16 year old girl came to Dr Pradnya Gadgil from West Bengal with a history of frequent seizures since the age of 8. She was experiencing seizures 3-5 times every week. She had suffered from a brain injury when she was extremely sick in the newborn period requiring NICU admission. She had a mild delay in developmental milestones but currently going to a mainstream school in 9th standard.
Multiple anti-epileptic medications were tried to no avail. The frequent seizures significantly limited her schooling, socialising with friends, and participating in simple things like picnics, etc.
Parents had visited multiple hospitals in India and even abroad hoping for a cure. They were refused epilepsy surgery.
We performed a presurgical evaluation which included video EEG, an Ictal SPECT scan, an MRI brain with tractography and a neuropsychological evaluation. MRI showed brain injury in multiple places. However, the evaluation revealed that we could treat her seizures by operating an area on the right side of the brain. There was a risk of her developing weakness post-surgery – ideally, we needed to perform awake surgery. The team (including her parents) felt this wasn’t possible.
Epilepsy surgery was performed using intraoperative monitoring- ECoG, Cortical stimulation, MEPs, etc. She woke up with weakness on one side but this improved to near normal in a few days of neurorehabilitation.
Her seizures have completely stopped since the surgery. She is now back to school-in 10th std.
This was a unique case as ideally, this patient would have needed two-stage surgery. We managed to achieve seizure freedom with one-stage surgery. This was made possible as we have highly advanced techniques of intraoperative monitoring and a dedicated multidisciplinary epilepsy surgery team.
