Epilepsy Surgery

Epilepsy

Epilepsy  

Malaysia is a small, developing country with a population of 28.5million people. It has a large population of patients with epilepsy, a segment of whom are refractory to medication. The goal of epilepsy treatment is to stop all seizures and improve the quality of life of these patients. As such, the refractory patients are prime candidates for assessment of suitability for surgical management.

In University Malaya Medical Centre, these patients are reviewed by a dedicated group of doctors with special interest in Epilepsy. This includes adult and paediatric epileptologists / neurologists, Epilepsy surgeons, Neuroradiologists, Psychologists and skilled electrophysiology technicians.

UMMC offers comprehensive assessments which include a fully equipped video telemetry unit with 24 hour monitoring facilities, extensive neuroimaging facilities which include a 3T as well as an open MRI, fMRI and SPECT scans. Our radiologists also have the expertise to perform WADA tests and DTI mapping.

Operative facilities include the most advanced image guidance system as well as the ability to perform invasive intraoperative electrocortical mapping as well as invasive grid and depth electrode monitoring.  A new intraoperative CT and MRI suite should be functional within the next 6 months, which should enhance the service further.

While the Epilepsy Surgery program in UMMC headed by Dr Vairavan Narayanan only started in 2012, the medical epilepsy services goes back to more than 30 years. In the past year, we screened an average of 50 patients for surgery, of whom about 20 patients underwent successful surgical resection of epileptic focus with no major morbidity. Among the surgery performed include

  • selective amygdalohipocampectomy

  • anteromedial temporal lobectomy

  • resection of focal cortical dysplasias

  • resection of low grade tumors

  • Vagal nerve stimulator (VNS) insertions

 

Epilepsy surgery assessment flow chart

Patients are seen in Adult and paediatric epilepsy clinics by epileptologist

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Pts who fulfill ILAE criteria ( more than 2 AEDs with inadequate seizure control over a 6 month period) will be referred for further evaluation

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Further evaluation includes

• 3T MRI (+ other imaging modalities as necessary)

• Full neurophysiology assessment inc scalp EEG and VT

• Assessment by neuropsychiatrist and social worker

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Pt’s case discussed in Epilepsy MDT and a consensus achieved

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Once planned for surgery, pt will be seen in next available surgical epilepsy clinic for in depth discussion on surgery

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High resolution MRI and CT for intraop image guidance performed

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Surgery and post op recovery in Neuro / Paediatric ICU

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Surgical follow up with imaging

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Routine neurology follow up