• Kochi: (0) 484 2852100, 6682100, Faridabad: 0129-2851234

Amrita Advanced Centre for Epilepsy

The Amrita Advanced Center for Epilepsy (AACE) was established in February, 2010 with the aim to cure epilepsy in the state. Today the AACE caters to patients from all over India, the middle east, Africa, Asia minor and other southeast Asian countries. The center has also emerged as an advanced epilepsy teaching centre for training neurologists, neurosurgeons, psychologists and technicians in the field - providing a strategy to help contain this globally devastating illness.

Epilepsy

Epilepsy is a common disease that afflicts nearly 60 million people worldwide of which 6 million (10%) reside in India. Apart from being a physical disease, epilepsy has a strong mental and social implication. This disease adversely affects women with pregnancy and also is an important contributor of learning disability in children. The incidence of divorce among epilepsy patients is on the rise. The unpredictability of the epileptic attack leaves the patients helpless and most of the time at the mercy of others.

Drug-resistant epilepsy

Approximately one-third of patients, whose seizures are not responsive to AEDs (drug-resistant epilepsies), can be cured of their seizures by surgical treatment (epilepsy surgery). Amrita Advanced Centre for Epilepsy (AACE) provides comprehensive care to individuals who suffer from epilepsy. The Centre celebrated the successful completion of over 800 epilepsy surgeries in its twelfth year of service on February, 2022. Our team of experts include adult epileptologists, pediatric epileptologists, epilepsy surgeons, radiologists, nuclear medicine physician, neuroscientists, neuropathologist, neuropsychologist, medical social workers and dieticians.

People

Doctors /Faculty

Post-doctoral Epilepsy Fellows

Current
Past

Post-doctoral Epilepsy Surgery Fellows

Current
Past

Research Faculty

Neuroradiologist

Nuclear Medicine Physicians

Neuropathologist

Neuropsychologist

Neuropsychiatrist

Ketogenic Diet Clinic

Neurotechnologists

Epilepsy Nurse-in-Charge

Epilepsy Co-ordinator

Salient features of AACE

  • AACE has the largest epilepsy monitoring unit in the country.
  • AACE is equipped with High Density EEG (256 channel) system.
  • Have completed over 800 cases of epilepsy surgeries till date.
  • Amrita epilepsy center is the first in the country to develop stereo EEG program.
  • Our center is also the first in the continent to start Robotic Assisted Stereo EEG.
  • AACE has performed the largest number (more than 200 cases) of stereo EEGs evaluations in the country.
  • Our centre is also the pioneer in minimally invasive epilepsy surgery - radio frequency ablation and has performed the largest number of ablations in the country.
  • AACE also treats, medically, refractory epilepsy cases with deep brain stimulation.

Services

1. Outpatient Services

4 full-time epileptologists (neurologists with fellowship training and expertise in modern management of epilepsy) are always available for consultations for patients with epilepsy.

2. Inpatient Services and Epilepsy Monitoring Unit (EMU)

AACE is equipped with a 12-bedded state-of-the-art unit dedicated to long-term Video-EEG (Electroencephalography) monitoring of patients with epilepsy. The unit is staffed full-time with nurses trained at detection and management of seizures and neurotechnologists trained in advanced EEG techniques. Equipped with the latest advances in EEG recording, the EMU is the heart of the epilepsy centre and accurate diagnosis and localization of seizures is key for leading to a successful cure.

3. 256-channel High Density EEG and Electrical Source Localization (ESI)

ESI is an advanced signal and image-based technique used to localize the brain circuit involved in seizure generation and propagation. In this technique, a 256-channel HD EEG is recorded from the patient’s brain for about 4-8 hours. In a careful review the epileptic activity will be identified. Following this, an electrical model patient head model will be constructed from the patient’s volumetric MRI. Finally, the brain area which generates the epileptic activity is localized using detailed mathematical inverse solutions. In our center, we have 256-channel high density EEG (EGI Magstim, USA) to conduct ESI studies in our epilepsy patients.

4. Neuroimaging facilities

Modern evaluation of epilepsy requires precise imaging - high strength MRI (3 Tesla MRI), 3T MRI PET scanner and Brain PET (Positron Emission Tomography) form the cornerstone of the epilepsy imaging. The AACE is equipped with a GE Discovery 750 W Silent 3T MRI, Siemens 3T MRI PET scanner and GE Discovery PET 8 slice CT scanner. Two full-time radiologists and a full time nuclear medicine specialist form part of the core-group in the AACE and provide their services and expertise in the twice weekly pre-surgical epilepsy conferences. In addition to PET imaging, the nuclear medicine department in conjunction with the EMU team of epileptologists, nurses and neurotechnologists are able to perform the difficult task of Ictal SPECT (Ictal Single Photon Emission Computed Tomography). This study which involves injection of a radioactive tracer at the onset of the patient’s seizures followed by imaging of the blood flow changes in the brain, helps to localize the focus responsible for seizures prior to surgical removal.

5. Functional MRI

Functional MRI (fMRI) is a technique that maps the physiological or metabolic consequences of altered electrical activity in the brain. Neuronal stimulation leads to a local increase in energy and oxygen consumption in functional areas. The subsequent local hemodynamic changes transmitted via neurovascular coupling are measured by fMRI. The blood-oxygen-level-dependent (BOLD) technique depends on the difference in the magnetic properties between oxygenated (oxy-Hb) and deoxygenated (deoxy-Hb) hemoglobin. Paramagnetic deoxy-Hb produces local field in homogeneities in the measurable range of MRI, resulting in signal decrease in susceptibility-weighted MRI-sequences (T2*), whereas diamagnetic oxy-Hb does not interfere with the external magnetic field. Therefore, fMRI provides the information of the regional blood flow corresponding to certain neuronal activity. fMRI is a good technique for localizing and lateralizing language function and other eloquent brain areas prior to surgery. This diagnostic information permits function-preserving and safe treatment. Besides this, resting state fMRI provides the information regarding the existence of functional connectivity in the brain. Therefore, this can also provide any information regarding the functional alteration in epileptic brain as deviated from the healthy brain.

6. Wada

Uses administration of a drug directly into the arteries of the brain to confirm the side of the brain involved in language and memory.

7. Extraoperative intracranial EEG (ICEEG) monitoring & Stereo-EEG

Though we try to localize the seizure focus in the brain using the above noninvasive methods and then proceed with a curative surgery as much as possible, these methods are often limited in providing exact information for curative surgery. Being limited to these approaches is probably one reason for surgical failures at many centres throughout the world. Hence advanced techniques of intracranial EEG were developed at our centre from the beginning to handle the most difficult cases and increase our success rates. To date, we have performed over 200 invasively monitored surgeries for the most difficult cases. The AACE is the first center in India to develop and actively practice the technique of Stereo-EEG. We have done the maximum number of intracranial EEG with this special technique of Stereo-EEG in this country. This minimally invasive surgery involves precise insertion of fine electrodes into the brain to safely target and monitor electrical activity throughout the brain and carefully reveal the structures and networks that give rise to seizures. This minimally invasive technique allows seizure focus detection without an open skull surgery. Today, the procedure is performed robotically at our centre.

8. Functional Brain Mapping

Electrodes implanted into the brain are used to precisely map the areas of the brain involved in different functions like speaking, moving, sensations, vision. This information is then used to safely preserve important brain functions while removing the area responsible for the seizures.

Surgical program

The surgical program at the AACE has successfully completed over 800 surgeries since its inception and has quickly emerged as one of the leading referral centres for epilepsy surgery. The majority of epilepsy surgeries are performed to remove the specific structures within the brain that give rise to the patient’s seizures. After a detailed pre-surgical evaluation through the EMU and imaging centres, the team meets twice weekly, dedicating time to evaluate and form a surgical plan for each individual patient. The unique strengths of the AACE surgical programme include 1) Robotic insertion of Stereo EEG electrodes for mapping seizure focus and brain functions (the first in India), 2) facilities and expertise in awake surgery to maximize the successful outcomes in brain surgeries (more than 100 awake surgeries successfully completed to date), 3) extraoperative brain mapping, 4) image-guidance technology, 5) advanced electrocorticography and 6) two trained epilepsy surgeons experienced in all techniques of adult and pediatric epilepsy surgery. As a result of the multi-modal, labor-intensive approach by a highly skilled team, the AACE has already demonstrated higher seizure-freedom rates (80-90 %), well above the reported norms.

Brain Mapping Laboratory

This facility helps in our pre-surgical evaluations with advanced signal and image post processing techniques. The lab consists of a computational neurologist, Dr. Harilal Parasuram (Ph.D in Computational Neuroscience, Amrita University) and a Senior Research Fellow, Shameer Aslam (M.tech. in Signal and Image processing, NIT).

1. Advanced Signal analysis

This facility helps in our pre-surgical evaluations with advanced signal and image post processing techniques. The lab consists of a computational neurologist, Dr. Harilal Parasuram (Ph.D in Computational Neuroscience, Amrita University) and a Senior Research Fellow, Shameer Aslam (M.tech. in Signal and Image processing, NIT).

A. Stereo-EEG analysis using Epileptogenicity Rank (ER)

Epileptogenicity Rank (ER) is a modified method of EI for quantifying epileptogenicity of brain structures in epilepsy patients. ER was calculated as the normalized values of the product of spatio-temporal parameter and energy of the signal. The spatial parameter was added along with the existing temporal domain based index calculation (EI) to bring the new epileptogenicity rank. ER classifies the seizure onset from the propagation using abrupt frequency change in the time domain and the spatial domain by the anatomical distance from the brain structure that initiated the seizure discharges.

B. High frequency oscillation analysis

High frequency oscillations (HFOs) are produced in the brain during higher cognitive tasks such as language processing, motor planning, and memory consolidation. Studies have also shown that the brain circuit that constitutes the epileptogenic network generates more elevated rates of HFOs (pathological HFOs). In our center, we study HFOs in the Ripples (80-250Hz) and Fast Ripples (250-600 Hz) band, then estimate the region-specific HFO rates for the prediction of the epileptogenic zone.

2. Advanced Image Analysis
A. PASCOM -Advanced PET analysis

18F FDG PET is an essential imaging modality for pre-surgical evaluation of drug resistant epilepsy (DRE) patients. PET provides the information of metabolism through proportional intensity on the image. In the interictal PET scans, the epileptic abnormalities are marked by the reduced metabolism in the corresponding regions. Therefore, identification of hypometabolism in PET images is an essential hunt to localize the epileptogenic zone. In the usual clinical setup, the PET scans are analyzed visually to identify the reduced metabolism referencing the contralateral side of brain. The standardized and efficient analysis of PET necessitates the computational intervention. Therefore, we developed a novel technique named PASCOM (PET asymmetry after anatomical symmetrization coregistered on MRI) to automatically identify the region of hypometabolism in PET. PASCOM is independent of comparison to the age and gender matched control PET data required for the existing automated PET analysis techniques. Therefore, PASCOM is suitable for the pediatric as well as the adult PET brain analysis.

B. Subtraction Ictal SPECT CO-registered to MRI (SISCOM).

Subtraction Ictal SPECT CO-registered to MRI (SISCOM) is an imaging technique used to help localize the epileptogenic focus in patients with intractable partial epilepsy. SISCOM processing is commonly divided into four steps: SPECT-SPECT (S-S) registration, intensity normalization, subtraction, and SPECT-MRI (S-M) co-registration. Along with other pre-surgical evaluations, SISCOM helps to identify brain structures which are epileptic and can map the epileptic circuit. SISCOM is proven to be superior to visual analysis of unsubtracted ictal SPECT studies.

C. Voxel Based Morphometry Analysis for MRI lesion detection

The voxel-based MRI analysis is an advanced image processing technique used to detect lesions in a patient’s brain. In this analysis, the distribution of grey and white matter is analyzed on a voxel-wise basis and compared with a normal database of 9000+ controls. Based on this analysis, a three-dimensional feature map is created that highlights brain areas if their signal intensities fall within the range between normal grey and white matter and differ from the normal database in this respect. This MRI post-processing helps to detect lesions unrecognized in conventional visual analysis.

D. Hippocampal volumetry

Hippocampal volumetry is a useful method for detecting MR-subtle temporal lobe epilepsy (TLE). In our analysis, we segment the complete hippocampal structure bilaterally in T1-weighted MRI images. Tracing is done using atlas-based segmentation. Then statistically compare calculate the volumes of the left and right hippocampus with age-matched normal hippocampal volumes.

The Lab also offers internship for master’s students.
For details, contact Dr. Harilal Parasuram

Research Collaborations

  • Impact of COVID-19 pandemic on epilepsy practice in India: A tripartite survey
  • Association of Child Neurology – Indian Epilepsy Society Expert Committee. Association of Child Neurology (AOCN) - Indian Epilepsy Society (IES) Consensus Guidelines for the Diagnosis and Management of West Syndrome.
  • Swiss epilepsy center, Zurich, EU for developing research tools for MRI lesion detections.
  • Multi-centric study on Human Intracerebral EEG Platform.
  • National Institute of Mental Health and Neurosciences, for magnetoencephalography (MEG) studies.

Fellowship Programs

  • Fellowships in Epileptology

Centre offers one-year postdoctoral clinical epilepsy fellowship programme: yearly intake of 2 candidates

For details, contact Dr.Siby Gopinath

  • Fellowships in Stereotactic/Functional Neurosurgery

Centre offers two-year postdoctoral epilepsy surgery fellowship programme: biennial intake of 1 candidate

For details, contact Dr. Ashok Pillai 

Courses

Research Training Programs

The center also provides internships for master’s/bachelor students from engineering /computer science / computational biology backgrounds.

For details, please contact Dr. Harilal Parasuram

Publications

  1. Aslam S, Rajeshkannan R, Sandya CJ, Sarma M, Gopinath S, Pillai A. Statistical asymmetry analysis of volumetric MRI and FDG PET in temporal lobe epilepsy. Epilepsy Behav. 2022 Sep;134:108810. doi: 10.1016/j.yebeh.2022.108810. Epub 2022 Jul 5. PMID: 35802989. 
  2. Devisetty R, Amsitha MB, Jyothirmai S, Ajai R, Pillai A, Kumar A, Gopinath S and Parasuram H. Localizing epileptogenic network from SEEG using non-linear correlation, mutual information and graph theory analysis, Journal of engineering in medicine, 2022.
  3. Shridharani A, Parasuram H, Mrudula B, Bhaskaran R, Kumar A & Gopinath S, Retrospective analysis of autonomic dysfunction in epilepsy patients from neurophysiological recordings, Neurology Asia, 2022.
  4. Aslam S, Damodaran N, Rajeshkannan R, Sarma M, Gopinath S, Pillai A. Asymmetry index in anatomically symmetrized FDG PET improves epileptogenic focus detection in pharmacoresistant epilepsy. Journal of Neurosurgery, 2022.
  5. Devisetty R, Amsitha MB, Jyothirmai S, Ajai R, Pillai A, Kumar A, Gopinath S and Parasuram H. Localizing epileptogenic network from SEEG using non-linear correlation, mutual information and graph theory analysis, Journal of engineering in medicine, 2022.
  6. Shridharani A, Parasuram H, Mrudula B, Bhaskaran R, Kumar A & Gopinath S, Retrospective analysis of autonomic dysfunction in epilepsy patients from neurophysiological recordings, Neurology Asia, 2022.
  7. Aslam S, Damodaran N, Rajeshkannan R, Sarma M, Gopinath S, Pillai A. Asymmetry index in anatomically symmetrized FDG PET improves epileptogenic focus detection in pharmacoresistant epilepsy. Journal of Neurosurgery, 2022.
  8. Jayapaul P, Gopinath S, Pillai A. Outcome following surgery for insulo-opercular epilepsies. J Neurosurg. 2022 Mar 11:1-11. doi: 10.3171/2021.12.JNS212220. Epub ahead of print. PMID: 35276652.
  9. Baheti N, Rathore C, Bansal AR, Kannan L, Gopinath S, Pillai A, Jagtap S,Patil S, Jabeen SA, Suryaprabha T, Jayalakshmi S, Ravat S, Shah U, Mani J, SinghAP, Nayak DS, Prakash S, Rana K, Khan FR, Udani V, Murthy JMK, Radhakrishnan K.Current practices in epilepsy monitoring units (EMU) in India. Seizure. 2021Dec;93:13-19. doi: 10.1016/j.seizure.2021.10.004. Epub 2021 Oct 8. PMID:34653788.
  10. Gopinath S, Pillai A, Diwan A, Pattisapu J.V, Radhakrishnan K. Reiterating the role of corpus callosum in generalization of interictal andictal epileptiform discharges: a case report with post-callosotomy intracranial electroencephalographyin Lennox–Gastautsyndrome, 2021, https://doi.org/10.17749/2077-8333/epi.par.con.2021.086
  11. George, A. Kurup, P. Balachandran, M. Nair, S. Gopinath, A. Kumar, H. Parasuram. Predicting Autonomic Dysfunction in Anxiety Disorder from ECG and Respiratory Signals Using Machine Learning Models, IJOE, 2021, https://doi.org/10.3991/ijoe.v17i07.22581
  12. Borlot F, Abushama A, Morrison-Levy N, Jain P, PuthenveettilVinayan K, Abukhalid M, Aldhalaan HM, Almuzaini HS, Gulati S, Hershkovitz T, Konanki R, Lingappa L, Luat AF, Shafi S, Tabarki B, Thomas M, Yoganathan S, Alfadhel M, Arya R, Donner EJ, Ehaideb SN, Gowda VK, Jain V, Madaan P, Myers KA, Otsubo H, Panda P, Sahu JK, Sampaio LPB, Sharma S, Simard-Tremblay E, Zak M, Whitney R. KCNT1-related epilepsy: An international multicenter cohort of 27 pediatric cases. Epilepsia. 2020 Apr;61(4):679-692. doi: 10.1111/epi.16480. Epub 2020 Mar 13. PMID: 32167590.
  13. Rathore C, Baheti N, Bansal AR, Jabeen SA, Gopinath S, Jagtap S, Patil S, Suryaprabha T, Jayalakshmi S, Ravat S, Nayak DS, Prakash S, Rana K, Jaiswal SK, Khan FR, Murthy JM, Radhakrishnan K. Impact of COVID-19 pandemic on epilepsy practice in India: A tripartite survey. Seizure. 2021 Mar;86:60-67. doi: 10.1016/j.seizure.2020.12.025. Epub 2021 Jan 8. PMID: 33550135; PMCID: PMC7837209.
  14. Parasuram H, Gopinath S, Pillai A, Diwakar S, Kumar A. Quantification of Epileptogenic Network From Stereo EEG Recordings Using Epileptogenicity Ranking Method. Front Neurol. 2021 Nov 3;12:738111. doi: 10.3389/fneur.2021.738111. PMID: 34803883; PMCID: PMC8595106.
  15. Udayakumaran S, Karthika KS, Nair NS, George M, Gopinath S. Prognostication of the neurological outcome of tethered cord based on intraoperative neuromonitoring findings: how close can we get? Br J Neurosurg. 2021 Aug 28:1-9. doi: 10.1080/02688697.2021.1940855. Epub ahead of print. PMID: 34459322.
  16. Jayakumar H, Gopinath S, Pillai A, Kumar A. Epileptic nystagmus due to a large parieto-temporo-occipital multilobar dysplasia. Epileptic Disord. 2020 Oct 1;22(5):691-692. doi: 10.1684/epd.2020.1214. PMID: 33146143.
  17. Pillai A, Ratnathankom A, Ramachandran SN, Udayakumaran S, Subhash P, Krishnadas A. Expanding the Spectrum of Robotic Assistance in Cranial Neurosurgery. OperNeurosurg (Hagerstown). 2019 Aug 1;17(2):164-173. doi:10.1093/ons/opy229. PMID: 30203040.
  18. Roy AG, Gopinath S, Kumar S, Kannoth S, Kumar A. Delayed Orthostatic Hypotension: A Pilot Study from India. Ann Indian Acad Neurol. 2017 Jul- Sep;20(3):248-251. doi: 10.4103/aian.AIAN_498_16. PMID: 28904457; PMCID: PMC5586120.
  19. Makhija P, Gopinath S, Kannoth S, Radhakrishnan K. A case of post- leptospirosis autoimmune epilepsy presenting with sleep-related hypermotor seizures. Epileptic Disord. 2017 Dec 1;19(4):456-460. doi: 10.1684/epd.2017.0941. PMID: 29160208.
  20. Rathore C, Radhakrishnan K. Epidemiology of epilepsy surgery in India. Neurol India. 2017;65(Supplement):S52-S59. doi: 10.4103/neuroindia.NI_924_16. PMID: 28281496.
  21. Gopinath S, Roy AG, Vinayan KP, Kumar A, Sarma M, Rajeshkannan R, Pillai A. Seizure outcome following primary motor cortex-sparing resective surgery for perirolandic focal cortical dysplasia. Int J Surg. 2016 Dec;36(Pt B):466-476. doi: 10.1016/j.ijsu.2015.10.036. Epub 2015 Nov 2. PMID: 26542986.
  22. Sharma S, Kaushik JS, Srivastava K, Goswami JN, Sahu JK, Vinayan KP, Mittal R; Association of Child Neurology – Indian Epilepsy Society Expert Committee. Association of Child Neurology (AOCN) – Indian Epilepsy Society (IES) Consensus Guidelines for the Diagnosis and Management of West Syndrome. Indian Pediatr. 2021 Jan 15;58(1):54-66. PMID: 33452776.
  23. Rathore C, Jeyaraj MK, Dash GK, Wattamwar P, Baheti N, Sarma SP, Radhakrishnan K. Outcome after seizure recurrence on antiepileptic drug withdrawal following temporal lobectomy. Neurology. 2018 Jul 17;91(3):e208-e216. doi: 10.1212/WNL.0000000000005820. Epub 2018 Jun 20. PMID: 29925547.
  24. Jayabal V, Pillai A, Sinha S, Mariyappa N, Satishchandra P, Gopinath S, Radhakrishnan K. Role of magnetoencephalography and stereo- electroencephalography in the presurgical evaluation in patients with drug- resistant epilepsy. Neurol India. 2017;65(Supplement):S34-S44. doi: 10.4103/0028-3886.201680. PMID: 28281494.
  25. Jayakumar H, Gopinath S, Pillai A, Kumar A. Epileptic nystagmus due to a large parieto-temporo-occipital multilobar dysplasia. Epileptic Disord. 2020 Oct 1;22(5):691-692. doi: 10.1684/epd.2020.1214. PMID: 33146143.
  26. Sankaranarayanan M, Makhija P, Gopinath S, Mathew N, Radhakrishnan K. Comparison of clinical and electrophysiological characteristics between ictal and cardiac asystole encountered during video-EEG monitoring. Epileptic Disord. 2019 Aug 1;21(4):337-346. doi: 10.1684/epd.2019.1085. PMID: 31371275.
  27. Dash GK, Rathore C, Jeyaraj MK, Wattamwar P, Sarma SP, Radhakrishnan K. Predictors of seizure outcome following resective surgery for drug-resistant epilepsy associated with focal gliosis. J Neurosurg. 2018 Aug 1:1-9. doi: 10.3171/2018.3.JNS172949. Epub ahead of print. PMID: 30141758.
  28. Ganti B, Chaitanya G, Balamurugan RS, Nagaraj N, Balasubramanian K, Pati S. Time-Series Generative Adversarial Network Approach of Deep Learning Improves Seizure Detection From the Human Thalamic SEEG. Front Neurol. 2022 Feb 16;13:755094. doi: 10.3389/fneur.2022.755094. PMID: 35250803; PMCID: PMC8889931.
  29. Khan F, Rathore C, Kate M, Joy J, Zachariah G, Vincent PC, Varma RP, Radhakrishnan K. The comparative efficacy of theta burst stimulation or functional electrical stimulation when combined with physical therapy after stroke: a randomized controlled trial. ClinRehabil. 2019 Apr;33(4):693-703. doi: 10.1177/0269215518820896. Epub 2019 Jan 8. PMID: 30618285.

Our Team

Our Team

Contact Us

Amrita Advanced Centre for Epilepsy (AACE),
Amrita Institute of Medical Sciences,
AIMS P. O, Kochi, Kerala 682041
Phone: 0484 – 2851310 / 9400998559

For epilepsy consultation appointments

Phone : 0484 6682100

For epilepsy surgery appointments

Ms. Nayana
Phone : 9400998546
Email: mswneurosurgery@aims.amrita.edu