Epilepsy

 

Video of stimulation on and off after DBS procedures

 

What is Epilepsy ?

 

  • Epilepsy is the tendency to have repeated seizures that start in the brain. Epilepsy is usually only diagnosed after a person has had more than one seizure.
  • The incidence of Epilepsy in general palulation is 0.5-1%
  • 15% of all Epilepsy patients do not respond to combination of three medications and are labelled as intrectable.
  • For such cases either surgery or Deep brain stimulation is a good alternative.
  • Very few 4-5% are good case of surgery. Rest 90-95 % of intrectable epilepsy
  • Patients continue to have seizure despite medications. Deep Brain Stimulation is a good alternative in such cases
  • DBS is very efective all kind of refractory epilepsy

 

 

European regulatory approved deep brain stimulation therapy system for patients with refractory (drug resistant) epilepsy.

 

 

Case Report

 

Thirty three years old S. A resident of Faridabad had become the first patient in India who had Brain Pacemaker for uncontrolled Epilepsy.

 

She was a second child born via normal delivery with normal milestones.

 

At the age of 18 months she started having fits specially on her left side. It used to last for 15-20 minutes with no loss of consciousness. After fit she used to feel weakness on left side.

 

She was treated in local hospital in Faridabad and remained controlled with medications for 12 years. Fits started again when she failed in 12th standard.

 

Her fits were same starting from left side and then goes to other part of body. Fits continued for 15-20 minutes and used to occur one to two times a day. Again she was put on medications but fits continued. Despite all kinds of medication fits used to occur once in 2-3 weeks time.

 

Gradually the frequency of fits increased to 2-3 fits every alternate day. Many times she was admitted in I.C.U in local hospital for control of fits but again after some time they used to recur.

 

Till December 2011 she was confined to her house as she can have fits outside house. Her father has to remain along with her to take care of any kind of emergency.

 

She was referred for Epilepsy surgery it was refused as she was not a proper candidate for surgery.

 

She came to us in the month of January at Artemis hospital. Having exhausted all the option for medications we decided to introduce a pacemaker in very specific area of her brain called Anterior Thalamus which is a gate way through which all epileptic discharges goes to brain and then to l the limbs.

 

This deep brain stimulation surgery (Pacemaker) is a approved therapy in Europe and has received CE Mark approval for Epilepsy

 

She was operated on 15th January 2012. By stereotactic technique very thin wires (Electrodes) were introduced in her deep nuclei on both side after making two small holes in her skull just behind hairlines and later-on they are connected to a Pacemaker implanted underneath the color bone on left side through connecting leads . Surgery lasted for 9-10 hours

 

After surgery programming of the pacemaker was started and continued for 10 days. After that she was discharged. Her stitches were removed on 10th day and she was followed in O.P.D. Presently she is seizure free for last one and a half month

 

Her post-operative E.E.G has become normal which was abnormal earlier and her PET CT Scan head showed improvement in blood flow in the affected area.

 

What is the role of DBS for epilepsy

We expect improvement in the range of 50-70% in seizure control and medication are gradually reduce over period of time

DBS is very effective all kind of refractory epilepsy