Epilepsy surgery

Epilepsy surgery in India: George C Vilanilam



Archives of Medicine and Health Sciences 2019 7(2):287-292



The history of epilepsy surgery dates back to the era before computerized tomography, magnetic resonance imaging (MRI), positronemission tomogram imaging, and electroencephalogram (EEG). Victor Horsley's resection of a cortical scar in 1886, based purely on localization is considered as the first epilepsy surgery recorded in history. In India, Prof. Jacob Chandy performed a pediatric hemispherotomy in 1952 at the Christian Medical College, Vellore. Prof. Malla Bhaskar Rao did a cortico-amygdalohippocampectomy in 1995 for hippocampal sclerosis at Sree Chitra Institute, Trivandrum. With over 1 million patients suitable for epilepsy surgery in India, the burden of disease is alarmingly high. The spectrum of epilepsy surgery resections in India has expanded tremendously over the past decade, but the centers performing them are few and far in between. Hence, the “surgical gap” (which includes eligible patients awaiting surgery) is ever increasing. With just around 1000 procedures performed every year, the surgical epilepsy programs in India need a massive overhaul in terms of skilled workforce and infrastructure. Sophisticated presurgical workup modalities, such as MEG, stereo-EEG, EEGfunctional MRI, etc., are have already been popularized in India. The results of epilepsy surgery in India are also at par with the world's state-of-art centers. As medical and surgical epileptology grows further over the years in India, the surgical treatment gap hopes to be effectively addressed.