Epilepsy Center, Seizures Treatments, Top Epilepsy Hospital, Vikram Hospital

Video EEG (Electroencephalography): This is a technique in which the brain activity from its surface to assess its functioning is recorded by placing electrodes on the scalp and connecting it to a detector-machine (similar to ECG which is recorded by placing electrodes on the chest). The wave-forms - even in between two episodes of fits - show abnormal spikes (sparks) or slowing. During a fit, typical electrical activity is demonstrated along with capturing the video recording of the patient as he throws the fit. By correlating the EEG with the Video recording the neurophysician can identify the type of epilepsy and localise the area from where the epilepsy is arising.

MRI of Brain: A vast majority have abnormalities of the brain that are detected by MRI and correlated with Video EEG for better understanding.

In certain complex situations, mere Video EEG is inadequate. In such a situation, the EEG has to be recorded by placing the electrodes on the surface of the brain itself! This is because the skull reduces the intensity of the brain activity by 200 times making the detection of the abnormal spikes difficult.

Functional MRI: This recent introduction helps identify each functional area of the brain. The person is instructed to carry out specific activities during the MRI and the specific area gets highlighted. These areas are well delineated so as to preserve them during surgery.

appointments: +91-99000-14820




High precision neurosurgery without side effects enables those suffering from epilepsy to lead a normal life
Rohit could never go to school like other children his age. Wracked by seizures from when he was only six months old, he was pulled out from school by his parents when his seizures made it impossible for him to play and study like other children. A surgery to ‘disconnect’ the seizure-causing part from the rest of his brain was all that it took for Dr Ravi Mohan Rao, Senior Consultant Neurosurgeon at Vikram Hospital to restore Rohit’s childhood. Today the boy is a topper at school and his seizures have vanished. Decoding the brain “The boy had a developmental malformation of the brain which was causing seizures,” Dr S Raghavendra, Consultant Neurologist and Epileptologist at the hospital’s Comprehensive Epilepsy Care Centre. A Video EEG on Rohit revealed to the neurologist’s trained eye that the young boy was having seizures originating from the right side of the brain and due to a developmental malformation in the brain. “The boy was having 50 – 100 attacks a day, sometimes unnoticed by his parents or teachers because the symptoms are not visible,” informs the neurologist. “Through the Video EEG, I could record the slightest abnormality in the brain and convince his parents that he was suffering from epilepsy,” he adds. An MRI too showed up the same symptom. The PET scan during a period when there are no seizures showed reduced blood flow in the region of the abnormality. Disconnecting the abnormality Although epilepsy surgery is complex, the treating team of neurologists and neurosurgeons follow a straightforward set of principles. The strategy is to identify the area of abnormally discharging neurons or the ‘seizure focus’, and to remove it when possible. In certain patients without a well defined epilepsy focus, surgery can sometimes help, by disconnecting or isolating the abnormal area so that seizures no longer spread to the neighboring normal brain. Understanding epilepsy Watching a person have epileptic seizures can be more frightening than the condition itself. Seizures, called ‘fits’, occur when the nerve cells or neurons of the brain generate abnormal electrical activity which gets propagated along the brain, and results in the person having an unexplained behavioral changes. Types of epilepsy Epileptic seizures are of two types. A typical symptom of an epileptic seizure is when the person falls to the ground, contracts the body, frothing at the mouth. However, this type actually accounts for about 30 - 40 percent of seizures. The second and more common types of seizures are sudden explained behavioural changes where the person seems to lapse into a trance lasting seconds to minutes. Many of these attacks may be unnoticed leading to a delay in diagnosis and appropriate treatment
Causes (in a box)
In children Abnormal brain formation Infections during pregnancy Birth injuries e.g. lack of oxygen to the brain, difficult labour, etc Febrile seizures due to high fever	In adults Head injuries in accidents Adult infections e.g cysticercosis due to tapeworm, Tuberculosis; Tumours Vascular malformations like cavernomas and AVM’s Alcohol or drugs Congenital conditions Genetic factors Drug withdrawal Medications
Tests and scans to identify and confirm epilepsy
The process of accurate diagnosis involves running the person through a detailed assessment of the seizure and then performing some important tests
Video EEG (Electroencephalography): This is a technique in which the brain activity from its surface to assess its functioning is recorded by placing electrodes on the scalp and connecting it to a detector-machine (similar to ECG which is recorded by placing electrodes on the chest). The wave-forms - even in between two episodes of fits - show abnormal spikes (sparks) or slowing. During a fit, typical electrical activity is demonstrated along with capturing the video recording of the patient as he throws the fit. By correlating the EEG with the Video recording the neurophysician can identify the type of epilepsy and localise the area from where the epilepsy is arising. MRI of Brain: A vast majority have abnormalities of the brain that are detected by MRI and correlated with Video EEG for better understanding. In certain complex situations, mere Video EEG is inadequate. In such a situation, the EEG has to be recorded by placing the electrodes on the surface of the brain itself! This is because the skull reduces the intensity of the brain activity by 200 times making the detection of the abnormal spikes difficult.

Planning treatment It is important to stress that not all patients with medically refractory epilepsy can be helped with surgery. The best surgical candidates have seizures arising from a single location and from an area of the brain that is relatively silent meaning that the seizure focus can be safely and completely removed. Once comprehensive data is collected, the neuro physician also called epileptologist lays out a plan of action. He knows the exact abnormality and the appropriate surgery to correct the same. He also can flag all the important areas of the brain which needs to be preserved and how to achieve the twin goals of cure / control as well as preserving of the brain functions. The challenge here is to ensure that while epilepsy is being cured, it should not result in collateral damage in the form of leaving behind deficits or side effects. For example, if the focus is close to the motor area of the brain, while operating on it if the motor area is damaged it will lead to permanent deficits. If the motor area is that of the thumb of the hand and that gets damaged, the person will lose the ability to use the same. Similarly certain areas of the brain are used for different functions, like memory, like thinking and processing information, etc. They all have to be preserved. So, it is important to recognize and identify these areas. This is done by: Neuropsychology testing: a variety of memory and other tests of brain are performed to assess the functioning level of different parts of brain Functional MRI: This recent introduction helps identify each functional area of the brain. The person is instructed to carry out specific activities during the MRI and the specific area gets highlighted. These areas are well delineated so as to preserve them during surgery. MR Tractography: The entire nerve tracts and the wayit flows around in the brain is mapped. PET Scan: may be required in specific situations only MRI EEG Video EEG
Social stigma and lifestyle Doctors are of the opinion that epilepsy is like any other disease such as diabetes where treatment is long term and yet people can live a normal lifestyle. However, the social stigma and fear attached to epilepsy does more damage to the patient and the family than the disease itself. Since some epileptic attacks can be physically harmful to the patient, he very often lives the life of a recluse. Parents are protective about the children who are epileptic and they are not allowed to go to regular school.
Life-changing cure Epilepsy occurs in one percent of the population and 80 percent of these people respond to medicines. However 20 percent - one in 500 persons - don’t respond to medication. These are termed to have ‘Refractory Epilepsy’. The cure or control of Refractory Epilepsy is through neurosurgery. The use of high end microscopes, navigating devices, frames, instrumentation and skilled team of neurologists, neurosurgeons and technicians have made it possible to perform high precision brain surgeries to cure epilepsy. These include isolating and removing or disconnecting the seizure causing abnormal focus in the brain thereby preventing the onset or propagation of the fits. “It is definitely a better quality of life for these people who would have suffered in isolation. Now they can get back into the mainstream and live a normal life,” says Dr S B Vikram, Managing Director, Vikram Hospital. To date more than 30 patients have undergone complex surgical procedures after a very detailed case evaluation and careful selection for surgery since the hospital opened in November 2010. This process has yielded tremendous results in all patients resulting either in a cure from epilepsy or made a considerable difference to the lives of those patients by eliminating major epilepsy.


appointments: +91-99000-14820