NEW DELHI: Around 15 million people in India suffer from epilepsy – a common brain disorder that causes seizures – and about 20%-30% among them are drug resistant. The Neuroscience Centre at AIIMS, Delhi, has devised a unique treatment method using an advanced neuro-robot that can ‘pop’ the brain and provide succour to millions who don’t respond to epilepsy drugs and aren’t fit for surgery.
The neuro-robot implants multiple electrodes into a patient’s brain in a bloodless procedure to identify the area from where the seizures get triggered. Then, the seizures are reproduced again by stimulating the electrodes to reconfirm the point of focus. Finally, the faulty part is burnt or ablated, causing a popping sensation in the brain, thus, stopping the seizures or reducing them.
“We have used this technique in over 60 patients suffering from uncontrolled epilepsy,” professor of neurosurgery at AIIMS, Delhi, Dr P Sarat Chandra, said. Recently, Chandra and his team performed the procedure on a 23-year-old woman, who had been suffering from drug-resistant epilepsy. Tanushree (name changed), who works with an MNC, had visited several doctors and undergone as many as 14 MRIs over nine years, but no abnormality could be detected even as the frequency of her seizures kept increasing.
“Through pre-operative investigations including video EEG, MRI, SPECT and PET scans, and magnetoencephalography, we identified the areas of suspicious neural activity in the brain. This data was fed into the neuro-robot, which directed its robotic arm to the right area to place thin electrodes,” Chandra said.
The patient was moved to ICU and monitored for next few days. On day five, she developed five to six seizure episodes, which the implanted electrodes demonstrated were arising from a specific portion of the brain and spreading to the left temporal lobe. This is called periventricular heterotopia (PVH) – small ‘lesions’ in the brain found next to the ventricle (cerebrospinal fluid-filled cavities in the brain), where the wiring between the neurons had gone ‘haywire’, constantly short-circuiting & generating abnormal amounts of electricity that spreads to the rest of the brain, leading to epilepsy. In Tanushree’s case, PVH was very small, and hence, missed by previous MRIs.
To reconfirm, doctors passed a very low-intensity current – similar to what normally passes through neurons – through electrodes to stimulate the PVH.
When the electrode in the PVH was stimulated at 10 milliamperes, the patient developed the typical ‘staring episode’ she used to have during seizures, said professor of neurology at AIIMS, Dr Manjari Tripathi. “Reproducing seizures with stimulation is a moment of jubilation for us as we now know exactly where the abnormal networks are located within the brain,” she said.
The final part involved burning the PVH around the electrodes using a bipolar current. The patient is conscious and gets a ‘popping’ sensation as the brain substance around electrodes heats up and coagulates,” Chandra said. Every electrode costs Rs 1.5 lakh. At AIIMS, they are being done at a fraction of cost with the same technology, and are often permanent cures for epilepsy, Chandra said.