Centre for Brain and Nervous System

Epilepsy

Epilepsy is the most common chronic neurological disorder. It is estimated that in India, there are over five million people with epilepsy and one million with medically refractory epilepsy. There are nearly five hundred thousand people with focal epilepsies and in a majority of them, surgery cures or controls epilepsy.

Kokilaben Dhirubhai Ambani Hospital (Mumbai) has established a comprehensive epilepsy care programme for the evaluation of people with epilepsy to provide the best medical and surgical managements.

Comprehensive Epilepsy Services

The comprehensive epilepsy care programme at Kokilaben Hospital is organised to provide multi-faceted and holistic epilepsy care. It is equipped to address the needs of:

• Children and adults with epilepsy
• Patients with the first seizure, newly diagnosed epilepsy patients and patients with difficult-to-treat epilepsy
• Patients who need epilepsy surgery

The Team

The hospital has a full team of professionals who are extensively trained and experienced in the diagnosis and management of epilepsy, including:

• Epileptologist: Dr. Jayanti Mani, a neurologist with special interest in epilepsy & video telemetry
• Epileptologist: Dr. Shekhar Patil, a paediatric neurologist with special interest in paediatric epilepsy and video telemetry
• Neurophysiologist: Dr. Poornima Shah, a specialist in EEG, video telemetry and intraoperative EEG
• Epilepsy Surgeon: Dr. Malla Bhaskara Rao, a neurosurgeon with expertise in specialised surgeries for epilepsy
• Neuroradiologists: Dr. Darshana Sanghvi and Dr. Mihir Munshi, specialists in imaging studies of the brain (CT, MRI, fMRI,)
• Psychiatrist: Dr. Jalpa Bhuta, to address emotional and psychological issues in patients
• Nuclear Medicine: Dr. Anshu Rajneesh Sharma, a specialist in ictal SPECT & PET
• Neuropsychologist: To assess IQ and conduct special testing for brain functions

Epilepsy Nurse Coordinator

Technology and Infrastructure

Kokilaben Hospital is the first and only centre in western India that provides state-of-the-art diagnostic facilities for epilepsy evaluation under one umbrella. These include:

Long-term video EEG monitoring is one of the key tests performed:

• To establish the diagnosis of spells whose epileptic nature is not certain.
• To determine the area in the brain from which the seizures originate (epileptic focus). This is done as a part of evaluation for epilepsy surgery.
The patient is admitted to a special monitoring room and continuous recording of video and EEG is performed simultaneously for a period of 1-5 days to record the habitual seizures. Medications are withdrawn gradually during this period to provoke the seizures. An expert analysis of the EEG & the patient's behaviour during the attack establishes that seizures are truly epileptic and also determines which area of the brain is firing the seizures.

Facilities Specifically useful for Presurgical Planning and Epilepsy Surgery at Kokilaben Hospital

Correct identification and complete resection of the seizure focus are essential for seizure freedom after surgery. The following studies are particularly useful in identifying the epileptic firing focus during the presurgical evaluation.

3 Tesla MRI
This is very useful in identifying subtle anatomical lesions that may be missed on routine MR images.

Functional MRI
This aspect of MR evaluation studies not only anatomy but also identifies areas of the brain associated with specific functions like the motor cortex, visual cortex or language areas in the brain. This is useful for non-invasive planning of surgical strategies, such that post-surgical motor visual or language deficits may be avoided.

SPECT & PET-CT
These are also available to evaluate more challenging patients with focal epilepsy and a normal MRI. These are used to provide visual evidence of the functional epileptic firing focus.

Neuronavigation System
This equipment is available in the operation theatre to provide surgeons with online MR imaging orientation of his surgical field. This greatly improves precision during surgery.

Intraoperative MRI
The first of its kind in India, the intraoperative MRI (IMRIS) system allows the surgeon to perform an MRI study in the operation theatre. This allows the surgeon to ensure complete resection of the epileptogenic lesion, which is crucial for seizure freedom.

Who needs presurgical evaluation?

• Any person who has epilepsy for over two years
• Any person with two or more disabling seizures per month
• Any person who did not respond to medication, despite a trial of 2 appropriate AED monotherapy or one combination therapy
• Patients with significant AED toxicity

Epilepsy Surgery

Epilepsy surgery is now considered the treatment of choice in certain lesional epilepsy syndromes. These include:

• Hippocampal sclerosis or mesial temporal sclerosis (MTS)
• Low-grade cortical tumours
• Focal cortical dysplasia
• Hemimegalencephaly
• Sturge-Weber syndrome
• Tuberous sclerosis
• Rasmussen's syndrome

Epilepsy Surgery Procedures

• Anterior Temporal Lobectomy
• Selective Amygdalo-hippocampectomy
• Lesionectomy
• Neocortical Resection
• Resection of Hypothalamic Hamartoma
• Multilobar Resection
• Hemishperotomy
• Corpus Callosotomy
• Multiple Subpial Transaction
• Implantation of Vagal Nerve Stimulator

Epilepsy Support Groups & Epilepsy Awareness Programmes

The epilepsy team at Kokilaben Hospital is committed to extend care that goes beyond medication and surgery to epilepsy patients.

The support group for epilepsy will meet regularly with patients for the purpose of addressing recurring issues related to medication, education, employment and social issues for patients and caregivers.

The team intends to improve awareness and remove fears about epilepsy in the community through periodic awareness programmes for the public.

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