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Suffering From Seizures. Having Occipital Calcified Tuberculoma. Does Surgery Help?

Posted on Tue, 10 Dec 2013

Question: Hello Sir My name Is XXXXX I did my MBBS in Osmania medical college Hyderabad Currently in USA seeking residency in Internal Medicine My family member has a left parieto occipital calcified tuberculoma suffering with siezures currently on anticonvulsunt therapy will surgery to remove the calcified tuberculoma help? (suggested as one treatment option by his neurosurgeon in Hyderabad ) how much is the risk in surgery? whats the longterm outcome? whats the anticipated prognosis with reference to seizures ,I will be grateful if you tell me briefly how surgery is done like incision ,approach to the calcified area, which areas of brain parenchyma will be cut ,what is the risk of residual functional deficiencies after surgery, what is your own suggestion after calculating the risk versus benefits for this person. Thank you for your valuable time and effort to go through this case. Have a good day. XXXXX

Answered by Dr. Praveen K Nath (13 hours later)

Brief answer: Tuberculoma calcified Detailed answer: Dear Dr. XXXXX Hello My best wishes for a speedy recovery to your relative. I have gone through your patient’s history & ct scans in detail. Patient has a moderately large left parietooccipital calcification with surrounding gliosis. Regarding surgical decompression may I suggest you to 1. Maintain a seizure diary to actually see the seizure frequency. 2. Minimize the seizure frequency with adequate anticonvulsant medications. 3. In my opinion, if patient is neurologically intact & seizure frequency is less than one/month, then we should manage him conservatively. 4 . Surgical decompression is reserved only for cases, which are refractory to anticonvulsant medications (adequate), who have high seizure frequency .or have neurological deficits. 5 surgical procedures are for those patients whose lesions & seizures correlate clinically and neurophysiologically . 6. Surgical procedures for epilepsy etc carry risk of complications like hemiplegia, infection, increased seizure frequency, etc. But risk ratio is decreasing in institutes where epilepsy surgery is being done regularly. 7. For assessment get his fresh mri brain /eeg/video eeg/serum drug levels for anticonvulsants & a thorough check up with neurology/neurosurgical team doing routine epilepsy surgeries. Thanx Hope this answers you query Sorry for this unavoidable delay. Dr XXXXXXX k XXXXXXX Director Deptt. Of neurosurgery

Above answer was peer-reviewed by : Dr. Shanthi.E

Follow up: Dr. Praveen K Nath (14 hours later)

Thank you for your clear and concise and timely answer. I appreciate your advise ,we will follow all the directions. Currently he is on the following Medications 1.Lobazam 5- Thrice daily 2.Levipil 500 (levetiracetam 500mg) -Thrice daily 3.Epilan (Phenytoin Sodium IP 100mg+Phenobabitone IP 30 mg) -Thrice daily off course he will do follow up with his neurologist but do you think these are adequate .he is complaining of lot of drowsiness. In your reply you were talking about latest MRI the last one was after 3 days post seizures I don't know about postictal changes masking the real current status I was not sure if it was uploaded properly so I uploaded again if needed you can chek again one last request can you please suggest few good neurosurgical teams or institutes where epilepsy surgery is being done regularly in India with good results. We would highly appreciate if you can advise in this matter, the patient lives in Hyderabad India. but he can travel to different city if needed for surgery.We have decided to follow conservative management as advised by you but if seizure activity increases and not able to control adequately then we want to have some information about surgical options, I will consult you when I need advise in future .Thank you with high Regards XXXXXX

Answered by Dr. Praveen K Nath (12 hours later)

Brief Answer: CALCIFIED TUBERCULOMA Detailed Answer: DEAR DR XXXXX MY BEST WISHES ALWAYS FOR YOU I have gone through all the scan images . It appears to be calcified tuberculoma with postictal oedema . He should continue with all anticonvulsants as advised . Get a repeat MRI BRAIN with CONTRAST after 3-6 months to see actual status of lesion , Centres where EPILEPSY SURGERY is being routinely done are a. APOLLO NEUROSCIENCE CENTER HYDRABAD b. CMC VELLORE c . AIIMS NEW DELHI d. MEDANTA MEDICITY GURGAON THANX Dr XXXXXXX k XXXXXXX

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Praveen K Nath (6 hours later)

Thank you very much sir we very much appreciate your suggestions and information I will consult if needed in future with this case or other with high regards XXXXX

Answered by Dr. Praveen K Nath (13 hours later)

Brief Answer: You are most welcome... Detailed Answer: Dear XXXXX You are most welcome always for any further query. Dr. Praveen K Nath

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Above answer was peer-reviewed by : Dr. Prasad