With the advancement of technology and boom of novel research ideas in the field of epilepsy, treatment is beaming with optimism

On National Epilepsy Day, Dr Siby Gopinath, Professor, Amrita Advanced Centre for Epilepsy, Amrita Hospitals, Kochi highlights the various aspects of the disease

Epilepsy is a neurological disorder that is characterised by seizures, unusual behavior, sensations and sometimes loss of consciousness. In India, nearly 60 lakh individuals suffer from epilepsy. Other than being a physical disease, epilepsy has a strong mental and social implication. This disease can have adverse affects on pregnant women and also causes learning disability in children. Also, there is a rise in the incidence of divorce among epilepsy patients. The unpredictability of the epileptic attack leaves the patients helpless and most of the time at the mercy of others. Moreover Sudden Unexpected Death of Epilepsy (SUDEP) is a reality accounting for 24 times the general population.

Epilepsy is usually treated with antiepileptic medication and the seizures get controlled in 70% of the patients. In 30 % of the patients, the epilepsy is drug resistant wherein the seizures continue in spite of the antiseizure drugs. 50 % of the drug refractory epilepsy patients become seizure free with surgical treatment. Here surgical resection of the ‘Epileptogenic Zone’, the brain circuits involved in the genesis of seizures’ will abolish the seizures. A variety of pre-surgical evaluations are carried out for the identification of the suspected brain regions which are epileptic, including but not limited to 1) electrographic (scalp Video EEG) and 256 channel High Density EEG, 2) imaging (MRI, PET, SPECT, ESI and MSI), etc. In cases, where MRI and EEG are inconclusive advanced technique of intracranial EEG (StereoEEG) was implemented at our center to handle the most difficult cases and increase our success rate of epilepsy surgery.

The AACE(Amrita Advanced Center for Epilepsy) is the first center in India to develop and actively practice the technique of Stereo-EEG. To date, the center has performed over 200+ invasively monitored epilepsy surgeries for the most difficult cases and about 750 epilepsy surgeries. This minimally invasive surgery involves precise insertion of fine electrodes into the brain to safely target and monitor electrical activity throughout the brain and carefully reveal the structures and networks that give rise to seizures. By this technique, we could localise the epileptic focus without performing an open brain surgery. Today, the procedure is performed robotically at our center and we are the first in the continent to start Robotic Assisted Stereo EEG. By implementing unique implantation protocols, our center has managed to cut the cost of this procedure by ~ 2/3 and even provide it completely free of cost to the needy in nearly 1/4 of patients requiring this.

Another advanced application of the stereotactic technique is the minimally invasive epilepsy surgery. It uses radio frequency to ablate the epileptic focus thereby avoiding open brain surgery. This advanced technique is used especially when the epileptic focus is adjacent to the functional brain area or in non lesional cases. Dr Siby Gopinath (Epileptologist) said, “We have pioneered this technique for epilepsy treatment and have the largest number in the country”.

One of our recent Stereo EEG studies published in high impact international journal: Frontiers in Neurology, highlighted the importance of using computational methods like Epileptogenicity rank (Parasuram et al, 2021) for quantification of epileptic focus for patient specific surgical planning.

Another very interesting study was on “Contralateral insular epileptogenic hub causing seizure relapse after opercular focal cortical dysplasia surgery and response to radiofrequency thermocoagulation” published in Journal of Neurosurgery, Jayapaul et al, 2021. These studies threw light into spatial organization and connectivity of epileptogenic network.

With the advancement of technology and boom of novel research ideas in the field of epilepsy, the treatment of epilepsy is beaming with optimism.