VISAKHAPATNAM: Thanks to availability of facilities like magnetic resonance imaging (MRI) and video electro-encephalogram (VEEG) for investigation of epileptical seizures, surgical treatment of epilepsy has been made easy, according to K. Venktateswarlu, Head, Department of Neurology, Andhra Medical College.

Talking to The Hindu on Wednesday, on the eve of National Epilepsy Day, he said: "Surgery offers a viable alternative treatment modality to epileptics who are refractory to medical treatment.''

Dr. Venkateswarlu said that it was necessary that both treating physicians and patients explored this option whenever seizures were not satisfactorily controlled with medication and when side-effects were bothersome.

"The `rule of two' states that whenever the disorder is present in a patient for more than two years without satisfactory control, and in spite of optimum treatment with two standard anti-epileptic drugs, he or she has two disabling seizures every month, the situation warrants evaluation for fitness for surgery,'' he explained.

Further, the results of surgery based on these inputs were very satisfactory with more than 80 per cent of the patients achieving a seizure-free state, and a good fraction of them being able to get rid of medication also.

While the available medication controlled seizures in 70 per cent of the patients, management of the rest was a challenging problem, and surgery could be an option for such patients, after a thorough investigation, the eminent neurologist said.

Disturbing trend

"Healthcare in developing countries like India is beset with huge disease burden - India accounts for 75 per cent of the global burden of 40 million epilepsy patients - inadequate infrastructure, problems of affordability and acceptability and lack of reliable information.

Unfortunately, all the 500 neurologists in our country practise in urban areas. While 70 per cent of the patients in India live in rural areas, the 70 per cent medical manpower lives in urban areas,'' he lamented.

Dr. Venktateswarlu was unhappy to point out that though the market was flooded with a range of new medications, they had not made the life easier for epileptics, because these medicines were not only expensive, but also ineffective in difficult-to-treat patients.

``However, India has taken rapid strides in the direction of surgery with a number of centres fulfilling this long-felt need. Sri Chitra Tirunal Medical Centre for Medical Sciences and Technology in Thiruvananthapuram, an autonomous centre of the Union Government, has pioneered the surgical technique and the results obtained are comparable to any centre in the West.

Institutions in Bangalore, Hyderabad and Delhi are also doing a commendable work,'' he said.

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