Functional Neurosurgery in Hyderabad
— Epilepsy Surgery, DBS, and Trigeminal Neuralgia at KIMS

This is one of the most consequential misconceptions about epilepsy management in India. Epilepsy surgery is a well-established, evidence-based treatment that has been performed for over 50 years and is supported by Class I evidence from randomised controlled trials. The landmark NEJM trial by Wiebe et al. (2001) demonstrated that surgery was superior to continued medical therapy for temporal lobe epilepsy — 64% of surgical patients were seizure-free at 1 year versus 8% of medically managed patients. The general principle: any patient with drug-resistant epilepsy (seizures continuing on two appropriate antiepileptic drugs at adequate doses) should be referred for a comprehensive epilepsy surgery evaluation at a specialist centre. This evaluation — not the surgery itself, but the evaluation — determines whether surgery is appropriate for that patient. Approximately 30–40% of drug-resistant patients who complete evaluation are found to have a surgically treatable focus. At KIMS, the epilepsy surgery programme provides the full evaluation and treatment pathway. A referral does not commit a patient or family to surgery — it begins an evaluation to determine whether surgery is an option. Call 040-44885000.

Deep brain stimulation (DBS) is the most effective surgical treatment for Parkinson's disease motor symptoms. It involves implanting thin electrodes in specific targets within the brain (most commonly the subthalamic nucleus, STN) and connecting them to a pulse generator (similar to a pacemaker) implanted under the skin of the chest. The electrodes deliver continuous high-frequency electrical stimulation to the STN, which modulates the abnormal motor circuit activity of PD and restores more normal motor function. The benefits of DBS in appropriately selected PD patients: 50–70% reduction in motor fluctuations and dyskinesia · Reduction in levodopa dose by 30–50% on average · Improvement in “off” state motor function (the PD symptoms when medication is not working) · Improved quality of life. DBS is not appropriate for all PD patients: it works best for patients with good levodopa response (the motor symptoms that respond well to levodopa are the ones that respond well to DBS) · Patients with prominent dementia, severe psychiatric illness, or postural instability and falls as the dominant feature are generally not good DBS candidates. Safety: the serious complication rate at a high-volume centre like KIMS is approximately 1–2% for intracranial haemorrhage and 2–4% for infection. At KIMS, DBS programming is provided by the movement disorders team after implantation. Call 040-44885000.

Trigeminal neuralgia at age 72 has several treatment options, and the best choice depends on her general health and fitness. The options range from least invasive to most invasive: (1) Gamma Knife radiosurgery: a same-day outpatient procedure requiring no anaesthesia. The most appropriate option for patients who are not fit for surgery. Pain relief in 70–80% of patients, beginning 4–12 weeks after treatment. The least immediately effective but the safest. (2) Percutaneous rhizotomy (balloon compression, glycerol injection, or radiofrequency thermocoagulation): a brief procedure under light general anaesthesia, accessing the trigeminal nerve through the cheek without opening the skull. Hospital stay 1 day. Immediate pain relief in 85–95% of patients. Well-tolerated in the elderly. Some degree of facial numbness is expected. Recurrence rate higher than MVD. (3) Microvascular decompression (MVD): open surgery through a small opening behind the ear under general anaesthesia. The most durable treatment (80–85% long-term pain freedom). Appropriate for patients who are fit for surgery. For a 72-year-old in good general health, MVD is often the best choice for durability. For a 72-year-old with significant cardiac or respiratory comorbidities, Gamma Knife or percutaneous rhizotomy are appropriate alternatives. At KIMS, all three options are available and the choice is discussed in detail at the consultation. Call 040-44885000.

The KIMS comprehensive epilepsy surgery evaluation follows international standards and includes: (1) Phase 1 evaluation (non-invasive): long-term video-EEG monitoring to capture habitual seizures and characterise the ictal onset zone · High-resolution 3 Tesla MRI epilepsy protocol (1 mm isotropic T1, FLAIR, T2) · Neuropsychological testing · SPECT interictal and ictal (where available) · FDG-PET · Magnetoencephalography (MEG) where available. (2) Multidisciplinary epilepsy surgery conference: all Phase 1 data reviewed by epileptologist, neurosurgeon, neuroradiologist, and neuropsychologist. Decision: proceed to Phase 2 (invasive) or direct to surgery. (3) Phase 2 (invasive EEG, where required): sEEG implantation using the Stealth AutoGuide robotic system · Chronic recording of seizures with depth electrodes in cortical and subcortical targets defined by Phase 1 data · Electrical stimulation mapping to define eloquent cortex. (4) Second multidisciplinary conference: Phase 2 data reviewed · Resection plan defined. (5) Surgery: under general anaesthesia with intraoperative ECoG and cortical stimulation mapping. Referrals are accepted from across Telangana, AP, Karnataka, and Odisha. Email neuroscience@kimshospitals.com or call 040-44885000.