1. International collaboration on epilepsy surgery in Tunisia - a model for the future

2. Introduction  Epilepsy is a frequent neurological disorder  Medication does not always work If seizures> 2 years and 2 drug trials then the chance of long term control of epilepsy with medication is ~10%  Epilepsy have an adverse impact upon Work Education Driving Mariage Life expectancy

3. Introduction  Epilepsy surgery : effective treatment for medically refractory seizures.  60–80% of patients with temporal epilepsy become seizure free after resective surgery  This technique, although effective, remains limited in developing countries, creating a significant ‘‘surgical treatment gap’’

4. Presurgical evaluation of epilepsy  Identification of candidates eligible for surgery : crucial step before surgery  Established at the Neurological Department of Charles Nicolle Hospital (Tunis)  Includes : detailed history, neurological exam, brain MRI, scalp video-EEG monitoring and neuropsychological tests

5. Video-EEG Monitoring Seizure focus Continuous EEG recording with simultaneous video recording of the patient clinical manifestations Objective: localization seizure origin and propagation Requires technical and medical competencies

6. Contribution of EUMEDCONNECT

7. EUMEDCONNECT network project Length of video-EEG Combination of Video and EEG  large files causing problems in data transfer Using in real time the high speed NECT backbone network, a rapid access transfer of the video-EEG recordings from Tunis to France was performed

8. Video-EEG recordings were then discussed between the two Neurophysiological teams. In cases of concordance of clinical, neuropsychological, neuroimaging data and video-EEG recording, the surgery indication was then considered