ANS : Advanced Neurology & Epilepsy Solution
Dr. Zubin Shah is a highly skilled and compassionate neurologist specializing in epilepsy. His expertise and patient-centered approach make a real difference.
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Epilepsy — also known as a seizure disorder — is a brain condition that causes recurring seizures.
It is estimated that there are more than 10 million persons with epilepsy (PWE) in India. Its prevalence is about 1% in our population.
Seizure symptoms vary depending on the type of seizure. Because epilepsy is caused by certain activity in the brain, seizures can affect any brain process. Seizure symptoms may include:
Some people with focal seizures have warning signs in the moments before a seizure begins. These warning signs are known as aura.
These are some warning signs
Seizures are classified as either focal or generalized, based on how and where the brain activity causing the seizure begins. When seizures appear to result from activity in just one area of the brain, they're called focal seizures. Seizures that appear to involve all areas of the brain are called generalized seizures.
Seek immediate medical help if any of the following occurs with a seizure:
Having a single seizure doesn't mean you have epilepsy. Hence most of the times you don’t require any treatment. Anti-seizure medications (ASM) is standard modality of treatment once diagnosis of epilepsy is confirmed by experienced neurologist/physicians. However, if seizures don’t respond to antiepileptic medications they should be evaluated and surgical option is given. If surgery does not appear to be feasible option after evaluation palliative procedures should be considered.
Drug-resistant epilepsy (DRE) is defined as failure to achieve seizure freedom despite adequate trials of two appropriately chosen and well-tolerated antiseizure medications (ASM). Around 30% of people with epilepsy have drug-resistant epilepsy. After the failure of first two antiseizure medications chances of the success rate of medical management is low (12.5 to 22%). Hence surgical option should be considered in patients with drug resistant epilepsy.
If your seizures are controlled by one or two medications, there is no need for surgery. However, if you have to take two or more than two medications and you continue to have seizures, surgery is a rational choice for following reasons.
Epilepsy medications have many side effects which include bone problems, weight gain, hair loss, mood problems, cognitive decline and loss of memory. More medications you take, more chances of cognitive decline over time period
Even financially, if you are on two medications, your monthly maintenance comes to around 6000-7000 per month i.e. 72,000-84000 annually. The cost of epilepsy surgery with all investigations, hospitalization is close to around 3.5 lakhs.
Once you are categorized as drug resistant epilepsy and being considered for epilepsy surgery, you will have to undergo pre-surgical evaluation consist of four main domains: Long term video EEG (48-72 hours), Specialized MRI Brain, PET scan & Neuropsychological evaluation. In pre-surgical evaluation, we decide the exact parts of your brain which is responsible for epilepsy and a team of doctor specialists from various related fields meet together to discuss and reach a consensus about the type of surgery you will need.
Chances of seizure control depend on many variables and it varies between 50-90%. If there is tumor or malformation or localized focal area which could be removed completely, then 90% patient achieves freedom from epilepsy. However, outcome is in the magnitude of 50% with palliative surgeries. Outcome typically depends on the responsible pathology. If MRI Brain shows some localized lesion which could be removed, then 9 out of 10 people can achieve seizure freedom and almost 6 out of 10 patients can be off medicine.
Approximate cost of hospitalization and pre-surgical evaluation is approximately 50,000-60,000. and further cost of surgical treatment is approximately 2.5-3 lac. making total of 3-3.5 lac. However, it varies from case to case basis.