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| Now hope for epilepsy patients | | What Is Epilepsy? | | Dr. Aditya Gupta | 3/26/2012 12:59:45 AM |
| Epilepsy is a brain disorder in which clusters of nerve cells, or neurons, in the brain sometimes signal abnormally. Neurons normally generate electrochemical impulses that act on other neurons, glands, and muscles to produce human thoughts, feelings, and actions. In epilepsy, the normal pattern of neuronal activity becomes disturbed, causing strange sensations, emotions, and behavior, or sometimes convulsions, muscle spasm and loss of consciousness. During a seizure, neurons may fire as many as 500 times a second, much faster than normal. In some people, this happens only occasionally; for others, it may happen up to hundreds of times a day.
For patients with uncontrollable epilepsy, life is miserable. Repeated epileptic fits, large doses of 4 or 5 epilepsy medicines with frequent falls and injuries prevent any kind of meaningful existence. Add to that the social stigma, as well as the decline in brain functions over time. Many families are likely to give up caring for such people as time goes by.
It is estimated that 1% of all people will have a seizure once in the lifetime. Going by our population figures, this is a mind-boggling number. As per Sr. Consultant Neurosurgeon at Medanta the Medicity, Dr. Aditya Gupta, in last decade epilepsy has seen sea of chages in medical treatment with introduction of new drugs which has less side effects and less drug interactions for different types of epilepsy. Sophisticated diagnostic technologies has enabled exact location of epilepsy focus in brain.
Usually, 90% epilepsy patients will respond well to medicines alone. The remaining 10% are extremely disabled with what is called uncontrolled or refractory epilepsy. Now there is a new ray of hope for such patients. Surgery is emerging as an option that can radically improve the quality of life of such people.
Sadly though, the Indian population is not aware enough to seek this new treatment. Patients from other regions such as Middle East and Africa are turning to India for this new treatment. As per Dr. Aditya Gupta, Senior Neurosurgeon, Medanta Institute of Neurosciences; Medanta The Medicity is one of the few centres in the country to have a dedicated Epilepsy program that has the specialised Epilepsy Neurologist, paediatric Neurologists, Epilepsy neurosurgeon and neuropsychologist under one roof.
Case Example Zafar (name changed ), a 15 year old boy was having epilepsy since 3 years of age. With fits not controlled even after 4 medcines, his family sought further evaluation. He was evaluated at Medanta with special tests, including a special protocol 3 Tesla MRI, PET scan, video EEG among others. These tests showed an area in the medial part of left temporal lobe as abnormal and giving rise to epilepsy. Dr. Aditya Gupta, who is the Head of Epilepsy Surgery program at Medanta, performed a rare and complex surgery for this problem. Zafar has not had any attack of epilepsy in the last 8 months.
Fig1: Abnormal area in temporal lobe
Fig 2: Grids that are placed on brain surface
Intractable epilepsy requires special expertise, both human and advanced technologies to obtain good results. Video EEG records a video of the patient along with electrical activity from the brain, which is usually done for one or two days to understand pattern and focal predominance. This allows the neurologist to define the likely area of the brain affected. A special high-quality MRI helps in picking up very minor anomalies which could potentially be causes of the uncontrolled epilepsy. The recent availability of 3 Tesla scanners has revolutionized this. A PET or SPECT scan shows brain function and helps to identify the likely areas of origin of the epileptic fits. A neuropsychological assessment is done to evaluate minor degrees of disturbances in brain function which can only be picked up by special batteries of tests. Once all these tests are done and show that the same area of brain is implicated across all these tests, surgery can generally be carried out with a very good chance of success.
Dr Aditya Gupta, Head- Epilepsy Surgery says that all patients do not require surgery. Surgery is only advised for uncontrolled (intractable) epilepsy if multiple investigations point towards the same area of the brain as being responsible for Epilepsy.
Epilepsy is not a rare condition, for which increased awareness is needed at every level. Sadly, Epilepsy patients are still not . It is very important to realize that we should not give up on patients who have this disabling disease, more so when scientific advances have opened up newer avenues for treating patients who do not respond to medicines.
(The article is provided By Dr. Aditya Gupta head radio Surgery at Medanta Institute of Neurosciences, Medanta -"The Medicity " Gurgaon Haryana , under Community Outreach Programme) |
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