Epilepsy, a chronic neurological disorder characterized by recurrent seizures, affects millions of people worldwide. While seizures can be effectively controlled with medication in many cases, a significant portion of patients experience drug-resistant epilepsy. This necessitates exploring alternative management strategies, including surgery. This report delves into the medical and surgical approaches for managing epilepsy.

The webinar boasted the combined attendance of both Neurology as well as Neurosurgery departments to present the medical and surgical management respectively for epilepsy.

We started with Neurology team discussing about the basic definition, classification and pathogenesis of epilepsy. Case based informative videos were used to show the actual symptoms of various forms of epileptic disorders so that our upcoming healthcare professionals could develop better understanding of the topic. Emphasis was laid on careful and detailed history taking for better prognostication and asserting various treatment modalities to the patients. Then we proceeded to understand the medical management of epilepsy.

Medications remain the cornerstone of epilepsy treatment. The goal is to find an anti-seizure medication (ASM) or combination that effectively prevents seizures with minimal side effects. The selection of an ASM depends on various factors like seizure type, cause of epilepsy, individual tolerability, and potential interactions with other medications.

Various ASMs discussed included:

Sodium channel blockers: Examples include Lamotrigine, Carbamazepine, and Phenytoin.

GABAergic drugs: Examples include Gabapentin, Levetiracetam, and Zonisamide.

Other mechanisms: Topiramate

Next, we discussed on the treatment initiation and monitoring regimens where we concluded that the guidelines were to start with a single ASM at a low dose and gradually increase it to achieve seizure control. Regular monitoring of seizure frequency, blood levels of the medication, and potential side effects was crucial.If a single medication failed to control seizures, a combination of two or more ASMs with different mechanisms of action was warranted. However, this would increase the risk of side effects and the complexity of medication management.

In some cases, additional medications would be used to manage specific seizure types or address co-existing conditions like anxiety or depression.

Further, we talked upon the surgical management of epilepsy where Neurosurgery department commenced by enumerating various surgical techniques available including the ones from the past to the recent advances. Ideal candidates for epilepsy surgery included those having seizures originating from a well-defined area of the brain (focal epilepsy) that can be safely removed without causing significant functional deficits. Pre-surgical evaluation involved extensive testing, including neuroimaging (MRI), electroencephalography (EEG), and neuropsychological assessment.

Various surgical techniques discussed included broadly:

Resective surgery:the most common type of epilepsy surgery, involving the removal of a small portion of the brain containing the seizure focus. The specific type of resection depended on the location of the seizure focus. Examples include temporal lobectomy (removal of part of the temporal lobe) and frontal lobectomy (removal of part of the frontal lobe).

Disconnective surgery: Aiming to disconnect the pathways between seizure-generating areas and other parts of the brain, thereby preventing seizure spread. Corpus callosotomy is an example, where surgeons sever the corpus callosum, the main bundle of nerves connecting the two hemispheres of the brain.

Minimally invasive surgery: Newer techniques like laser interstitial thermal therapy (LITT) use lasers to destroy the seizure focus with minimal tissue damage were also discussed.

Potential complications that were discussed included bleeding, infection, and neurological deficits depending on the location of the surgery.

The concluding remarks emphasized the importance of proper history taking and dedicated workup before assigning any treatment modality to the epileptic patients. The webinar served as providing continued medical education in understanding the technical aspects and guidelines regarding epilepsy management and the recent updates and innovations regarding the same.