A 15-year-old boy who was treated for recurrent epileptic seizures at a city hospital is now seizure-free, the doctors say.
The boy, hailing from Bilaspur in Chattisgarh, had encephalitis (brain fever) when he was 18-months-old. He remained unconscious for 35 days and started having seizures. Though he regained consciousness and while much of his cognitive function was retained, he continued to have four or five episodes of seizures every month. He had to stay away from school as a result.
He had been put on multiple medicines to arrest seizures, without success. The seizures would begin with him hearing a ‘distressing generator’ noise in his ears, after which he would lose consciousness and exhibit confused behaviour for about 3-5 minutes. This affected his studies.
He had visited several hospitals across the country. MRI scans revealed scarring of the hippocampus, called hippocampal or mesial temporal sclerosis (MTS).
The Hippocampus is important for processing of memory function and is frequently affected in encephalitis.
Doctors ruled out surgical treatment for drug resistant epilepsy as he had MTS on both left and right side, but more marked on the left. The challenge was to prove that the seizures were arising only from one side and to accurately define the language areas in the brain.
The medical team at Gleneagles Global Hospital decided to adopt the stereo-EEG procedure that involves inserting multi-contact electrodes of 1 mm diameter in the brain using neuro-navigation and stereo-tactic guidance without damaging sensitive brain tissues.
A total of 14 electrodes, seven on each hemisphere, were inserted and seizures were recorded. The study revealed that all his seizures arose from the left hippocampus and temporal lobe, and the language area was safely away from the seizure generating zone. Also, the right hippocampus and temporal lobe were not involved in seizure generation.
With the family’s consent, the next procedure of resecting part of the left temporal lobe and the left hippocampus was done on October 9 last year. Since then the boy has not had any seizure and his memory and language skills are well preserved. The boy has been discharged.
Dinesh Nayak, director and senior consultant of the Institute of Neuro Sciences and Spinal Disorders said: “The stage 1 of the patient’s diagnostic work included a high resolution MRI, PET scan, detailed neuro psychological evaluation and video EEG to record his seizures. Only a very few centres in the country have the technical expertise to perform such complex multi-staged evaluation. This surgical expertise provided by Dr. Ravi Mohan Rao, Dr. Nigel Symss, Dr. K. Arul were instrumental and vital for the successful outcome of such a complex procedure that required high degree of coordination”.
GGHC CEO Alok Khullar said the hospital had a level 4 epilepsy surgery centre with State-of-the-art facilities that could undertake most advanced procedures. “Clinical expertise, comprehensiveness of our neuroscience team, sub-specialty focus and continuous integration between neurology, neuro surgery and neuro critical care were instrumental in successfully treating the young patient and bringing him back to his active student life,” he said.
