Epilepsy surgery: Epilepsy surgery is the most promising treatment that provides freedom from seizures in patients with the persistent seizures despite of requisite trials of at least 2-3 antiepileptic drugs. The effectiveness of the surgery depends on the form of epilepsy, related pathology and appropriate identification of the seizure focal area with the help of neuroimaging and neurophy siological investigations. The modern advances in neuroimaging and EEG monitoring techniques have led to more accurate localisation of the lesion and thus yields best results from epilepsy surgery in India.The ultimate aim of the epilepsy surgery is to eliminate or reduce the episodes of seizures by analysing and removing the abnormal part of the cerebral cortex causing seizures.
- Medication- Anti-convulsant or anti epileptic drugs are the most common treatment for epilepsy. If one medication is not successful in controlling seizures, the doctors switch the drugs or adjust the dosage. About two- thirds of people with epilepsy become free of seizures with prescribed medication.
- Surgery- If your doctors can determine that your seizures always begin in a single area of the brain, removing that part of the brain can stop them or make seizures easier to manage. Surgery can also treat conditions that cause seizures, such as brain tumour. The procedures included in this approach are:
- Temporal lobe resection surgery: This surgery is performed more commonly. In this the anterior and the middle portion of the temporal lobe, which is most often responsible for causing seizures is resected or removed.
- Functional Hemispherectomy: This is rare but most successful surgery which is performed in most of the widespread and fatal epilepsies. This surgery aims in removing almost entire half of the cortex (brain) to eliminate the seizures completely.
- Palliative: This approach is opted when there is no definite lesion identified. The aim for this procedure is to reduce the frequency and severity of the seizures by disrupting the nerve pathways that propagates the seizure. Following procedures are performed in palliative treatment-
- Corpus Callosotomy: It is surgical procedure performed to reduce the frequency and severity of mostly the generalised seizure or primary atonic (drop attacks) seizure by simply disrupting or cutting the fibres of the corpus callosum which serve a pathway for conduction of the seizure impulse between the two halves of the brain.
- Multiple Subpialtransections: This surgical procedure is indicated when the centre of seizure is well localized but cannot be removed or resected as it is located in the vital area of the brain that is involved in speech production, memory and sensorimotor tasks. In such case, the surgeon cuts the nerve fibres in the outer layer of the brain and preserves the deeper fibres that control the vital neurologic function.
- Vagus Nerve Stimulation: It is a palliative procedure for the patient with partial or generalized seizures. During this procedure, the vagus nerve stimulator is implanted under the skin of the chest which electrically stimulates the vagus nerve periodically. These signals are then transmitted from the vagus nerve to part of brain expected to be involved in producing seizures resulting in subsequent decrease in frequency and severity of the seizures.
Deep Brain Stimulation Surgery: Deep brain stimulation is the surgical intervention which involves implanting a medical device, called brain pacemaker in the skin of the chest, below the collarbone. The pacemaker, also known as implanted pulse generator (IPG) sends electrical impulses to specific parts of the brain to help in the treatment of otherwise treatment resistant disorders of nervous system like Chronic pain, Parkinson's disease, rigidity, tremours, dyskinesia, dystonia etc.Deep brain stimulation is most commonly used to treat the symptoms of these common neurological conditions:
- Parkinson's disease-Deep brain stimulation, approved by FDA in 2002 to treat Parkinson's disease has now become the standard treatment for Parkinson's disorder. Symptoms associated with Parkinson's which include stiffness and tremor are controlled with medication for only short duration while DBS offers complete control and thus better quality of life.
- Dystonia- Dystonia is a condition in which patients experience involuntary muscle contractions that force parts of the body into abnormal postures. DBS has been FDA approved for this condition under what is known as the Humanitarian Device Exemption (HDE.) This means that DBS surgery can be done on those with debilitating dystonia that does not respond well to medication, and in whom dystonia is the only neurological condition.
Treatment Option- When patients have inadequate response to medication, deep brain stimulation is an option to effectively treat essential tremor. Research shows that medications often only elicit a response in about half of patients with essential tremor. However, patients who undergo deep brain stimulation can experience approximately 80 percent improvement in hand tremor.Obsessive Compulsive Disorder (OCD)-Deep brain stimulation has been approved by the FDA under the Humanitarian Device Exemption (HDE) for the treatment of obsessive compulsive disorder (OCD.).
The goal of DBS is:
- To improve the mobility and overall functioning
- To improve and maintain quality of life
- To improve gait, balance, posture, speech and writing skills
- To reduce tremors and rigidity
- To restore dyskinesias and to maintain the mental sharpness
Multiple sclerosis Treatment: Multiple sclerosis is the chronic inflammatory demyelinating disease of central nervous system. It is an autoimmune disorder and is characterised by the production of antibodies that damage the nerve myelin sheath and ultimately the nerve itself. This leads to production of the significant physical disability commonly called as paralysis along with other symptoms like paraesthesia, intention tremor, scanning speech, nystagmus, heat intolerance, bowel and bladder dysfunction, sharp pain, ataxia, tremors and many more.
Treatment Option- There is no known cure for Multiple Sclerosis. The focus of the treatment is to limit MS attacks and prevent further disability.
- Drug therapy: There are certain drugs which can modify the course of M S or can reduce the symptoms.
- Physical therapy and Occupational Therapy: This should be encouraged in patients with multiple sclerosis to improve their quality of life and to make their daily life easier and productive.
- Surgical Options:
- Deep brain stimulation: Usually it is performed to control tremors and is only considered when other options have failed. During the procedure a device is implanted in the brain which helps to improve the symptoms by blocking the nerve signals that cause severe and disabling tremors
- Drug catheter/pump implantation: This is performed to reduce pain and spasticity. A catheter or a pump is implanted in the lower portion of the spine to provide constant flow of medicine preferably baclofen.
- CCSVI Liberation: CCSVI stands for chronic cerebrospinal venous insufficiency. Chronic cerebrospinal venous insufficiency is the narrowing of veins which carry blood away from the brain and spinal cord. The basic premise is that when blood flow is slowed, the blood backs up into the brain and spinal cord leading to oxygen loss and iron deposits in the brain. CCSVI liberation or opening up blocked vessels can improve MS or no is still a matter of debate. Some researchers state that there has definitely improvement in symptoms of patients who undergo liberation treatment while some do not believe it. It is an endovascular procedure which involves placing a stent or balloon inside the blocked vein to open it and restore the blood flow.