November 17, 2021
Epilepsy is a condition of the brain causing seizures. In lay man's terms a seizure is a sudden, uncontrolled electrical disturbance in the brain. It can cause changes in behavior, movements or feelings, and in levels of consciousness. The causes of epilepsy can be several. Neonatal brain injury, infantile febrile seizures, brain tumors, traumatic brain injury and stroke are few to name. It is estimated that there are more than 1.2 crore persons with epilepsy in India. In India the gap in epilepsy treatment ranges from 22% among urban, middle-income people to 90% in villages.
The treatment of epilepsy is predominantly medical with medicines called anti-epileptic medications. They alter the electrical conduction in the brain and help reduce the occurrence of seizures. However, about 20-30% of persons developing epilepsy continue to exhibit chronic recurrent seizures despite optimal treatment with AEDs.
When this is uncontrolled it is termed drug resistance or intractable epilepsy. The occurrence of two or more seizures per month for a period of more than 2 years despite using two or more medicines in maximum tolerated dose. These patients suffer both social and personal isolation as they live in constant fear of experiencing a seizure. They also face economic hardships as they are unable to work and care for their family. Unfortunately, the patients or their family are unaware of specialized treatment that can be provided to treat medically refractory or drug resistant epilepsy.
In India with over 1.2 billion people, we have over 1 million people with such kind of medically refractory epilepsy, of which one half are potential surgical candidates. In India with over 500,000 potential epilepsy surgery candidates, not more than 200 epilepsy surgeries per year are being undertaken today. This is because the decision making for epilepsy surgery needs a multidisciplinary approach in which different investigators involved with the program work in conjunction to create an integrated picture of epileptogenesis and its impact on the patient and care givers. Knowing when not to operate, because of the need for further investigations is as important as selecting which patient may benefit from surgery in a resource-limited setting.
The Department of Neurosurgery and Neurology at Kasturba Hospital, Manipal has established a comprehensive epilepsy center under the guidance of Prof K Radhakrishnan, an epileptologist of international repute. We have advanced imaging tools such as MRI, SPECT, positron emission tomography (PET) as well as a multidisciplinary team of neurologists, neurosurgeons, neuroradiologists, electrophysiologists, psychologists, psychiatrists, and medical social workers. Our Video EEG lab can simultaneously record continuous brain activity, electroencephalogram (EEG) of 3 patients which is very essential in surgical planning. State-of-the-art Neurosurgical theater with laminar flow and the latest Medtronic Stealth Neuronavigation systems make surgery extremely safe and pain-free. We have successfully performed over 30 epilepsy surgeries with excellent results comparable to international centers.
For more details or to make an appointment call 0820-2923093.
Frequent Questions about epilepsy surgery:
1. Who is a good candidate for Epilepsy surgery?
A person who has uncontrolled seizures or two or more anti-epileptic medications can be considered for epilepsy surgery. These patients are known to have medically treatment resistant epilepsy. Young patients have better outcomes when operated earlier.
2. What tests will be required before surgery is considered?
EEG is the basic test that will determine if a patient continues to have seizures. A video EEG will then be performed to continuously monitor brain activity over 24-48 hours (about 2 days) and to video record the seizure. In addition to this an MRI scan will be required to determine if surgery is indicated. Sometimes we might have to perform additional tests like SPECT / PET to exactly determine what type of surgery should be performed.
3. When and Why SHOULD surgery be considered an option to treat epilepsy?
When patients with drug resistant epilepsy are operated 70% stop having seizures or have less frequent seizures. In the same group adding a third medication rather than surgery, only one to three percent will become seizure free. This means surgery is more effective than trying another medication for controlling seizures. People who have surgery report their quality of life improves because seizures are less frequent or have stopped. They can do more both physically and mentally after they have recovered from surgery. Unfortunately, many people or their health care providers do not realize that a patient may be able to have epilepsy surgery and do well. Reports suggest that a delay of up to 20 years can occur before someone is referred for epilepsy surgery. Therefore, it is particularly important to be aware that surgery can tremendously benefit patients who have drug resistant epilepsy.
4. What are the advantages of having surgery for epilepsy?
When a patient has epilepsy, every instance the patient has a seizure there is some damage that occurs to the brain. Over time this damage is compounded and causes permanent brain damage. Surgery can help decrease this risk of permanent brain damage. Seizure freedom also improves the social and personal lifestyle of epilepsy patients who are usually isolated due to the constant threat of experiencing seizure. Financially epilepsy medications can be expensive costing over Rs 5,000 a month. Epilepsy surgery can significantly reduce these costs over a period of 1-2 years.
5. HOW CAN I TALK WITH MY DOCTOR ABOUT REACHING A TREATMENT DECISION?
• Call us on 0820-2923093 to make an appointment.
• Discuss any concerns about surgery with your family, friends, and health care team including any after surgery follow-up care and what recovery to expect.
• Decide if you need more information to make the decision.
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