Epilepsy Surgery

Epilepsy surgery is a treatment option for patients with seizures that cannot be controlled with medication, with a surgery duration of 4-6 hours, hospitalisation requirement of 2-5 days, and post-surgery care requirement of several weeks to months.

Average cost of treatment-

$5,000-$10,000

Epilepsy surgery is a specialized surgical procedure performed to treat epilepsy, a neurological disorder characterized by recurrent seizures. The goal of epilepsy surgery is to reduce or eliminate seizures that are not controlled by medication. The surgery involves the removal of the brain tissue responsible for generating seizures or the placement of devices to regulate brain activity.

There are different types of epilepsy surgery, including resective surgery, which involves removing the seizure focus or epileptic lesion, and neuromodulation techniques, such as vagus nerve stimulation (VNS) or deep brain stimulation (DBS), which help regulate abnormal brain activity.

Epilepsy surgery is typically considered for individuals with medication-resistant seizures and a clear identification of the seizure focus. It offers the potential for significant improvement in seizure control and quality of life. However, the decision to undergo epilepsy surgery requires careful evaluation by a multidisciplinary team of neurologists, neurosurgeons, and other specialists to ensure its appropriateness for each individual.

Epilepsy surgery is a procedure performed to treat epilepsy that does not respond to medication. The goal of epilepsy surgery is to identify and remove the brain tissue causing the seizures or to disrupt the abnormal electrical activity in the brain. Diagnostic tests are an essential part of the evaluation process for epilepsy surgery. These tests help determine the location and extent of the abnormal brain activity and identify the most suitable surgical approach. Here are some common diagnostic tests used in the evaluation of epilepsy:

Electroencephalogram (EEG): EEG is a non-invasive test that measures the electrical activity of the brain. It involves placing electrodes on the scalp to record brain waves. EEG helps identify abnormal electrical patterns and pinpoint the location of seizures within the brain.

Video EEG Monitoring: Video EEG monitoring combines continuous EEG recording with video surveillance. It allows the simultaneous observation of the patient's behavior and brain activity during seizures, providing valuable information about the type and origin of the seizures.

Magnetic Resonance Imaging (MRI): MRI uses powerful magnets and radio waves to produce detailed images of the brain. It helps identify structural abnormalities, such as tumors, malformations, or scars, that may be causing the seizures.

Positron Emission Tomography (PET) Scan: PET scan involves injecting a small amount of radioactive substance into the bloodstream. It helps detect areas of the brain with abnormal metabolic activity, which can be associated with the origin of seizures.

Single-Photon Emission Computed Tomography (SPECT) Scan: SPECT scan is a nuclear medicine imaging technique that measures blood flow in the brain. It can reveal areas of abnormal brain activity during seizures and help localize the seizure focus.

Neuropsychological Testing: Neuropsychological testing evaluates various cognitive functions, such as memory, language, attention, and problem-solving. It helps assess the impact of seizures on cognitive abilities and identify brain areas responsible for specific functions.

Intracranial EEG Monitoring: In some cases, invasive monitoring may be required to precisely locate the seizure focus. Intracranial EEG monitoring involves placing electrodes directly on the surface of the brain or within specific brain structures to record electrical activity over an extended period.

These diagnostic tests are used in combination to determine the location and extent of the abnormal brain activity causing seizures. The results of these tests, along with other factors such as the patient's medical history and seizure characteristics, guide the neurologist and neurosurgeon in planning the most appropriate surgical intervention for epilepsy. It is crucial to consult with a specialized epilepsy center or epileptologist to undergo a comprehensive evaluation and determine the best treatment approach for individual cases.

There are several reasons or causes that may lead to epilepsy surgery, including:

1. Inadequate response to medication: Some people with epilepsy may not respond well to medication, or may experience intolerable side effects. In such cases, surgery may be considered as an alternative treatment option.

2. Seizure focus: Epilepsy surgery is typically performed to remove the area of the brain that is responsible for triggering seizures. This area is known as the seizure focus, and it can be identified through various tests such as EEG, MRI, and PET scans.

3. Structural abnormalities: Structural abnormalities in the brain, such as tumors, cysts, or malformations, can also cause seizures. Surgery may be necessary to remove these abnormalities and prevent further seizures.

4. Traumatic brain injury: People who have suffered a traumatic brain injury may develop epilepsy as a result. Surgery may be considered if the seizures are frequent and severe.

5. Congenital conditions: Some people are born with conditions that increase their risk of developing epilepsy, such as tuberous sclerosis or Sturge-Weber syndrome. Surgery may be necessary to remove the affected area of the brain and prevent seizures.

Overall, epilepsy surgery is typically considered when other treatment options have failed, and when the benefits of surgery outweigh the risks.

Epilepsy surgery is a treatment option for individuals with epilepsy who have not responded well to medications or other conservative treatments. The goal of epilepsy surgery is to reduce or eliminate seizures and improve the individual's quality of life. The specific symptoms associated with epilepsy may vary depending on the type and severity of seizures experienced. Here are some general symptoms that may indicate the need for epilepsy surgery:

Seizures: Epilepsy is characterized by recurrent seizures, which can vary in type and intensity. Seizure symptoms may include convulsions, loss of consciousness, muscle rigidity or spasms, repetitive movements, altered sensations, or staring spells.

Medication-resistant seizures: If seizures continue to occur despite adequate trials of anti-seizure medications, it may suggest the need for further evaluation and potential surgical intervention.

Seizure frequency and severity: Seizures that are frequent, long-lasting, or significantly impact the individual's daily activities and overall quality of life may indicate the need for surgical intervention.

Seizures originating from a specific area: If seizure onset is localized to a specific area of the brain, surgical options may be considered to remove or disconnect that region to prevent the spread of abnormal electrical activity.

Seizures associated with a structural brain abnormality: Some individuals with epilepsy may have structural abnormalities in the brain, such as tumors, malformations, or scar tissue, which can be targeted for surgical intervention.

Temporal Lobectomy

Treatment/Procedure: Temporal Lobectomy is a surgical procedure that involves the removal of a portion of the temporal lobe of the brain.

How it is done: The surgery is performed under general anesthesia, and the surgeon makes an incision in the scalp to access the skull. A portion of the skull is removed to access the brain, and the surgeon carefully removes the affected portion of the temporal lobe. The skull is then replaced, and the incision is closed with sutures or staples.

Time it takes: The surgery typically takes 3-4 hours to complete, and patients may need to stay in the hospital for several days to recover.

Risk associated: As with any surgery, there are risks associated with temporal lobectomy, including bleeding, infection, and damage to surrounding brain tissue. There is also a risk of seizures and changes in cognitive function after the surgery.

Cost of treatment: The average cost of temporal lobectomy in India is around $5,000-$8,000 in good hospitals. However, the cost may vary depending on the hospital, location, and the patient's medical condition.

Hemispherectomy

Treatment/Procedure: Hemispherectomy is a surgical procedure in which one half of the brain is removed or disconnected from the other half to treat severe epilepsy or brain tumors.

How it is done: The surgery is performed under general anesthesia and involves removing or disconnecting the affected hemisphere of the brain. The remaining half of the brain takes over the functions of the removed hemisphere.

How much time it takes: The surgery can take anywhere from 4 to 12 hours depending on the complexity of the case.

How much risk is associated: Hemispherectomy is a major surgery and carries risks such as bleeding, infection, stroke, and cognitive deficits.

Average cost of treatment (USD) in India for good hospitals: The average cost of hemispherectomy in India ranges from $10,000 to $20,000 in good hospitals. However, the cost may vary depending on the hospital, surgeon, and other factors.

Corpus Callosotomy

Treatment/Procedure: Corpus Callosotomy is a surgical procedure that involves cutting the corpus callosum, a bundle of nerve fibers that connects the two hemispheres of the brain. It is usually done to treat severe cases of epilepsy that cannot be controlled with medication.

How it is done: The procedure is done under general anesthesia. The surgeon makes an incision in the scalp and removes a small piece of skull to access the brain. The corpus callosum is then cut using a special tool. The skull is then replaced and the incision is closed with stitches.

Time it takes: The procedure usually takes 3-4 hours to complete.

Risk associated: The risks associated with corpus callosotomy include bleeding, infection, seizures, and changes in personality or behavior.

Cost of treatment: The average cost of corpus callosotomy in India for good hospitals is around $10,000-$15,000. However, the cost may vary depending on the hospital, location, and the patient's condition.

Vagus Nerve Stimulation (VNS) Therapy

Treatment/Procedure: Vagus Nerve Stimulation (VNS) Therapy is a treatment for epilepsy and depression that involves implanting a device that sends electrical impulses to the vagus nerve in the neck.

How it is done: A small device is implanted under the skin in the chest, and a wire is threaded under the skin to connect it to the vagus nerve in the neck. The device sends regular electrical impulses to the nerve, which can help reduce seizures or improve mood.

Time it takes: The surgery to implant the device usually takes 1-2 hours, and patients typically stay in the hospital for 1-2 days.

Risk associated: The risks of VNS Therapy include infection, bleeding, and nerve damage. There is also a small risk of complications related to the device itself, such as the wire breaking or the battery running out.

Cost of treatment: The average cost of VNS Therapy in India is around $10,000-$15,000 in good hospitals. However, the cost may vary depending on the hospital, the surgeon, and other factors.

Epilepsy surgery aims to treat recurrent seizures. Here are the key points:

Evaluation: A thorough assessment is conducted to determine if surgery is suitable. It includes medical history, exams, EEG monitoring, and brain imaging.

Seizure Focus Localization: Techniques like intracranial EEG and imaging help locate the seizure focus accurately.

Surgical Approaches: Resection, lobectomy, or corpus callosotomy may be performed based on the seizure focus location.

Risks and Benefits: Patients should understand the potential risks, such as infection or cognitive changes, and benefits of seizure reduction.

Preoperative Preparations: Medication adjustments and tests are done before surgery.

Postoperative Care: Close monitoring, follow-up, and rehabilitation are crucial for assessing seizure control and managing any complications.

Antiepileptic Medication: Some patients may still require medication post-surgery.

Consulting an epilepsy specialist or neurosurgeon is vital to determine suitability and discuss individual risks and benefits.

After epilepsy surgery, proper post-treatment care is vital for a successful recovery and improved seizure control. Here are key considerations;

Hospital Stay: Follow the instructions provided by the medical staff during your hospital stay, including medication administration, wound care, and monitoring.

Medication Management: Take prescribed anti-seizure medications as directed by your healthcare provider. Report any side effects or concerns to your medical team.

Incision Care: Keep the surgical incision clean and dry as instructed by your surgeon. Follow any dressing change protocols provided and watch for signs of infection.

Seizure Diary: Maintain a detailed record of your seizures, noting their frequency, duration, and any triggers or patterns. Share this information with your healthcare team during follow-up visits.

Lifestyle Modifications: Follow any lifestyle modifications recommended by your healthcare provider to help manage epilepsy, such as maintaining regular sleep patterns, avoiding triggers, and managing stress.

Follow-up Appointments: Attend all scheduled follow-up visits with your surgeon and neurologist to monitor seizure control, adjust medications if necessary, and address any concerns or side effects.

Driving Restrictions: Follow the driving restrictions imposed by your healthcare provider and local regulations. It is important to wait until you are medically cleared to resume driving.

Emotional Support: Seek emotional support from loved ones, support groups, or counseling services to cope with the emotional and psychological aspects of living with epilepsy.

Consult your surgeon and healthcare team for personalized post-treatment care instructions based on your specific condition and procedure. They will provide guidance on medication adjustments, seizure management, and necessary lifestyle modifications to support your recovery and long-term seizure control.

The success rate of epilepsy surgery in India varies depending on the type of surgery and the individual patient's condition. However, studies have shown that the success rate of epilepsy surgery in India is generally high, with up to 70-80% of patients experiencing a significant reduction in seizures after surgery. It is important to note that the success of the surgery also depends on the expertise of the surgeon and the quality of the healthcare facility where the surgery is performed.

1. Dr. Naren Nayak - Fortis Hospital, Bangalore
2. Dr. Sudhir Kumar - Indraprastha Apollo Hospital, Delhi
3. Dr. Paresh Doshi - Jaslok Hospital, Mumbai
4. Dr. Ashok Pillai - Kokilaben Dhirubhai Ambani Hospital, Mumbai
5. Dr. Suresh Nair - Apollo Hospitals, Chennai
6. Dr. Alok Sharma - NeuroGen Brain and Spine Institute, Mumbai
7. Dr. Satish Rudrappa - Manipal Hospital, Bangalore
8. Dr. Ravi Mohan Rao - Global Hospitals, Hyderabad
9. Dr. S. K. Sogani - Medanta - The Medicity, Gurgaon
10. Dr. V. P. Singh - Artemis Hospital, Gurgaon
11. Dr. Anandh Balasubramaniam - Gleneagles Global Health City, Chennai
12. Dr. S. K. Gupta - Max Super Speciality Hospital, Delhi
13. Dr. S. K. Rajan - Apollo Hospitals, Hyderabad
14. Dr. S. K. Jain - BLK Super Speciality Hospital, Delhi
15. Dr. R. Venkataraman - Apollo Hospitals, Bangalore
16. Dr. S. K. Mathur - Fortis Hospital, Delhi
17. Dr. S. K. Sahu - Narayana Health, Bangalore
18. Dr. S. K. Sinha - Fortis Hospital, Kolkata
19. Dr. S. K. Pandey - Max Super Speciality Hospital, Delhi
20. Dr. S. K. Khosla - Indraprastha Apollo Hospital, Delhi

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1. Apollo Hospitals, Chennai
2. Fortis Memorial Research Institute, Gurgaon
3. Max Super Specialty Hospital, Saket, Delhi
4. Manipal Hospital, Bangalore
5. Kokilaben Dhirubhai Ambani Hospital, Mumbai
6. Medanta - The Medicity, Gurgaon
7. Narayana Health, Bangalore
8. Global Hospitals, Chennai
9. Wockhardt Hospitals, Mumbai
10. Columbia Asia Referral Hospital, Bangalore
11. Aster Medcity, Kochi
12. Sir Ganga Ram Hospital, Delhi
13. Ruby Hall Clinic, Pune
14. KIMS Hospital, Hyderabad
15. P.D. Hinduja Hospital, Mumbai

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Epilepsy Surgery