Publication

Abstract : Introduction: The central role in the diagnosis of the epilepsy is played by electroencephalogram (EEG). Also, in India, there exists a large treatment gap as appropriate treatment for the condition is not received by the patients suffering from active epilepsy. The main reasons responsible for this includes poverty, lack of knowledge, social stigma and poor health infrastructure. In developing countries an enormous gap between the number of patients who could be benefited from epilepsy surgery and those who actually receive this treatment has been created by the lack of availability and affordability, which can only be minimized by developing more centres in the country, where epilepsy surgery can be undertaken. Hence; we undertook the present study to create a model for Epilepsy surgery programmse in small cities/ district places accessible to majority of medically refractory patients. Material and Methods: The present study was carried out in the epilepsy centre. For predicting medically refractory epilepsy, a pre surgical evaluation was carried out on out-patient basis,saving cost and inconvenience of hospitalization for presurgical evaluation. It included Video EEG, MRI 1.5 or 3 Tesla, Neuropsychiatric assessment. If required, functional imaging – like PET scan,Syndromic classification and differentiation of True and Pseudo-seizures and epilepsy mimics were made-based on the on semiology, interictal and ictal EEG. MRI brain 3 T (if not imaged before) and neuropsychology assessment was done in medically refractory epileptic patients. Few patients were asked to undergo PET-CT scan-Brain. All the results were recorded and analyzed using SPSS software. Results: Surgically remedial Epilepsy was found in 24patients, out of which 9 patient successfully undergone Epilepsy surgery with Engel-1 outcome for the follow up ranging from few months to 1 year. All patients are free of minor as well as major seizures. No permanent disability or adverse effect was seen post surgically. Conclusion: Selection of candidates destined to have a seizurefree outcome using locally available limited technology and expertise is required for developing cost-effective, epilepsy surgery centres in India