Monday, May 23, 2022

Electrodes in brain new hope for severe cases of epilepsy

Neurosurgeons at All India Institute of Medical Sciences have devised a new technique for operating on children suffering from a severe form of epilepsy that cannot be controlled by drugs. It involves drilling small holes in the brain and passing electrodes through them to burn the interface between the damaged and the healthy parts of the brain.

At least six patients, including a five-month-old baby, have already undergone the procedure successfully, according to Dr P Sarat Chandra, professor of neurosurgery at AIIMS, who led the team that devised the new technique. The innovative technique made it to the cover of Journal of Neurosurgery (Paediatrics), a top-rated medical journal.

Epilepsy affects nearly 10 million people in India. While most patients can manage with medications, a few require surgical management. Chandra said the new technique can help thousands suffering from a severe form of the disease where seizures arise from one half of the brain.

The conventional form of treatment for such cases involved removing the damaged part of the brain entirely (hemispherectomy) or disconnecting the damaged part (hemispherotomy) from the healthy portion. This is not only complex but also poses a high risk.

Robotic thermos-coagulative hemispherotomy (ROTCH) involves using robotic guidance to drill small holes in the skull to avoid a large incision to access the brain. Electrodes are introduced into the holes and radio waves ablate, or burn, the interface the right hemisphere and the left hemisphere, thus disconnecting the diseased hemisphere from the healthy one.

Dr Chandra explained that the new surgical technique was more accurate, effective and guided by advanced robotic systems and, most importantly, caused minimal or no blood loss. “Radiofrequency has been used in the past also to treat different forms of epilepsy but this is the first time that it has been used to disconnect an entire hemisphere of the brain from the rest of the organ,” he said.

One of the patients to undergo the surgery using the novel technique at AIIMS was a five-month-old boy, who developed epilepsy when just three days old. There was twitching and involuntary movement in the left upper hand that spread to the whole left side of the body. The family consulted a family physician and were referred to a neurologist who started the baby on medication. But the intensity and frequency of seizures only increased.

MRI showed a right hemispheric cortical dysplasia, a rare disease characterised by the presence of short-circuited neurons causing the generation of excessive ‘electricity’ and so uncontrolled epilepsy. The patient was referred to AIIMS, where neurologist Dr Manjari Tripathi advised surgery after detailed examination.

Chandra, who led the team of neurosurgeons operating on the boy, said the procedure took about nine hours. “The infant became seizure-free immediately after surgery and now is two years old with development milestones and continues to suffer no seizures,” he said.

For the parents, it was like their son getting a rebirth. Once the few sutures were removed, the parents couldn’t even make out the surgical site, the neurosurgeon claimed. Untreated, most such patients would eventually die of the uncontrolled seizures.

AIIMS is also among the first medical institutions in India to develop robotic guided stereo encephalography, a highly complex procedure in which electrodes are introduced robotically to identify the seizure networks in patients who show normal MRI results. “Of the 10 million people in India with epilepsy, two million, children and young adults included, have drug-resistant epilepsy and require surgical therapy,” said Dr Manjari Tripathi.

Tripathi added, “With epilepsy in the family, there is stigma and the entire family’s productivity goes down, usually because society has several misconceptions about epilepsy. Nearly 75% of epilepsy can be treated and cured with medications.”

Source: ET Healthword

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