvard University, 5Clinica Ricardo Palma, 6University of Western Ontario
Objective:
This scoping review examines the availability of epilepsy surgery, including institutional programs, across LAC.
Background:
Epilepsy is a major public health challenge in Latin America and the Caribbean (LAC). Although neurosurgical interventions such as resective surgery and neurostimulation benefit patients with refractory epilepsy, access to these treatments remains severely limited in resource-constrained settings. 
Design/Methods:

We conducted a comprehensive literature search across PubMed, Embase, SciELO, Global Index Medicus, Web of Science, and EBSCO, using terms related to epilepsy, neurosurgical interventions, and LAC. We used the Preferred Reporting Items for Systematic review and Meta-Analysis Protocols (PRISMA-P). Eligible studies addressed availability and access to neurosurgical procedures, institutional programs, or training opportunities for epilepsy surgery.

Results:

From 475 screened records, 49 studies were included, covering only 27% of the 33 LAC countries. These studies revealed significant inequities in access to epilepsy surgery across LAC. Of these, 75.5% were from South America, 12% from the Caribbean and Central America and 10% from Mexico. Lobectomies were the most commonly reported procedure (61% of studies), followed by lesionectomies (26.5%), amygdalohippocampectomies (26.5%) and callosotomies (22%). 14% studies from Argentina, Brazil, Peru, and Mexico, reported on patients who underwent vague nerve stimulation (VNS). Challenges included socio-economic and regional barriers to diagnosis and treatment, limited trained personnel, high surgical costs, and disparities between institutions due to limited technical equipment, especially outside major urban centers.

Conclusions:

Access to epilepsy surgery in LAC is hindered by geographic, institutional, and training-related barriers. Expanding specialized surgical centers and improving training opportunities in underserved areas are urgently needed. Regional collaboration could bridge gaps in care and ensure equitable access to epilepsy treatment.

10.1212/WNL.0000000000211428
Disclaimer: Abstracts were not reviewed by Neurology® and do not reflect the views of Neurology® editors or staff.