Amrita Advanced Centre For Epilepsy

The Amrita Advanced Center for Epilepsy (AACE), established in February 2010, 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.

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.
• 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.

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

In our center, we have 256-channel high density EEG (EGI Magstim, USA) to conduct ESI studies in our epilepsy patients In this technique, a 256-channel HD EEG is recorded from the patient’s brain for about 4-8 hours. Finally, the brain area which generates the epileptic activity is localized using detailed mathematical inverse solutions.

 Neuroimaging facilities

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. 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).

Functional MRI

Functional MRI (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.

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.

 Extra operative intracranial EEG (ICEEG) monitoring & Stereo-EEG

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. This minimally invasive technique allows seizure focus detection without an open skull surgery. To date, we have performed over 200 invasively monitored surgeries for the most difficult cases.

 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.

Brain Mapping Laboratory

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 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. In the interictal PET scans, the epileptic abnormalities are marked by the reduced metabolism in the corresponding regions. In the usual clinical setup, the PET scans are analyzed visually to identify the reduced metabolism referencing the contralateral side of brain. 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 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
• 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

 Outpatient Services

4 full-time epileptologists are always available for consultations.

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 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

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.

• 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

• B.Sc. Neuroelectrophysiology
• M.Sc. Neuroelectrophysiology

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

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