Advanced Epilepsy Treatment Options in India - Epilepsy Surgery in India

Epilepsy Surgery

Epilepsy is a brain disorder in which a person has repeated seizures (convulsions) over time. Seizures are episodes of disturbed brain activity that cause changes in attention or behavior. Epilepsy is a common chronic neurological disorder characterized by seizures. These seizures are transient signs and/or symptoms of abnormal, excessive or hypersynchronous neuronal activity in the brain. About 50 million people worldwide have epilepsy, and nearly two out of every three new cases are discovered in developing countries. Epilepsy becomes more common as people age. Onset of new cases occur most frequently in infants and the elderly. As a consequence of brain surgery, epileptic seizures may occur in recovering patients.

Epilepsy is usually controlled, but not cured, with medication. However, over 30% of people with epilepsy do not have seizure control even with the best available medications. Surgery may be considered in difficult cases. Not all epilepsy syndromes are lifelong – some forms are confined to particular stages of childhood. Epilepsy should not be understood as a single disorder, but rather as syndromic with vastly divergent symptoms but all involving episodic abnormal electrical activity in the brain.

Why is Epilepsy surgery required?

Epilepsy surgery has proven to be successful in reducing and even eliminating seizures in patients who did not respond well to the epilepsy medications. It is important to get the treatment for epilepsy, repeated seizures may result in:

• Irreparable Brain damage from repeated seizures
• Sudden death, a rare complication
• Injuries from falling / driving during various activities

Candidates for Epilepsy Surgery

It is very important that right candidates be chosen for the best results of the surgery. You are a good candidate for epilepsy surgery if:

• You have tried at least two anti-epileptic drugs (AEDs), and they have not stopped, or greatly reduced the number of seizures.
• There must be a specific cause for your epilepsy that can be removed with surgery, without harming your brain or you in any other way.
• Your surgeon must weigh the pros and cons and is confident that you would have a better quality of life after the surgery than without it.

Advanced EpilepsyTreatment Options in India

Till the time a person develops a second seizure, treatment for epilepsy will not begin. This is due to the reason that a person may have one seizure and never develops a second seizure. Medicines are successful in treating epilepsy. These medicines do not cure epilepsy, they prevent recurring of the seizures. These medicines changes the chemical or electrical transmissions in the brain in a particle way that decreases the chance of a seizure.

Vagus Nerve Stimulation (VNS) :

VNS therapy is recommended when medicines are unable to control epilepsy. During the surgical procedure, an electrical device is implanted underneath the skin. The lead of this device is wrapped around one of the nerves on the neck’s left side. This nerve is called as vagus nerve. This device continuously passes an electric dose to the nerve in order to stimulate it. This process reduces the severity and frequency of the seizures. If a person is feeling a warning seizure symptom then extra stimulation is given for preventing recurrence of the seizure.

Ketogenic Diet :  This is also considered as one of the treatment for epilepsy. Ketogenic diet is recommended for children as it involves eating a diet which is low in proteins and carbohydrates and high in fats. The chemical balance of the brain can be altered that also reduces the chance of having seizures. Ketogenic diet is not meant for adults as the diet can result in any other serious medical condition like heart disease, high blood pressure or strokes.

Advanced Surgical Procedures for Management of Epilepsy

Depending on the particular clinical situation, one of the following surgical procedures is chosen by the Medical team at our affiliate hospital. These operations either aim to resect the disease area of the brain, to disconnect it from other areas so as to relieve the seizures, or to lessen their impact.

• Anteromedial Temporal Lobectomy
• Selective Amygdalohippocampectomy
• Electrocorticography guided Resections
• Multiple Subpial transections
• Quadrantic Resections
• Multilobar Resections
• Functional Hemispherotomy
• Vagal Nerve stimulation
• Radiosurgery (selected cases)

Epilepsy Surgery inIndia

Epilepsy is one of the most common neurologic diseases, present in about 4% of the world's population. The disease can be well controlled with medications alone, but many patients do not respond well to the epileptic medications and thus need surgery to control seizures.Epilepsy surgery is advised to people who have tried at least two epilepsy drugs without success and have seizures originating on the same place of the brain.

Epilepsy surgery removes or isolates the area of brain where seizures originate. If it is an area of the brain which cannot be removed, the surgeon makes incisions to prevent seizures from spreading to other parts of the brain.

Best Stroke Treatment Hospital in India

Stroke Recovery Treatment in India

What is Stroke?

Stroke refers to a brain disease caused by either blockage of blood supply or rupture of a blood vessel to a particular part of the brain. This results in reduction of blood and oxygen supply to the affected part of brain resulting in loss of function

A Stroke can be categorized into two types:

• Hemorrhagic Strokes: This type of stroke occurs when a blood vessel bleeds and burst within the brain. This accumulated blood compresses the nearby tissues of the brain. This could be due to:
  
  • A blood vessel on the brain surface starts bleeding in between the area of the skull and the brain.
  • A blood vessel bleeding or bursting inside the brain
  • Hemorrhagic strokes has two main types:
    
    • Subarachnoid hemorrhage: In this, there is bleeding in between the area of the brain and the thin tissues covering the brain.
    • Intracerebral hemorrhage: This is considered as the most common type of hemorrhagic strokes. This occurs when an artery bursts inside the brain and resulting in the flooding of the nearby blood tissues.
• Ischemic Stroke: This occurs when something is causing blockage in an artery which is carrying blood to the brain. The potential causes are:
  
  • When there is a blockage in the small blood vessels within the brain
  • When a blood clot develops in the main artery to the brain
  • When an air bubble, a blood clot or fat globule develops in a blood vessel which is carried to the brain.
  • There are two common types of Ischemic stroke:
    
    • Embolic Stroke: This stroke occurs when other debris or a blood clot develops away from the brain. This mostly happens in the heart and is swept from the bloodstream into the narrow brain arteries. This kind of blood clot is known as an embolus.
    • Thrombotic Stroke: This occurs when thrombus (a blood clot) develops in one of the arteries which supply blood to the brain. This clot may be due to the accumulation of plague (fatty deposits) in the arteries that causes decreased blood flow.

When there is temporary blockage in the blood supply to the brain and there is a feeling of stroke for a little time. This entire process is termed as mini stroke or a transient ischaemic attack (TIA). A mini stroke is an indication that a part of the brain is not getting sufficient blood and this can result into a severe stroke in the future.

Causes

Some of the causes that can lead to a stroke are as follows:

• Ageing
• High blood pressure
• Diabetes
• Cardiovascular diseases
• High cholesterol
• Obesity
• Vitamin B12 deficiency
• Excessive alcohol and drug abuse

Symptoms

Symptoms of a stroke occur suddenly. Symptoms vary depending on the location of the stroke. Each area of the brain is supplied by specific arteries. If an artery supplying the area of the brain that controls the left arm movements is blocked, that arm becomes weak or paralyzed.

The five most common signs and symptoms of stroke are:

• Sudden numbness or weakness of the face, arm, or leg - like weakness of half of the body called as hemiplegia.
• Sudden confusion or trouble speaking or understanding others called aphasia in medical terms.
• Sudden trouble seeing in one or both eyes called as mono or binocular vision disturbance. This could be due a stroke anywhere in the visual pathway.
• Sudden dizziness, trouble walking, or loss of balance or coordination, this is commonly due to posterior circulation strokes.
• Sudden severe headache with no known cause is due to hemorrhage or sometimes infarction.

Diagnosis

The diagnosis is based on the symptoms and a good history given by the patient or an observer. Usually any neurologic symptom occurring suddenly in a neurovascular territory is attributed to a stroke. CT scan done immediately after a stroke is almost always normal in ischemic strokes. MRI with diffusion images is sensitive to diagnose acute infarction.

Treatment of a Stroke

The treatment for both hemorrhagic and ischemic stroke is different.

The purpose of treating ischemic stroke is to restore the flow of the blood in the brain. Medications are given in the first four and a half hours of the stroke for destroying the clots in the blood vessels. An injection of tissue plasminogen (TPA) can also be given to a patient for improving the probability of a full recovery.

The main purpose of treating a hemorrhagic stroke is to stop bleeding and decrease the pressure on the brain. Instead of blood thinners, clotting drugs can be given. After the area has been healed and the bleeding is controlled, the damaged and leaky blood vessels are then repaired.

The first stroke device approved by FDA is Merci retriever. The aim of this device is to restore the flow of the blood in the neurovasculature by removing thrombus in those patients who have ischemic stroke.

The penumbra system (endovascular thromboaspiration) is the last FDA approved device that has been primarily developed for removing a clot in the case of acute ischemic stroke. In order to eliminate or reduce the clot burden, this system uses dual approaches to clot extraction by using debulking and aspiration of the thrombus. Clot retrieval is then used where a ring device holds the thrombus by capturing it in clasps with a cylinder. This is then withdrawn at the time of flow arrest. This new aspiration device (the penumbra system) has an excellent safety profile and a high rate of ‘target vessel’ recanalization. 

 

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