Pioneering Epilepsy Surgery in Cameroon: Outcomes from the First Prospective Cohort of Surgical Patients with Drug-Resistant Epilepsy

Background: Drug-resistant epilepsy (DRE) represents a public health burden that affects one-third of people with epilepsy and carries a high risk of premature death. Although surgical resection achieves seizure freedom in up to 70% of cases in high-income settings, access to epilepsy surgery in sub-Saharan Africa remains limited. Cameroon initiated an epilepsy surgery program seven years ago, but no prospective outcome data have been reported. Methods: We conducted a single-center, prospective observational cohort of 31 consecutive Cameroonian patients with DRE who underwent epilepsy surgery between January 2018 and March 2024. Collected data included sociodemographic and clinical characteristics, surgical and histopathological findings, postoperative complications, seizure outcomes (Engel classification), neuropsychological performance, and health-related quality of life (QoL) at baseline, 6 months, and 12 months postoperatively. Primary endpoints were seizure freedom (Engel I), cognitive change, and QoL improvement. Survival estimates were computed using Kaplan–Meier analysis and assessed time from surgery to disabling seizure. Results: In this cohort, female was predominant (74.2%), the median age at surgery was 21 years (IQR 14–29), and the median disease duration was 8 years (IQR 5–13). Complex partial seizures comprised 61.3% of cases. Anterior temporal lobectomy was performed in 61.3%; hippocampal sclerosis was the most common pathology (61.3%). At final follow-up, 71% achieved seizure freedom. Postoperative complications were uncommon: 12.9% experienced transient neurologic deficits, and 3.2% had wound infections. Cognitive outcomes varied by laterality: left-side resections showed declines in most domains, whereas right-side surgeries demonstrated improvement in several measures. Seizure-free patients maintained better QoL and neuropsychological performance across all domains (p < 0.05) except for energy level and medication effects. Overall QoL and sum QoL scores rose from a mean of 6.4 to 9.1 (p < 0.001) and 48.8 to 63.18 (p < 0.001), respectively, with significantly greater gains among seizure-free individuals. Mean estimated survival time was 270.4 days (95% CI 217.1–323.8); median survival was not reached. Conclusion: Epilepsy surgery in Cameroon is safe, effective, and yields outcomes comparable to global standards. The procedure significantly enhances seizure control and QoL, though cognitive effects vary by surgical site. These findings underscore the feasibility and importance of expanding surgical epilepsy care in resource-limited settings.