Epilepsy is a disease characterized by causing two types of seizures: partial (in a defined part of the brain) or generalized (they originate simultaneously throughout the brain). The former can range from movement and memory disturbances, but without loss of consciousness or contact with the environment; going through disconnection with the world around him and lost gaze with automatic repetition of certain movements, until a general seizure crisis.
Focal epilepsies are caused by abnormal electric shocks in specific (localized) parts of the brain. In up to 30% of patients, drugs do not control these epileptic seizures. Whether the site of origin of these signals (the epileptogenic zone) can be located from the description of the epileptic seizures or the results of magnetic resonance imaging (MRI) (a medical imaging exam using magnetic fields and waves strong radio signals to produce detailed images of the inside of the body) and electroencephalography (EEG) (recording of electrical activity along the scalp) the patient should be offered the possibility of extracting the epileptogenic zone.
In the case of generalized ones, Dr. Manish Kumar explained that the crises range from loss of contact with the environment and fixed gaze at one point (absence crisis); a sudden jerk of the extremities without altered consciousness (myoclonic seizures); and contraction of the muscles of the body with sudden hyperextension, which may be accompanied by loss of consciousness (tonic crisis).
Other symptoms are loss of muscle strength, so the person falls to the ground (atonic crisis); and falling to the ground and body stiffness, followed by rhythmic jerking of the arms and legs. In addition, it can generate bites of the tongue, purple lips, foam emission from the mouth and relaxation of the sphincters (seizures).
Epilepsy currently has a therapeutic range for each type of epilepsy and patient, even for those in which the most common treatments do not work. In this sense, 70-80 percent of those affected find a solution in antiepileptic drugs, although there are 20-30 percent of patients in whom it is not possible to control their epilepsy.
Epilepsy surgery in Delhi is performed only in patients with refractory epilepsy, also called drug-resistant. In other words, it is estimated that about 10% of all patients with epilepsy can be considered candidates for this type of surgery.
It is in drug-resistant patients that a pre-surgical study is proposed, even more so if their epilepsy is focal. The success of the surgery is directly related to the early detection of the drug resistance condition, as well as the adequate selection of the patient and the correct pre-surgical diagnosis.
The surgical treatment of epilepsy aims to eliminate epileptic seizures (curative surgery) or to decrease the frequency or intensity of seizures (palliative surgery). It is very important to emphasize that in addition to crisis control, the success of an Epilepsy surgery in Delhi must consider the impact that this control causes on the quality of life of the patient and his family.
The success of curative Epilepsy surgery in Delhi (crisis-free patient) ranges from 60 to 80%. This depends on the disease that produces the epileptic seizures, the affected brain lobe, and the evolution time of the epilepsy.
Among resective surgeries we can highlight:
- 1. Surgery of the epilepsy of the temporal lobe: Where there are different surgical techniques, depending on the case, but basically focused on the hippocampus.
- 2. Resective surgical treatment of extra-temporal epilepsy outside the temporal lobe: Within these, resections on the frontal lobe are more frequent than on the parietal or occipital lobes.
- 3. Functional hemispherectomies: It consists of a combination of disconnection of the hemisphere, with partial resection of the same. This technique is indicated in patients with lesions of one hemisphere, which cause refractory epilepsy originating in a damaged brain and the function of that hemisphere is lost.
Non-resective or palliative surgery is an intervention of disconnection of the cerebral pathways or implantation of stimulators that slow down the spread of crises. Here, the objective is to decrease the frequency or intensity of the crises and the most used are:
- 1. Callosotomy: Corresponds to the section of the corpus callosum, which connects the two cerebral hemispheres. The goal of surgery is to prevent a crisis from spreading from one hemisphere to another. Its most important indication is atonic seizures (falls) and primarily generalized epilepsies.
- 2. Multiple subpial transection: They are small sections perpendicular to the cerebral cortex, 3 mm. deep, every 5 mm., that disconnect part of the cerebral cortex with its neighborhoods. This is done when the epileptogenic focus coincides with eloquent brain tissue, which is unresectable.
- 3. Vagal Stimulator (ENV): It is the implantation of electrodes in the Vago nerve, on the left side of the neck. These are connected to a stimulus generator that implants under the skin of the chest. The stimuli go to the brain. Between 43 to 63% of patients decrease the frequency of their seizures, beyond 50% of their original seizures, in addition to improving the mood of the patients. Its indications and results are similar to a callosotomy, but the latter, being an intracranial surgery, has greater risks, elements not present with VNS, unfortunately, this device is high cost in our setting.