EPILEPSY NEUROSURGERY

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When neurosurgical intervention can help an epileptic patient?

Brain is made up of millions of specialized cells called neurons that have electrical activity. Normally, brain generates very precise electrical impulses in response to a sensory stimulus or to execute a voluntary motor response.

In an epileptic patient, a part or multiple parts of the brain are sending random, uncontrolled, electrical impulses spreading to adjacent brain sometimes to ipsilateral or bilateral hemispheres of brain from a focus, through its neurons. It is similar to spread of fire from a focus to its surroundings. Surgical removal of the epileptic focus is like calming down the source of fire.

If the origin of the fire is from one area, the patient is a good candidate for surgical excision and chances of recovery are bright. The surgical  part of the brain called temporal lobe located in front of ears has the best chance of seizure if the focus is found in this area.

EPILEPSY & ROLE OF NEUROSURGERY IN EPILEPTIC DISORDERS

Epilepsy is one of the most common neurological disorder presenting as seizures. It arises due to abnormality in the brain. More than 50 million people are suffering from epilepsy world wide, majority from lower to middle socioeconomic group.
Epileptic seizures are intractable in 30% patients which means that the seizures are not controllable by 2 or more anti seizure medication compared to rest where it can be controlled by anti-epileptic drugs.

Patients of intractable seizures can be helped by neurosurgical intervention. Preoperatively, patients is commonly evaluated by history and clinical examination, MRI brain and Electroencephalography(EEG), WADA test and neuropsychological assessment in most of the cases. The aim of investigation is to localize that the origin of the seizure is from one area of the brain.

If the origin of seizures from a part of brain is confirmed on investigations, neurosurgical excision of that part of the brain may result in decreased frequency or complete recovery from seizures.