Outcome of Surgical Treatment in Medically Refractory Epilepsy.

The aim of epilepsy surgery is not only to control seizures but also to curtail future adverse neurological sequelae and improve quality of life. Epilepsy surgery is a viable treatment option for selected cases of medically refractory epilepsy. A study was carried out with a series of 34 cases who underwent epilepsy surgery at Sree Chitra Tirunal Institute for Medical Science & Technology, Kerala, India during July, 2010 to December, 2010. Clinical features, operative procedures and early response to treatment were cha'racterized. Among 34 cases, main clinical manifestation was recurrent seizures. All cases were evaluated by Video Electro Encephalogram (EEG) & Magnetic Resonance Imaging (MRI) of brain with epilepsy protocol. Nearly 58% cases were diagnosed as mesial temporal sclerosis who were treated by anterior temporal lobectomy (ATL) with amygdalohippocampectomy (AH). Excision of epileptogenic foci was confirmed by preoperative Electro Cardiogram. Early response to surgery was good. However, a prolonged longitudinal follow up is essential for accurate assessment of seizure outcome.

Surgery for primary intracerebral haemorrhage: is it safe and effective?

This prospective study was conducted to compare the outcome between medical and surgical treatment of primary intracerebral haemorrhage at the department of Neurosurgery, Dhaka Medical College Hospital from January 2006 to October 2007. All patients with primary intracerebral haematoma with Glasgow Coma Scale (GCS). 5-15 (on admission) and heamatoma volume 30 cc or above admitted at Neurosurgery department managed conservatively or surgically were included in this study. Total 60 patients were selected, of them 30 patients managed conservatively and 30 patients managed surgically. Conservatively managed patients regarded as control group (Group-A) and surgically managed patients regarded as experimental group (Group-B). Patients or attendants refused to operate were included in the conservative group. All the selected patients were evaluated on the basis of detailed history, clinical examination (general and neurological examination) and CT scan findings. Outcome was evaluated in term of Glasgow Outcome Scale (GOS). Best medical treatment was given for conservative group and operations were done for surgical group and followed up after surgery till discharge by observing GCS and GOS at discharge. Number of death were 15 (50%) patients in group-A and 13 (43%) patients in group-B. There was no significant difference in mortality rate between two groups but outcome was relatively better in group-B. According to Glasgow Outcome Scale, dependency in group-A and group-B was 26.6% and 23.4% respectively. So dependency were more in group-A. But there was no significant difference statistically. Seven (23.4%) patients were independent in group-A but 10(43.3%) patients were independent in group-B. However in relative terms of outcome of group-B was better than that of group-A. In our study we found no statistically significant difference in outcome between medical and surgical management of primary intracerebral haemorrhage.