Epilepsy is considered to be a group of neurological disorders, which are characterized by epileptic seizures. Episodes or epileptic seizures do vary from slight or brief episode to long periods that may be undetectable and could be of vigorous shaking.
The seizures are usually recurred usually do not have immediate underlying causes. The causes of the epilepsy are usually unknown, though some of the epilepsy can be caused from,
- Brain tumor
- Brain injury
- Drug misuse
- Alcohol misuse
- To some extent genetic mutations
Whatever may be the cause, epileptic seizures are happened from the abnormal and excessive activity of cortical nerve cell, present in the brain.
Diagnosis of Epilepsy
Diagnosis is usually done, by ruling out some conditions that could cause the symptoms like syncope. Other diagnosis procedures involve the situation of electrolyte problems or alcohol withdrawal problems and done by blood tests and imaging of the brain.
For the epilepsy surgery, the candidate has to go through pre-surgical evaluation.
- Establishing the complete epileptic seizure diagnosis
- Defining the exact kind of epilepsy
- Defining the particular area of the brain that cause the seizures
- Evaluation of the abnormal area, if present, with special MRI
- Ideal surgical candidates are to be selected with appropriate correlation
- Ensure that the result of the surgery will not lead to disable the neuropsychological deficits, ensuring to carry to dedicated epilepsy center
So the pre-surgical evaluation usually involves video ECG monitory, PET/SPECT for neuropsychological evaluation and psychiatric evaluation, and MRI brain. After these tests are done, a detailed discussion is happened at the conference, among the team of multidisciplinary patient management. The team should include neuro-radiologist, epileptologist, neurosurgeon and neuro-psychiatrist, etc.
Treatment of Epilepsy
Some of the seizures can be controlled with the help of medication and some of them need the surgery. Other treatments can be medication, dietary changes or neurostimulation. When the epilepsy is treated, the problem could be completely treated, without prolonging in the life.
The patients, who have not recurred of about 5 to 10% from the anti-epileptic drug combination are categorized as the patients having intractable epilepsy or refractory epilepsy. Such patients have the need of special evaluation and special treatment that is more than medical management.
Epilepsy surgery is the brain surgery. During the surgery, a small part in the brain that causes the epilepsy to be uncontrollable is safely removed, by ensuring that there is no harm to the brain.
Advanced Epilepsy Surgical Procedure
There are multiple advanced epilepsy surgical procedures, available and the selection of appropriate procedure depends on the specific clinical situation. These surgical procedures are performed either to resect the disease area of the brain or disconnect the affected area from the brain, to lessen the impact or relieve from the seizures.
The different surgical procedures are,
- Selective Amygdalohippocampectomy
- Quadrantic Resections
- Anteromedical Temporal Lobectomy
- Multiple Subpial Transections
- Electrocorticography Guided Resections
- Vagal Nerve Stimulations
- Multilobar Resections
- Functional Hemispherotomy
Selection of Cases
When the cases and the candidates are carefully selected for intractable epilepsy, there can be gratifying outcomes found in most of the cases. There are two key points considered and followed to select the cases. These are,
- Epileptogenic zone concordant demonstration found from all the performed specialized investigations, like PET / SPECT scan, 3T MRI, clinical evaluation, videoEEG and neuropsychological assessment. When all of these tests show the outcome that same area or same point from the brain is causing the fits.
- Another case to consider is the area of the origin of the fits consideration, whether this origin can be operated safely without any result of deficit. Such decisions are taken only by the qualified and experienced surgeon.
When the two above conditions are met, the patient is considered for the advanced epilepsy surgery. Then the patient is given counseling.
Cost of Advanced Epilepsy Surgery
The above Package Cost is a tentative Approximate Package Estimate, which includes initial investigations & specialists screening, stay in a Private Room wherein patient’s assistant or relative can also stay with patient, doctor / surgeon fee, nursing care, medicines & consumables, Airport Pick-Up & Drop.
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