Noida Sector 12

Noida Sector 11

Faridabad

Preet Vihar, Delhi

Pandav Nagar, Delhi

Haridwar

Jaipur

Meerut

Rewari

Vadodara

Metro Advanced Centre for Epilepsy: A Beacon of Hope in Epilepsy Treatment

About the Centre

Metro Advanced Centre for Epilepsy (AACE) at Metro Hospital, Noida, has emerged as a leading facility dedicated to the relentless pursuit of upgrading the treatment of epilepsy. This pioneering center has become a beacon of hope for individuals affected by epilepsy worldwide, extending its healing touch to patients from India, the Middle East, Africa, Asia Minor, and various Southeast Asian countries.

Comprehensive Epilepsy Care

The AACE’s multidisciplinary team, comprising adult epileptologists, pediatric epileptologists, epilepsy surgeons, radiologists, nuclear medicine physicians, neuroscientists, neuropathologists, neuropsychologists, medical social workers, and dieticians, collaborates seamlessly to provide personalized and effective treatment. The center recognizes the profound impact that epilepsy can have on individuals and their families, and is committed to offering not just medical treatment, but also support and education to empower patients & help them lead fulfilling lives.

Cutting-Edge Facilities and Expertise

The AACE boasts of several key features that set it apart as a premier epilepsy treatment facility:

Largest Epilepsy Monitoring Unit in India

The center houses the largest epilepsy monitoring unit in the country, equipped with a 15-bedded state-of-the-art unit for comprehensive long-term Video-EEG (Electroencephalography) monitoring of patients with epilepsy.

Minimally Invasive Surgery

The AACE is a pioneer in minimally invasive epilepsy surgery, particularly radiofrequency ablation, having performed the largest number of such procedures in the country.

Stereo EEG Expertise

Setting a benchmark, the AACE has conducted the largest number (more than 290 cases) of stereo EEG evaluations in the country, and is the first in India to implement this advanced diagnostic approach.

Extensive Surgical Expertise

The AACE has successfully completed over 1000 cases of epilepsy surgeries, showcasing a wealth of surgical experience and expertise.

Advanced Treatment Options

The center is at the forefront of addressing medically refractory epilepsy cases, offering cutting-edge treatments such as deep brain stimulation.

Metro Advanced Centre for Epilepsy (AACE): Transforming Lives Through Comprehensive and Cutting-Edge Care

First-Time Patient Focus

At Metro Advanced Centre for Epilepsy (AACE), we recognize the importance of understanding each patient’s unique history and circumstances. When new patients visit our center, we prioritize taking detailed medical histories and conducting thorough clinical examinations. This personalized approach allows us to tailor our care to the specific needs of each individual, ensuring the most effective treatment plan.

Multidisciplinary Collaboration

Complex epilepsy cases are carefully reviewed by our multidisciplinary team, which includes epileptologists, epilepsy surgeons, neuroradiologists, nuclear medicine physicians, neuropsychologists, neuropsychiatrists, neuropathologists, geneticists, neuroscientists, neurotechnologists, epilepsy nurses, and nutrition experts. Through in-depth discussions, our team develops a comprehensive understanding of the patient’s condition, enabling us to provide holistic and coordinated care.

Outpatient Excellence

Our outpatient services go beyond routine care. We provide specialized attention and support for cases of suspected epilepsy, ensuring accurate diagnoses and personalized long-term care plans. Complex and difficult-to-treat cases receive dedicated attention from our expert team, who work tirelessly to find the most effective solutions.

Why Choose Metro Advanced Centre for Epilepsy (AACE)?

Leading Expertise

Our center is home to a team of renowned epileptologists, epilepsy surgeons, neuroradiologists, nuclear medicine physicians, neuropsychologists, neuropsychiatrists, neuropathologists, geneticists, and neuroscientists, each with specialized training and expertise in the modern management of epilepsy. By focusing on cutting-edge practices, we remain at the forefront of providing advanced care.

Innovative Treatments

Our center offers a spectrum of innovative treatments, from minimally invasive epilepsy surgeries to revolutionary therapies like Deep Brain Stimulation. We are committed to exploring and implementing the latest advancements in epilepsy management to provide our patients with the best possible outcomes.

Comprehensive Patient Support

Our team of four full-time epileptologists is always available for consultations, ensuring specialized care for patients with epilepsy.

Services Offered

Inpatient Services and Epilepsy Monitoring Unit (EMU)

Metro Advanced Centre for Epilepsy is equipped with a 15-bedded state-of-the-art Epilepsy Monitoring Unit (EMU) dedicated to long-term Video-EEG (Electroencephalography) monitoring of patients with epilepsy. Staffed by nurses trained in seizure detection and management, as well as neurotechnologists proficient in advanced EEG techniques, the EMU is the heart of our epilepsy center. Accurate diagnosis and localization of seizures are crucial for successful treatment.

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

Our center utilizes a sophisticated 256-channel high-density EEG system, the EGI Magstim from the USA, to record the brain’s electrical activity in patients with epilepsy. This comprehensive data is then analyzed using advanced signal processing and imaging methods to precisely localize the brain circuits responsible for generating and propagating seizures. This Electrical Source Localization (ESI) technique allows for a more targeted and effective approach to diagnosing and treating epilepsy, leading to better outcomes and personalized care for our patients.

Comprehensive Neuroimaging Capabilities at the Advanced Centre for Epilepsy (AACE)

At the Advanced Centre for Epilepsy (AACE), we pride ourselves on our state-of-the-art neuroimaging technologies that enable us to provide advanced and detailed insights into the diagnosis and treatment of epilepsy.

Advanced Imaging Modalities

Our facility is equipped with a range of cutting-edge neuroimaging tools, including:

  1. 3 Tesla MRI (3T MRI): A high-field magnetic resonance imaging system that provides exceptional spatial resolution and contrast, enabling detailed visualization of brain structures and abnormalities.
  2. 3T MRI PET Scanner: A hybrid imaging system that combines the anatomical detail of MRI with the functional information from positron emission tomography (PET), offering a comprehensive assessment of the brain.
  3. Brain PET: A dedicated positron emission tomography system that allows for the detection and characterization of various metabolic and molecular processes in the brain, which is particularly valuable for epilepsy diagnosis and management.

These advanced imaging modalities are essential for identifying the extent and characteristics of brain anomalies, which in turn informs our treatment strategies for epilepsy patients.

Complementary Neuroimaging Techniques

Beyond our PET capabilities, our nuclear medicine department works closely with the Epilepsy Monitoring Unit (EMU) team, which includes epileptologists, nurses, and neurotechnologists, to conduct Ictal SPECT (Ictal Single Photon Emission Computed Tomography).

Functional MRI (fMRI)

Functional MRI (fMRI) is another invaluable tool in our arsenal, as it allows us to visualize and map the brain’s functional activity. By detecting changes in blood flow related to neural activity, fMRI helps us identify the specific brain regions responsible for language, sensory, and motor functions, which is essential for planning safe and effective epilepsy surgeries.

Wada Test

The Wada Test, a specialized procedure involving the injection of a drug into the brain’s arteries, enables us to evaluate language and memory functions, further informing our surgical decision-making process and ensuring the preservation of crucial cognitive abilities during epilepsy treatment.

Invasive Monitoring Techniques

In cases where noninvasive methods fail to provide precise information for curative surgery, we employ advanced intracranial EEG techniques, such as Extraoperative Intracranial EEG (ICEEG) monitoring and Stereo-EEG. These innovative approaches, including the robotic-assisted implementation of Stereo-EEG at AACE, have significantly improved our ability to accurately detect seizure foci and enhance patient outcomes in the most challenging epilepsy cases.

Functional Brain Mapping

Functional Brain Mapping is a sophisticated technique that involves the surgical implantation of electrodes in the brain. This process enables us to precisely map various brain areas responsible for essential functions, such as speech, movement, sensation, and vision. By identifying these critical functional regions, we can tailor our surgical approach to minimize the risk of impairing crucial brain functions while effectively treating the patient’s epilepsy.

At the Advanced Centre for Epilepsy (AACE), our commitment to providing comprehensive and cutting-edge neuroimaging solutions is unwavering. We strive to continuously push the boundaries of epilepsy diagnosis and treatment, ensuring our patients receive the most advanced and personalized care possible.

Our Philosophy

At the Metro Advanced Centre for Epilepsy, our approach to patient care is centered on providing individualized, compassionate, and innovative solutions for those living with epilepsy. We believe that by addressing the unique needs of each patient and fostering a holistic healing environment, we can empower them to manage their condition effectively and achieve the best possible outcomes.

Individualized Care

Recognizing the complex and varied nature of epilepsy, we prioritize tailored treatment plans for our patients. Our team of experts carefully evaluates each individual’s medical history, symptoms, and personal circumstances to develop a comprehensive care strategy that addresses their specific needs. This personalized approach ensures that our patients receive the most effective and appropriate interventions, maximizing their chances of achieving seizure control and improved quality of life.

Holistic Wellness

Beyond medical interventions, we are committed to supporting the overall well-being of our patients. Our holistic approach encompasses not only the physical aspects of epilepsy but also the emotional and psychological dimensions. We understand the profound impact that living with a chronic condition can have on an individual’s mental health and social functioning. To address this, we offer a range of support services, including counseling, stress management techniques, and opportunities for patients to connect with a community of individuals facing similar challenges.

Innovation and Research

Driven by a desire for continuous improvement, the Metro Advanced Centre for Epilepsy is at the forefront of epilepsy care innovation. We actively engage in research initiatives, collaborating with leading experts and institutions to explore cutting-edge treatments, diagnostic methods, and management strategies. By staying at the cutting edge of advancements in the field, we are able to provide our patients with access to the latest and most effective solutions for their condition.

Facilities Available 

Surgical Program

The surgical program at the Metro Advanced Centre for Epilepsy has established itself as a leading referral center for epilepsy surgery, having successfully completed over 1,000 procedures since its inception. Our team of highly skilled surgeons utilizes a comprehensive, multidisciplinary approach to evaluate and develop personalized surgical plans for each patient.

The key strengths of our surgical program include:

  • Pioneering the use of robotic technology for the insertion of Stereo-EEG electrodes, which helps in precise mapping of the seizure focus and brain functions.
  • Expertise in performing awake surgeries, maximizing the success of brain surgeries through intraoperative brain mapping.
  • Utilization of advanced technologies, such as image-guidance, electrocorticography, and extraoperative brain mapping, to enhance surgical outcomes.
  • A dedicated team of two experienced epilepsy surgeons, proficient in a wide range of adult and pediatric epilepsy surgery techniques.

As a result of this comprehensive, patient-centered approach, the Metro Advanced Centre for Epilepsy has consistently achieved higher seizure-freedom rates (80-90%) compared to the reported norms in the field.

Brain Mapping Laboratory

The Brain Mapping Laboratory at the Metro Advanced Centre for Epilepsy is distinguished by its seamless integration of clinical expertise and cutting-edge scientific research. This collaborative approach enables us to conduct advanced pre-surgical evaluations using state-of-the-art signal and image processing techniques, particularly for complex epilepsy cases.

The laboratory team includes Dr. Harilal Parasuram, a computational neurologist with a Ph.D. in Computational Neuroscience from Metro Vishwa Vidyapeetham, and Romero Arakulam, a Biomedical Engineering graduate from the University of Strathclyde in Glasgow, UK. Their combined expertise in neuroengineering and computational neuroscience allows us to develop innovative solutions for improved epilepsy diagnosis and treatment.

One of the key techniques employed in our lab is Stereo-EEG analysis with Epileptogenicity Rank (ER). ER is an advanced method that builds upon the existing Epileptogenicity Index (EI) by considering not only the temporal patterns of brain activity but also the spatial distribution of these changes. This approach helps us to accurately identify the precise starting point of a seizure and distinguish it from the areas where the seizure activity spreads, providing invaluable insights for surgical planning and patient management.

High-Frequency Oscillation Analysis in Epilepsy

High-frequency oscillations (HFOs) are abnormal brain activity patterns that occur at high frequencies, typically between 80-600 Hz. These oscillations are of particular interest in the study and treatment of epilepsy, as they are often associated with the epileptogenic zone – the area of the brain responsible for generating seizures.

Studying HFOs

At our center, we focus on analyzing two specific ranges of HFOs:

  1. Ripples (80-250 Hz): These higher-frequency oscillations are observed in various cognitive processes, but are also found at elevated rates in the epileptogenic network.
  2. Fast Ripples (250-600 Hz): This higher range of HFOs is more specific to the epileptogenic zone and is considered a biomarker for epileptogenic tissue.

By carefully analyzing the occurrence and characteristics of these HFOs in different brain regions, we can gain valuable insights into the location and extent of the epileptogenic zone. This information is crucial for guiding surgical planning and improving the outcomes of epilepsy treatment.

Computational Tools for HFO Analysis

To enhance our ability to detect and analyze HFOs, we utilize advanced computational techniques:

  1. Automated HFO Detection: We have developed algorithms that can automatically identify and characterize HFOs in intracranial electroencephalography (iEEG) recordings. This allows us to efficiently process large datasets and identify patterns that may be missed by manual inspection.
  2. Spatial Mapping of HFOs: By combining HFO analysis with neuroimaging data, such as MRI and PET scans, we can create detailed maps of HFO activity across the brain. This helps us pinpoint the specific regions associated with the epileptogenic zone.
  3. Connectivity Analysis: We also examine the functional connectivity patterns between brain regions exhibiting HFOs. This can reveal the complex networks underlying seizure generation and propagation, providing valuable insights for surgical planning.

Integrating HFO Analysis with Other Diagnostic Techniques

High-frequency oscillation analysis is just one component of our comprehensive approach to epilepsy diagnosis and treatment. We also employ various other advanced neuroimaging and electrophysiological techniques, including:

  • Subtraction Ictal SPECT Co-registered to MRI (SISCOM): This method helps identify the precise location of seizure activity by comparing SPECT images acquired during and between seizures.
  • Voxel-Based Morphometry (VBM): VBM analysis of MRI scans can reveal subtle structural abnormalities that may be associated with the epileptogenic zone.
  • Hippocampal Volumetry: Precise measurement of the hippocampus can help detect temporal lobe epilepsy, a common form of the disorder.

By integrating these diverse diagnostic tools, we can build a comprehensive understanding of each patient’s unique epilepsy profile, enabling more targeted and effective treatment strategies.

Cutting-Edge Techniques in Epilepsy Diagnosis and Treatment

Wada Test

The Wada test, also known as the intracarotid sodium amobarbital procedure (ISAP), is a diagnostic technique used to confirm the side of the brain involved in language and memory functions. During this procedure, a drug is administered directly into the arteries supplying blood to the brain, allowing the clinicians to temporarily deactivate one side of the brain and assess the patient’s cognitive abilities.

Extraoperative Intracranial EEG (ICEEG) Monitoring and Stereo-EEG

Our center utilizes advanced techniques such as extraoperative intracranial EEG (ICEEG) monitoring and Stereo-EEG to pinpoint the origins of seizures within the brain. When conventional non-invasive methods fail to provide adequate information for effective surgical treatment, we employ these cutting-edge approaches to enhance our success rates, particularly in complex cases.

Stereo-EEG involves the precise placement of electrodes within the brain, enabling us to meticulously track and analyze the brain’s electrical activity. This minimally invasive technique allows for the detection of the seizure source without the need for open skull surgery, and is currently performed with robotic assistance at our center to ensure enhanced precision and safety.

Functional Brain Mapping

During the surgical treatment of epilepsy, we utilize electrodes implanted into the brain to precisely map the areas responsible for various functions, such as speaking, movement, sensations, and vision. This information is then used to safely preserve these vital brain functions while removing the area responsible for the seizures.

Comprehensive Treatment Approaches

Our epilepsy management program employs a range of effective treatments, including:

Medication

Most individuals with epilepsy can achieve seizure freedom through the use of anti-seizure medications. Our epileptologists work closely with patients to find the right medication and dosage, considering factors like seizure type, frequency, age, and overall health.

Surgery

When medications fail to provide sufficient seizure control, epilepsy surgery becomes an option. Our surgeons remove the specific brain area responsible for seizures, guided by comprehensive tests to ensure minimal impact on vital functions. Minimally invasive approaches, such as MRI-guided laser ablation, are also available as alternatives to traditional surgery.

Other Therapies

In addition to medications and surgery, we offer other innovative treatment options, including:

  • Minimally invasive procedures like radiofrequency ablation
  • Deep brain stimulation
  • Ketogenic diet therapy

Our Epilepsy Care Team

Our multidisciplinary team of experts, led by experienced neurologists, works collaboratively to provide comprehensive, state-of-the-art care for individuals with epilepsy. The team includes:

  • Dr. Sonia Lal Gupta, Director and Sr. Consultant – Neurology
  • Dr. Neeraj Kumar, Sr. Consultant – Neurology
  • Dr. Puja Kushwah, Sr. Consultant – Neurology
  • Dr. Sushma Sharma, Director and HOD – Neurology
  • Dr. Rajesh Kumar, Sr. Consultant – Neurosciences
  • Dr. Shyam Sunder Lakshkar, Neurologist
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