May 2025

Diseases which look like Parkinson’s disease, but have additional features are called “Parkinson’s Plus” syndromes. You can read more about Parkinson’s Plus Syndromes here. Multiple System atrophy (MSA) is a Parkinson’s Plus syndrome. In MSA, a component of our nervous system called the “Autonomic Nervous System” is also affected. This causes problems in body functions such as urination, maintaining blood pressure & cardiac rhythm. What does the Autonomic Nervous System do? The Autonomic Nervous System helps us do things that we don’t think about consciously. Thus, it helps us in: Preventing a drop in blood pressure when we stand up from a chair or bed. The Autonomic Nervous System helps us maintain our Blood Pressure. Maintaining heart rhythm Having an erection Sweating Passing urine and stool The following symptoms can be seen because of this system dysfunction: A sudden drop in blood pressure can cause sudden dizziness, blurred vision, or loss of consciousness if you stand up abruptly. In MSA, patients may feel lightheaded, have blurred visions, or experience loss of consciousness if they stand up suddenly. Heart rhythm problems (these are uncommon). Impotence Reduced sweating Loss of bladder or bowel control or severe constipation Occasionally, trouble breathing or stridor may be seen. This is a significant problem. Stridor needs to be detected and treated immediately, especially if it occurs in sleep. Types of MSA There are 2 types of MSA. The two types are MSA-P and MSA-C. Both types have the autonomic symptoms described above. Here are the other differences between the two: MSA-P MSA-C More common Less common The P stands for Parkinsonism The C stands for Cerebellum. This brain part helps with balance and coordination. The 4 cardinal features of Parkinsonism are seen. These are – slowness, tremor, stiffness & instability. Out of these, slowness (also called bradykinesia) is most common in MSA-P These patients appear uncoordinated and unsteady. This is called ATAXIA. When they are walking, they are unsteady. Therefore they may sway from side-to-side. Onlookers may mistakenly think that they are drunk. Coordination problems may make it difficult to drink water, write or button shirts. Swallowing trouble is common. Swallowing trouble appears a bit later. In the early stages, MSA-P is often misdiagnosed as Parkinson’s disease. In the early stages, MSA-C patients may have a lot of investigations. This is because many diseases can cause similar symptoms. Click here to know more [External link: Practical Neurology – Khemani 2013]. Later, the autonomic symptoms (described above) become easily noticeable. So, in later stages the diagnosis of MSA becomes easier. What Causes Multiple System Atrophy (MSA)? MSA is caused by the accumulation of the same waste material as in Parkinson’s disease (synuclein). We don’t know why the accumulation of synuclein causes Parkinson’s disease in some and Multiple System Atrophy in others. What is the Treatment of Multiple System Atrophy (MSA)? Like all Parkinson’s Plus syndromes, the mainstay treatment is Levodopa. As noted before, the patient’s response to Levodopa is unpredictable and sometimes may not be excellent. Just like all Parkinson’s Plus syndromes, and Parkinson’s disease itself, many MSA symptoms are treatable. For example: Drop in blood pressure: Maintaining a proper fluid balance and taking medications such as pyridostigmine, fludrocortisone, midodrine may be helpful. Heart rhythm problems: We can control these with medications. In rare cases, a pacemaker may be needed. Very rarely, a pacemaker may be needed to make sure the heart beats regularly. Impotence: There are many effective medications for impotence. Bladder & bowel control: A mixture of behavioural changes, physical supports (diapers), and medications are usually helpful. Stridor: Patients with stridor may need further evaluation with a sleep study. If there are severe breathing problems while sleeping, then a machine called CPAP can be used to keep the airway open. For critical problems, putting a small tube in the windpipe (tracheostomy) may be considered. Click here to know more about Stridor in MSA [External Link: Cortelli 2019 in the journal Neurology]. Caution: This information is not a substitute for professional care. Do not change your medications/treatment without your doctor’s permission.

A DAT scan or F-DOPA PET scan can be used for Parkinson’s diagnosis. But, Parkinson’s disease is primarily a clinical diagnosis. In other words, an evaluation of symptoms & examination by a doctor experienced in Parkinson’s disease is usually sufficient for diagnosis and treatment. Usually, your history a thorough examination is better than any testing for Parkinson’s disease. Let us know these symptoms & signs, and understand when a DAT scan or F-DOPA PET scan is needed. Symptoms of Parkinson’s disease There are 4 main symptoms of Parkinson’s disease. At least one of these symptoms is present, and slowness is almost always present. Shaking = Tremor. This is the most easily recognized sign of Parkinson’s disease. Usually, the shaking only affects one hand or one leg in the early stages of the disease. The affected limb may shake both at rest, and while it is moving. Occasionally there might be shaking of the head. Shaking of hands is the most commonly recognized symptom of Parkinson’s disease. Slowness = Bradykinesia. The patient’s movements become slow. Sometimes only the movements of a particular hand/leg become slow. But usually, there is some slowness of movement of the entire body. This is best noticed while walking. Relatives will often say “Well, she was one of the fastest walkers in the family. Now she walks slowly so that she gets left behind when we are walking in a group. After every 10 feet or so we have to wait so that she can catch up with us. Perhaps it’s old age…?”. This isn’t old age – It is frequently Parkinson’s disease and the good news is that it is curable. Walking slowly could be a symptom of Parkinson’s disease. Stiffness = Rigidity. The patient’s body parts become stiff. This may be restricted to one hand so that, for the example, the patient has difficulty buttoning his shirt. A frequent complaint is that the patient is not able to reach the top of their head to comb or tie their hair. If a leg has become stiff, the patient may feel like he/she is dragging it while walking. Stiffness of the arms can make it difficult to comb hair, wear clothes or apply hair clips. Imbalance The person feels unsteady while walking, or even standing. Falling is uncommon in the early stages but may become more frequent later. Other symptoms useful for Parkinson’s diagnosis Now, in addition to these three main symptoms, the patient may also have other features which support the diagnosis of Parkinson’s disease. There are many problems with movement in Parkinson’s disease. Postural instability: Many doctors/guidelines consider this to be a core symptom of Parkinson’s disease. The patient is unstable while walking. Falls are not common in the early stages of Parkinson’s disease. But the patient may appear wobbly while taking turns, or if given a slight nudge in a crowded place. An expressionless face. Bending forwards while walking. Shuffling while walking. Freezing or getting stuck while walking. Decrease in dexterity, or fine motor skills such as drawing. Problems with thinking or memory (Dementia). Parkinson’s Misdiagnosis: These features are usually enough to make a clinical diagnosis of Parkinson’s disease. However, before the diagnosis can be made, two important things need to be ruled out: Parkinsons-Plus syndromes can cause symptoms just like Parkinson’s disease. Some medications can cause symptoms like Parkinson’s disease. These problems look like Parkinson’s disease, so they are called Parkinson’s disease Mimics. Parkinsons-Plus syndromes are diseases that appear to be just like Parkinson’s disease but are subtly different – e.g. in terms of eye movements, or early falls. These diseases have complicated names: Progressive Supranuclear Palsy (PSP), Multiple Systems Atrophy (MSA), Cortico-Basal Disease (CBD), etc…. These are further described here. Certain medications can cause symptoms, just like Parkinson’s disease! This is an absolutely essential and often overlooked part of treating the patient. Some patients don’t require more medications, they require less! Type of medication Examples 1. Many medications used for psychiatric problems such as schizophrenia Haloperidol, Risperdal, Olanzapine, Aripiprazole, Trifluoperazine, Amisulpuride and many more. Clozapine and low dose Quetiapine usually do not cause problems. 2. Some medications for mood and depression Fluphenazine, Tranycypormine, Lithium 3. Some anti-nausea / anti-vertigo medications Metoclopramide, Levosulpuride, High doses of domperidone about 30-40 mg/day, Flunarazine, rarely cinnarizine 4. Some heart and blood pressure medications Amiodarone, methly-dopa Besides these two mimics, there are 30+ mimics which may be mistaken for Parkinson’s disease. Additional testing for Parkinson’s Many doctors I know make a confirmatory diagnosis of Parkinson’s disease at this stage. If there are no red-flags, then a single office visit is usually enough to confirm the diagnosis. Some doctors, including myself, do request some simple investigations (see box below). These are done to rule out rare causes and Parkinson’s Mimics. Usually, these tests do not show an additional problem. Simple tests to detect Parkinson’s Mimics 1. MRI-Brain – with size measurements of brain parts called the midbrain and pons. I usually also request a unique picture called SWI, which shows iron inside the brain. 2. Blood tests: Complete blood count Liver function tests Renal function tests Thyroid hormone levels (TSH/T3/T4) Parathyroid hormone level Ceruloplasmin level & eye examination to look for a “ring of copper” Ferritin level HIV VDRL (Syphilis test) DAT Scan & F-DOPA PET scan Very rarely, the clinical diagnosis of a patient may be difficult. This can happen in two scenarios: Very early Parkinson’s disease with very subtle symptoms. When features of two different diseases are present – such as Parkinson’s disease and Essential tremor. The diagnosis of Parkinson’s disease is usually very straightforward. Sometimes, it can be difficult. In these cases, there are two options: Treat with levodopa: if the patient responds he/she probably has Parkinson’s disease. Do a DATscan or even better – a F-DOPA PET scan. The DAT scan & the F-DOPA PET scans can measure Dopamine activity inside the brain. Unlike an MRI which can only look at the structure of the brain, these scans are actually able to look at Dopamine activity itself. The image below is of a DAT scan: The F-DOPA PET scan is superior overall to

1. भारत में मिर्गी की सर्जरी क्यों की जाती है? कुछ लोगों को दौरे पड़ते हैं. दिमाग में बिजली अनियंत्रित होने के कारण ऐसा होता है. इस स्थिति को “मिर्गी” कहते हैं. दवाइयां लेने के बाद करीब 80% मरीज़ों में दौरे पड़ने बंद हो जाते हैं. लेकिन, 20% लोगों को 2 या अधिक दवाएं लेने के बाद भी दौरे पड़ते रहते हैं. इन मरीज़ों को “चिकित्सकीय रूप से प्रतिरोधी (रेझिस्टंट) मिर्गी” होती है. दौरे रोकने के लिए उन्हें भारत में मिर्गी की सर्जरी करने की ज़रूरत होती है. 2. क्या भारत में मिर्गी की सर्जरी की जाती है? हां. भारत में भी सभी प्रकार की मिर्गी की सर्जरी की जा सकती है. अमरिका में मिर्गी की सर्जरी बहुत ही सामान्य है. बड़े अस्पतालों में (जैसे कि, यूसीएसएफ, जहां मैंने पढ़ाई की है) हर हफ्ते करीब 2-3 मिर्गी की सर्जरी की जाती है. भारत में, मिर्गी की सर्जरी बहुत ही कम पैमाने पर की जाती है. इसका कारण है: –     मरीज़ों और डॉक्टरों को इसकी जानकारी नहीं है. –     मिर्गी की सर्जरी करने के लिए बहुत कम प्रशिक्षित डॉक्टर है. –     इसका खर्च –     जटिलताओं (कॉम्प्लीकेशन्स) का डर –     लेकिन सबसे ज़रूरी बात, बहुत से भारतीयों की यह दुखद, निराशाजनक और पूरी तरह से गलत धारणा है कि मिर्गी को नियंत्रित नहीं किया सकता. मिर्गी की सर्जरी कितने प्रकार से की जाती है? भारत में मिर्गी सर्जरी कई प्रकार से की जाती है. रिसेक्टिव (खराब हिस्सा निकालने की सर्जरी): यह सबसे बढ़िया प्रकार की मिर्गी की सर्जरी है. दिमाग में दौरा पैदा करनेवाले खराब हिस्से को निकाल दिया जाता है. इससे दौरे पड़ने बंद हो जाते है. वेगस नर्व स्टिम्युलेशन (VNS): कुछ मामलों में, रिसेक्टिव (निकालने की) सर्जरी मुश्किल होती है. अगर खराब हिस्सा बहुत बड़ा हो, या फिर दिमाग के महत्वपूर्ण हिस्सों के पास हो तो ऐसा हो सकता है. ऐसे मामलो में, वेगस नर्व स्टिम्युलेशन (VNS) सर्जरी की जाती है. इस सर्जरी के लिए ज़्यादा समय नहीं लगता है. छाती पर त्वचा के नीचे एक छोटी-सी बैटरी बिठा दी जाती है. गर्दन की त्वचा के नीचे की एक नस एक पतली तार से जोड़ दी जाती है. VNS उपकरण दिमाग में बिजली की छोटी धाराएं छोड़ता है जिससे दौरे रुक जाते हैं. दूसरी सर्जरियां: खास परिस्थितियों में दूसरी सर्जरियां की जाती है. उदाहरण के लिए, मरीज़ अगर VNS का खर्च नहीं उठा सकता तो VNS की बजाय कॉर्पस कॉलोस्टॉमी की जा सकती है. 3. भारत में मिर्गी की सर्जरी से पहले कौन-कौन–से टेस्ट करने की ज़रूरत होती है? किसी भी मिर्गी की सर्जरी से पहले किए जानेवाले सामान्य टेस्ट्स की सूची नीचे दी गई है. 1.   हमारे मरीज़ की मिर्गी किस प्रकार की है और उसे किस प्रकार के दौरे पड़ते हैं? 2.   कौन-से हिस्से की वजह से दौरे पड़ रहे हैं? 3.   क्या इसे सुरक्षित तरीके से निकाला जा सकता हैं? 4.   सफलता की संभावना कितनी है? 5.   क्या दूसरी सर्जरियां की जा सकती है?  हम इन टेस्ट्स से जुड़े सवालों के जवाब देने की कोशिश करते हैं: कुछ मरीज़ों के मामले में, इन सवालों के जवाब देने के लिए ज़्यादा टेस्ट्स करने की ज़रूरत होती है. ज़्यादातर मरीज़ों में, इन टेस्ट्स की ज़रूरत नहीं होती है. बहुत ही कम मामलो में, इन टेस्ट्स के बाद भी खराब हिस्सा कहां है यह पता नहीं चलता है. ऐसे समय, हमें सीधे दिमाग से ईईजी रिकॉर्ड़ करने की ज़रूरत होती है. दिमाग में पतले तार डालकर ऐसा किया जाता है. इस प्रक्रिया को स्टीरियो-ईईजी कहा जाता है. 4. वीड़ियो ईईजी मॉनिटरिंग (मिर्गी की मॉनिटरिंग) में कौन-सी बाते शामिल है? लगातार ईईजी मॉनिटरिंग करने के लिए मरीज़ को भर्ती किया जाता है. इस दौरान, हम दवाओं की मात्रा कम कर सकते हैं जिससे रोगी को दौरे पड़ने शुरू होते हैं. हम हर प्रकार में से करीब 2 दौरे रिकॉर्ड़ करने कि कोशिश करते हैं. उदाहरण के लिए, रोगी को एक दौरा पड़ता है जिससे वह गिर जाता है, और दूसरा दौरा पड़ता है जिससे वह होठों को चटकाता है, तो हम 2+2 = 4 दौरे रिकॉर्ड़ करते हैं. यदि आपको बार-बार दौरे पड़ते है, तो मिर्गी की मॉनिटरिंग में सिर्फ 1-2 दिन लग सकते हैं. दूसरे लोगों में, 7 या उससे ज़्यादा दिन लग सकते हैं. 5. भारत में मिर्गी की सर्जरी कितने हद तक सफल होती है? भारत में मिर्गी की सर्जरी की सफलता बहुत ही उच्च होती है, लेकिन 100% नहीं. सफलता दर मिर्गी के प्रकार और मिर्गी की सर्जरी के प्रकार पर निर्भर करता है.उदाहरण के लिए: ·       रिसेक्टिव सर्जरी की सफलता दर 80% से ज़्यादा हो सकती है. ·       दूसरे सर्जरियों की सफलता दर कम होती है, लेकिन सामान्यत: बहुत अच्छी होती है. ·       VNS के बाद, ज़्यादातर मरीज़ों के दौरों में 50% या उससे ज़्यादा की कमी आ जाती है. खासकर, ऐसे दौरे बड़े पैमाने पर कम हो जाते हैं, जिसमें मरीज़ गिर जाते हैं और खुद को चोट पहुंचाते हैं. सर्जरी से पहले किए जानेवाले टेस्ट्स करने के बाद सफलता की दर के बारे में आपके साथ बात की जाएगी. 6. क्या मिर्गी की सर्जरी के बाद मुझे दवाएं लेने की ज़रूरत नहीं पड़ेगी? मिर्गी की सर्जरी का लक्ष्य है दौरों को रोकना. भारत में मिर्गी की सर्जरी के बाद लगभग 50% मरीज़ अपनी दवाएं लेना बंद कर पाने में सक्षम होते हैं. लेकिन, दूसरे मरीजों को अपनी दवाएं लेते रहने की ज़रूरत होती है. कुछ मरीज़ अपनी दवाओं की मात्रा कम कर पाने में सक्षम हो पाते हैं. 7. संभावित जटिलताएं (कॉम्प्लीकेशन्स) कौन-सी हो सकती है? किसी भी सर्जरी में एनेस्थीसिया और संक्रमण (इन्फेक्शन) से संबंधित कुछ जोखिम हो सकते हैं. रिसेक्टिव सर्जरी में, आसपास के हिस्सों को नुकसान पहुंचने का डर लगा रहता है. यह इस बात पर निर्भर करता है कि खराब हिस्सा असल में कहां पर है. यदि खराब हिस्सा दिमाग के महत्वपूर्ण हिस्सों के पास हो (उदा. बोलने का और स्मृति का क्षेत्र) तो सर्जरी बहुत ही सावधानी से करने की ज़रूरत होती है. खुशी की बात है, कि रिसेक्शन के बाद दौरे रुकने से बहुत से लोगों में सोचने की और स्मृति की शक्ति में सुधार होता है. यह इसलिए, क्योंकि दिमाग के स्वस्थ हिस्से अच्छी तरह से काम कर रहे होते हैं. सर्जरी से पहले किए जानेवाले टेस्ट्स

All doctors and possibly all patients should know what can mimic Parkinson’s disease. There are more than 30+ diseases that produce similar similar symptoms. These mimics may cause Parkinson’s misdiagnosis. For example, hypothyroidism also produces slowness of movements. Therefore hypothyroidism can be misdiagnosed as Parkinson’s disease. The treatment is different for each of these conditions. Misdiagnosis may lead to ineffective treatment. A DAT scan (or F-DOPA PET scan) of the brain can confirm the diagnosis. Hello! I am Dr Siddharth Kharkar, a Neurologist in Thane, India and a Neurologist in Mumbai, India. I provide Parkinson’s treatment in India and am an Epilepsy specialist in India. I provide Epilepsy surgery in India at Mumbai & Parkinson’s surgery in India. Come, let’s learn together about diseases that can be very similar in presentation to Parkinson’s disease. What can mimic Parkinson’s Disease? Before we proceed, let’s take a minute to understand some basic stuff. Here is a collection of 4 extremely important movement problems. 4 movement problems = “Parkinson-ism” 1. Slowness (Bradykinesia, Hypokinesia or Akinesia)2. Uncontrolled shaking (tremor)3. Stiffness (rigidity)4. Unsteadiness & shuffling gait. This group of problems is collectively called “Parkinsonism”. Parkinsonism means “like those produced by Parkinson’s disease”. Many diseases produce Parkinsonism. Of course, the most common one is Parkinson’s disease itself! But, other diseases can mimic Parkinson’s disease by producing similar symptoms. These are called the “Parkinson’s Mimics”. Let us talk about these Parkinson’s Mimics under 4 headings. Mimics of Parkinson’s Disease 1. Drug-induced Parkinsonism 2. Parkinson’s Plus Syndromes 3. Mimics caused by brain destruction 4. Completely unrelated Mimics The most important Parkinson’s Mimic: Drug-Induced Parkinsonism Certain medications can reduce the activity of Dopamine inside the brain. These medications produce symptoms very similar to Parkinson’s disease. Tremor is usually not seen, but some people can even have tremor! So, drug-induced movement problems can be tough to distinguish from Parkinson’s Disease. This is the most important cause underlying Parkinson’s Misdiagnosis, by far. The most important thing is carefully telling the doctor which medications you took recently. Unfortunately, some medications can cause Parkinsonism (Symptoms like Parkinson’s disease). If you are on any of these medications, your symptoms may be a side-effect of these medications. Type of medication Examples 1. Many medications used for psychiatric problems such as schizophrenia Haloperidol, Risperdal, Olanzapine, Aripiprazole, Trifluoperazine, Amisulpuride and many more. Clozapine and low dose Quetiapine usually do not cause problems. 2. Some medications for mood and depression Fluphenazine, Tranycypromine, Lithium 3. Some anti-nausea / anti-vertigo medications Metoclopramide, Levosulpiride, High doses of domperidone (30–40 mg/day), Flunarizine, rarely Cinnarizine 4. Some heart and blood pressure medications Amiodarone, Methyldopa Parkinson’s Plus Syndromes You could think of these as the “evil sisters” of Parkinson’s disease. These diseases can mimic Parkinson’s disease very closely. Misdiagnosis is very common in the early stages of these diseases. They have the exact symptoms of Parkinson’s disease. But they also produce additional symptoms such as falling backwards. So, they are called “Parkinson’s Plus syndromes”. “Parkinson’s Plus Syndromes” are the evil sisters of Parkinson’s disease. For example, in one such condition called PSP, the person has trouble moving his eyes. He/She can look from side-to-side but has difficulty looking up or down. Here is a video of a patient with PSP. This video has been posted on youtube by Dr Dusan Pavlovic. This patient has trouble looking upwards. He can look downwards, but there is a slight difficulty in doing that as well. https://www.youtube.com/watch?v=LU7TC0wufhg When present, difficulty in looking downwards is highly suggestive of PSP. Parkinson’s plus syndromes are the diseases that mimic Parkinson’s disease most closely. Misdiagnosis is very, very common. Parkinson’s Plus syndromes are often mistaken for Parkinson’s disease in the early stages. As they progress and additional symptoms build-up, they are correctly diagnosed. A table of such diseases is given below. You can read more in this article: What are the Parkinson’s Plus Syndromes? Parkinson’s Plus Syndrome Additional Features 1. Dementia with Lewy Bodies (DLB) DLB is the most similar to Parkinson’s disease. But patients with DLB also have: Visual hallucinations Fluctuating confusion Dream enactment [Click here for the NIH webpage] 2. Multiple Systems Atrophy (MSA) There is dysfunction of the “Autonomic Nervous System”. This part helps our brain to manage automatic actions like passing urine and sweating. So, MSA patients can have: Drop in blood pressure on standing Heart rate abnormalities Loss of urinary control Impotence Sweating problems etc… 3. Progressive Supranuclear Palsy (PSP) PSP patients have: Trouble moving eyes, especially looking upwards & downwards Frequent falls, mostly backward 4. Corticobasal Degeneration (CBD) CBD is a rare disease. The person forgets how to use a hand That arm/hand may have jerks It may twist into unnatural postures 5. Many kinds of Dementia Dementia is a term for “losing memory”. Many causes of Dementia also produce Parkinson’s symptoms. These include: Alzheimer’s disease Fronto-temporal dementia Dementia with Lewy bodies (DLB) Luckily, decreased Dopamine activity is the main problem in all these diseases. So, the treatment of these Parkinson’s Plus Syndromes is similar to Parkinson’s disease. Mimics caused by brain destruction Most of these diseases are due to damage caused by various chemicals. This process also destroys brain cells which produce Dopamine. This can create a condition very similar to Parkinson’s disease. Name of the disease Caused by 1. Wilson’s disease Excessive copper in the brain 2. Neuronal Brain Iron Accumulation (NBIA) Excessive iron in the brain 3. Fahr’s disease Excessive calcium in the brain 4. Toxins Examples: Carbon monoxide poisoning Methanol poisoning Exposure to industrial chemicals such as solvents, petroleum waste & insecticides 5. Lack of oxygen or blood supply Multiple strokes Brain damage due to drowning or a cardiac arrest 6. Infections HIV –

1. Why is Epilepsy surgery in India done? Some people have seizures. These happen because of uncontrolled electricity in the brain. This condition is called “Epilepsy”. About 80% patients stop having seizures when they take medications. But 20% people keep having seizures despite taking 2 or more medications. These patients have “Medically resistant epilepsy”. They need Epilepsy surgery to stop their seizures.   2. Is Epilepsy surgery done in India? Yes. All types of epilepsy surgeries can be done in India. In the USA epilepsy surgery is very common. Larger hospitals (like UCSF, where I was educated) do about 2-3 epilepsy surgeries per week. In India, Epilepsy surgery is less common. This is because: –     Patients & doctors are not aware of it. –     Fewer doctors are trained in Epilepsy surgery. –     Cost –     Fear of complications –     But most importantly, many Indians have a sad, hopeless and completely wrong belief that epilepsy is uncontrollable. 3. What are the types of Epilepsy Surgery? There are many types of Epilepsy surgery. RESECTIVE (REMOVAL SURGERY): This is the best Epilepsy surgery. The bad seizure-producing part of the brain is removed. This stops seizures. VAGUS NERVE STIMULATION (VNS): In some cases, resective (removal) surgery is difficult. This can happen if the bad part is too large, or is near important brain parts. In such cases, Vagus Nerve Stimulation (VNS) surgery is done. This is a faster surgery. A small battery is placed in the skin over the chest. A thin wire is attached to a nerve below the neck skin. The VNS device sends small currents to the brain which prevent seizures. OTHER SURGERIES: Other surgeries are done in special situations. For example, corpus callostomy can be done instead of VNS if the patient cannot afford VNS. 4. What tests Need to be done before Epilepsy surgery? The routine tests done before every epilepsy surgery are listed below. We try to answer many questions with these tests: In some patients, we need to do additional tests to answer these questions. In most patients, these tests are not needed. In very rare cases, the location of the bad part is unclear even after these tests. In such cases, we need to record EEG directly from the brain. This is done by placing thin stiff wires in the brain. This process is called stereo-EEG. 5. What is Video EEG Monitoring (Epilepsy Monitoring)? The patient is admitted for continuous EEG monitoring. During this time, we may reduce medications so that the patient has seizures. We try to capture at least 2 seizures of each type. For example, if the patient has one seizure type where he falls down, and another type where he starts smacking his lips, then we capture 2+2 = 4 seizures. If you have seizures frequently, epilepsy monitoring may take just 1-2 days. In other people, it may take 7 days or more. 6. What is the success rate of Epilepsy surgery in India? The success rate of epilepsy surgery is high but not 100%. The success rate depends on the type of epilepsy, and the type of epilepsy surgery. For example: ·       The success rate of Resective surgery can be more than 80%. ·       The success rates of other surgeries are lower, but usually quite good. ·       After VNS, most patients seizures decrease by 50% or more. Specifically, drop attacks, where patients fall and hurt themselves, are significantly reduced. The success rate will be discussed with you after the presurgical tests. 7. Will my medications stop after Epilepsy surgery? The goal of epilepsy surgery is to stop your seizures. Approximately 50% patients are able to stop their medications after Epilepsy surgery. However, other patients need to keep taking their medications. Some patients may be able to reduce their medications. 8. What are the possible complications? Any surgery has some risks of anaesthesia and infection. In resective surgery, there is a concern that surrounding areas may be damaged. This depends on the exact location of the bad part. Surgery needs to be done very carefully if the bad part is close to important brain areas (e.g., speech & memory areas). Thankfully, stopping seizures after resection improves thinking and memory in many people. This is because the healthy parts of the brain work better. All possible complications will be discussed with you after the presurgical tests. 9. What is the cost of Epilepsy surgery? Patients need different evaluations and surgeries, so the cost is different for each patient. Please note that these costs are approximate and change with time. For example: If our patient has frequent seizures and requires a simple resection, the total cost is between 4.5 – 5 lakhs. This is the total cost, including all tests. Test Cost in India STEP 1: EVALUATION MRI Rs. 12,000 PET & MRI-PET fusion Rs. 15,000 functional MRI (fMRI) Rs. 12,000 Video-EEG monitoring (3 days) Rs. 30,000 x 3 = Rs. 90,000 Psychiatry & Neuropsychological testing Rs. 6,000 Total cost of evaluation Rs. 1.35 Lakh STEP 2: SURGERY ITSELF Resective surgery with intraoperative Electrocorticography Rs. 3.5 Lakh TOTAL COST Rs. 4.95 Lakh VNS surgery is very expensive. The major part of the expense is the device, which has to be imported. Test Cost in India VNS procedure cost (cost of placement) Rs. 1.5 Lakh VNS device cost – Demipulse Rs. 8.5 Lakh VNS device cost – Aspire SR Rs. 10.5 Lakh VNS device cost – Sentiva (newest model) Rs. 14.5 Lakh 10. Should I (or my child) have Epilepsy surgery? If a person has medically resistant epilepsy, I usually encourage them to have epilepsy surgery, if: The patient really has medically resistant epilepsy. 1. Patients may be misdiagnosed. For example, people with heart rhythm issues or stress-related seizures may be wrongly diagnosed with epilepsy. 2. Sometimes, the type of medication or the dose may be incorrect for the type of epilepsy. 3. Sometimes, patients have seizures because they don’t take their medications. Possible complications are acceptable to the patient. For example, if someone’s right hand remains very strong

In 2024, Epilepsy surgery cost in India is between Rs. 2 Lakh and Rs. 15 lakhs (USD 2500 to USD 18,000). This includes the cost of evaluation and of the surgery itself. This article’s purpose is to educate patients so that they can properly plan their finances. It is critical to know that Epilepsy surgery can be affordable in most cases. Anticipating Epilepsy surgery cost in India correctly will prevent financial surprises. At the same time, it is useful to know which therapies are very expensive. This will prevent unanticipated financial problems. You need to pay attention to the evaluation cost. Sometimes, the cost of evaluation can be more than the surgery itself. I recommend reading the article, to understand the process. But if you are in a hurry then click here to download the quick sheet [Epilepsy Surgery Cost in India – Calculation sheet]. Table of Contents Why is Epilepsy surgery cost in India variable? How is Epilepsy surgery in India done? Step 1: Epilepsy surgery evaluation cost in India A. Simple Epilepsy surgery evaluation cost in India B. Complex Epilepsy surgery evaluation cost in India C. Very complex Epilepsy surgery evaluation cost in India Step 2: Epilepsy surgery cost in India (The surgery itself) Resective (Removal) Epilepsy surgery cost in India Vagus Nerve Stimulator (VNS) Epilepsy surgery cost in India Cost of other epilepsy surgeries in India What is the minimum cost of Epilepsy surgery in India? Calculation sheet for Total Epilepsy surgery cost in India: Summary: Epilepsy surgery cost in India Dr. Siddharth Kharkar NeuroPlus Epilepsy & Parkinson’s Clinic – Dr. Kharkar Why is Epilepsy surgery cost in India variable? Epilepsy surgery cost in India is variable because each person needs different tests & surgeries. To understand this, you need to understand how Epilepsy surgery in India is done. So, How is Epilepsy surgery in India done? You can read the Epilepsy surgery in India article to get a detailed description of the process. The same process is described briefly here. This will help you understand how to calculate the Epilepsy surgery cost in India. The process of Epilepsy surgery involves two steps: Step 1: Evaluation: This is also called Epilepsy surgery evaluation. This is a set of tests. They tell us which is the abnormal part of the brain, what problems could happen if we take it out etc. Step 2: The surgery itself: There are many different types of surgeries. But the two most common surgeries are resective (removal) epilepsy surgery & Vagus Nerve Stimulation (VNS) surgery. To calculate Epilepsy surgery cost in India correctly, the cost of evaluation needs to be taken into account. So, when calculating the epilepsy surgery cost in India, we need to calculate the cost of evaluation + the cost of the surgery itself. Type of room & Foreign nationals The cost can be much higher based on the kind of room that you want. Most of these costs are for general ward admissions. The costs for a single/luxury room can be much higher, depending on the hospital. The cost can be higher for Foreign nationals. In general, most private hospitals charge foreign nationals about 30% more than Indian citizens. Let us first talk about the cost of epilepsy surgery evaluation in India. Step 1: Epilepsy surgery evaluation cost in India Epilepsy surgery evaluation may be simple, complex or extremely complex. The complexity of this evaluation depends on your MRI, EEG and type of seizures. A. Simple Epilepsy surgery evaluation cost in India Epilepsy surgery evaluation starts with a basic set of tests. Some of these tests locate the abnormal brain part producing seizures. The f-MRI scan, psychiatric & Neuropsychological evaluations us understand if we can safely remove this area. High-resolution MRI:The abnormal areas producing seizures can be very small. Therefore, a high-resolution MRI (3 Tesla or 3T MRI) needs to be done. Special methods are used to detect very small abnormalities. These may detect small abnormal areas missed on earlier scans. A 3T MRI using special techniques can detect very small abnormal areas. These areas may not be visible on low resolution MRIs. 2. PET scan & PET-MRI fusion:A PET scan measures which areas of the brain are using less glucose. Usually, the abnormal area and normal areas around it use less glucose. These areas are less bright on PET images. Ideally, the PET scan and the MRI scan should be overlaid over one another (see figure below). This process is called PET-MRI fusion. This is a critical part of the evaluation, without which abnormal areas in the brain may be missed. A 3T MRI using special techniques can detect very small abnormal areas. These areas may not be visible on low resolution MRIs. 3. Video EEG monitoring:The patient is admitted to the hospital. Video and EEG are recorded continuously. 2-3 seizures are recorded. Both the video and EEG are carefully studied. Video EEG is very comfortable. Sometimes, patients may get bored because they need to stay in the hospital. 4. Functional MRI (fMRI) scan:Functional MRI is a special MRI. Functional MRI (fMRI) shows which brain part is processing language, controlling movement etc. Functional MRI helps us to find brain areas controlling lanauge and limb movement. 5. Neuropsychological & Psychiatry assessment:A neuropsychologist is a person who measures the functioning of your brain by making you solve simple puzzles, draw objects, remember lists and so on.A psychiatrist helps us to understand your mental health and willingness for surgery. He/she helps to treat any underlying issues such as depression, anxiety etc. Please note that the cost of Video EEG monitoring in India is different for each patient. Each day of Video-EEG monitoring costs about Rs. 30,000 (USD 360) in India. We need to capture 2-3 seizures of each seizure type. This may take just one day or up to 1 week. Let us calculate the cost using 3 days. The approximate cost of these tests in India is as follows: Test Cost in India Cost in India in US dollars 3 Tesla MRI Rs. 12,000 USD

Please note: Here we will only be talking about the early symptoms of Parkinson’s disease. When you go to a doctor, he/she will examine you to detect the early signs of Parkinson’s disease [Video: Parkinson’s patient examination on YouTube]. Let us talk about the early symptoms of Parkinson’s: The 4 earliest symptoms of Parkinson’s disease are constipation, decreased sense of smell, thrashing in sleep, and depression. These are called “pre-motor” symptoms. 4 other symptoms can also appear early before movement problems: fatigue, anxiety, urinary urgency, and soft or lowered voice. A few years later, movement problems begin. There are 4 cardinal movement symptoms: tremor, slowness (bradykinesia), stiffness (rigidity), and unsteadiness (postural instability). 4 other early movement-related symptoms include small handwriting (micrographia), shuffling walk, stooped posture, and reduced arm swing. In summary: These are the 16 early symptoms of Parkinson’s disease. Caused by Details 4 earliest symptoms (pre-motor) 1. Constipation 2. Problems with smell (Anosmia) 3. REM behavior disorder (RBD) in sleep 4. Depression 4 less common pre-motor symptoms 1. Back pain with no apparent cause 2. Cramping of hands or feet 3. Fatigue 4. Subtle problems in using hands for fine jobs like typing or cooking 4 cardinal (most important) movement problems 1. Tremor (uncontrolled shaking) 2. Slowness (bradykinesia) 3. Stiffness (Rigidity) 4. Instability while standing or walking 4 other movement problems 1. Decrease in facial expressions (Hypomimia) 2. Problems with speech (low volume) 3. Problems swallowing (dysphagia) 4. Shuffling gait and/or festinating gait Let us talk about these 16 early symptoms of Parkinson’s disease. 4 Earliest Symptoms of Parkinson’s Disease Most people know that Parkinson’s disease causes problems with movement. But did you know it can produce non-movement (also called non-motor) symptoms as well? In fact, non-motor symptoms can occur many years before movement problems. The 4 most common non-motor symptoms are remembered using the short-form: CARD. These letters stand for: C = Constipation. People with Parkinson’s disease almost always have constipation. Constipation happens before any of the movement problems. Constipation can be a very early symptom of Parkinson’s disease. Some researchers think that Parkinson’s disease starts in the gut. Or more specifically, in the intestines. According to this theory, a virus or virus-like particle (prion) first infects the intestines. It then moves upwards through a long nerve called the “Vagus Nerve”. It reaches the brain, where it destroys the cells that produce dopamine. You can read more about this theory here: [What causes Parkinson’s disease?] & here (external link). This is one theory why constipation is so common in Parkinson’s disease.Read more about how to manage this uncomfortable problem: [Constipation in Parkinson’s disease]. 4 Earliest symptoms of Parkinson’s disease 1. Constipation 2. Anosmia (Decrease in the ability to smell) 3. REM Behavior Disorder (RBD) 4. Depression A = Anosmia Anosmia means being unable to smell. Parkinson’s disease  patients may have trouble smelling their food. Their sense of taste may change. In the later stages, even harsh smells like rot may be difficult for the patient to smell. People with Parkinson’s disease may have difficulty smelling before they develop any other symptoms. R = REM Sleep Behavior Disorder (RBD) REM Sleep Behavior Disorder (RBD) is a problem related to dreams. When a person without Parkinson’s disease sleeps, the body is paralyzed. Thus, he/she cannot move or act out their dreams. This is a normal process. When Parkinson’s patients sleep, this does not happen. So, they may act out their dreams. Patients with Parkinson’s disease may move excessively while sleeping, sometimes talking or hitting whoever is near them. Parkinson’s patients may start talking when sleeping. They may walk or run while sleeping, and sometimes thrash wildly. These movements can be violent. They can hurt the patient or the person sleeping beside them. This problem of moving while dreaming is called REM Sleep Behavior Disorder (RBD) . You can read more about sleep problems with Parkinson’s here: [Sleep problems in Parkinson’s disease]. Also, here is a good website (external link: Sleepfoundation.org) explaining RBD in greater detail. D = Depression Depression is common in Parkinson’s disease. It may happen many years before the movement problems. It can also be a severe problem later in the illness. Read about treatments for depression here: [How can I reduce depression & anxiety?] Depression is common in Parkinson’s disease. Just like many of the other problems, it is treatable. 4 less common premotor symptoms The CARD symptoms are the most common early symptoms of Parkinson’s disease. However, some patients may have other early symptoms as well. They are important to know. These symptoms may be dismissed as “vague” or “strange” at first. 5 less common pre-motor symptoms 1. Back pain with no apparent cause 2. Cramping of hands or feet 3. Fatigue 4. Subtle problems in using hands for fine jobs like typing or cooking 4 cardinal motor problems Usually it is these problems which cause you to go to the doctor. Although most patients report these motor problems as their earliest symptoms, now we know that the most common early symptoms of Parkinson’s are non-motor (not related to movement). Movement problems start a few years after the pre-motor problems.There are 4 cardinal signs of movement in Parkinson’s disease. One or more of these cardinal problems can be part of the early symptoms of Parkinson’s disease. 4 Cardinal signs of Parkinson’s disease 1. Slowness (Bradykinesia, Hypokinesia or Akinesia) 2. Uncontrolled shaking (tremor) 3. Stiffness (rigidity) 4. Unsteadiness & shuffling gait. 1. Shaking = Tremor. This is the most widely recognized sign of Parkinson’s disease. The shaking begins in one hand or one leg. This shaking happens even when the person is completely at rest. Even when he/she is sitting and doing nothing. So, it is also called “rest tremor”. You can see a video example of a rest tremor below. This video has been posted by Dr. Osama Amin & Dr. Saad Shiwani of Kurdistan on youtube: The shaking of hands/legs may continue when the hands/legs are moved. For example, the person’s hands may shake when he is trying to hand over some papers to another person. Shaking

Neuromodulation, including Vagus nerve stimulator (VNS) for Epilepsy in Mumbai Each year brings fantastic new developments in the treatment of Epilepsy! Neurostimulation devices use electrical currents to prevent seizures. 3 such devices have been approved. Fantastically, these devices can be used in patients who could not have surgical treatment before ! Vagus Nerve Stimulator (VNS) ============================= Relatively minor surgery. A small battery is connected to a nerve just below the skin, in the neck. Reduces all kinds of seizures, but especially those causing sudden falls (“Drop Attacks”) On average, reduces seizures by 50 %. Deep Brain Stimulation (DBS) ============================= “Medium” level surgery. A small hole is made in the skull, and a very thin wire is inserted into the brain. Useful in seizures coming from one area in the brain (Focal seizures), especially the temporal lobe. On average, reduces seizures by 50 %. Responsive Neurostimulation (RNS) ================================== Relatively major surgery. Phenomenal device that detects seizure activity as soon as it happens, then sends a small shock to abort it. Currently, it reduces seizures by 50 % But it is a programmable device – future detection algorithms may make it much more effective.   ***********************************Written by:Dr. Siddharth D Kharkar For more information: visit https://drkharkar.com/Targted Keywords – Neurostimulation in the Treatment of Epilepsy, responsive neurostimulation (RNS), Neurostimulation for Drug-Resistant Epilepsy, neurostimulation for epilepsy seizures in hindi Caution: This information is not a substitute for professional care. Do not change your medications/treatment without your doctor’s permission.

Which circumstances can provoke Seizures? This article is for patients with Epilepsy. For factors which are severe enough to provoke seizures even in non-epileptic patients, read the following article below. Please note that this other article is essential to read even if you have Epilepsy – it is necessary for you to to avoid these provoking agents as well [Provoked seizures: Click here]. Here is the list of circumstances (taken from the article above) which can precipitate seizures if you have Epilepsy. Factors that Can Precipitate Seizures if You Have Epilepsy High fever (Children) Lack of sleep Stress Menses Missing your Anti-Epileptic dose Let us talk about these factors in detail. If my child has a Seizure when he has a high fever, does it mean that he/she has Epilepsy? In the vast majority of cases: No, the child does not have Epilepsy. Children can have seizures when they have a fever. Seizures which happen during a high fever are called “Febrile Seizures”. They usually occur in children. In the vast majority of cases (>90%), Febrile Seizures do not indicate the onset of (or lead to the development of) Epilepsy. Rarely, however, some Epilepsy syndromes which happen in Children may present initially with Febrile Seizures. Some researchers multiple febrile seizures in childhood may slightly scar some brain parts, e.g. the “mesial temporal lobes”. This scarring may cause Epilepsy in adulthood. The risk of this happening is minimal, and many doctors believe it is almost zero. If a child has pre-existing Epilepsy, then a high fever can precipitate a seizure. This is less common in Adults. Does lack of sleep lead to Seizures? Yes, definitely. If you have Epilepsy, you should sleep for 8 hours a day. No excuses, no exceptions. Lack of sleep may precipitate seizures. Lack of sleep is a very strong precipitant of Seizures in certain Epilepsy Syndromes, especially Juvenile Myoclonic Epilepsy (JME). If patients with JME don’t sleep well, they get many jerks of the body in the morning. If they are lucky, that is all that happens. Unfortunately, sometimes they also get a whole body generalized seizure. Lack of sleep can precipitate all kinds of Seizures. Video-EEG monitoring is an unusual situation when the patient is admitted to the hospital, hooked up to the EEG, and everyone is waiting for a seizure to happen so that it can be studied. If seizures don’t occur by the third day, guess what the doctor and patient conspire to do: Sleep deprivation! The patient sleeps for only 4 hours in the night. Sure enough, many of these patients have a seizure the next day, regardless of their Epilepsy Syndrome. Does alcohol precipitate seizures? Excessive intake of alcohol can precipitate seizures in a person with Epilepsy. Excessive intake of alcohol may precipitate seizures. Some people who drink huge quantities of alcohol may get seizures, even if they dont have Epilepsy. Does Stress precipitate Seizures? Yes, it seems to. 25% of patients with Epilepsy report that Stress precipitates their seizures (Nakken et al. 2005). No one quite understands why this happens; some people believe that hormonal imbalances may play a role. Stress may precipitate both Epileptic seizures & Non-Epileptic attacks. Note: Here we are talking about stress precipitating seizures in Epilepsy, due to an increased abnormal tendency of the Brain to have seizures. But, stress can cause seizure-like attacks even when the Brain has NO tendency to have seizures – These are called “Psychogenic Non-Epileptic Seizure-like-attacks” or PNES, described in another article (click here). It is very important to find out if you have Epilepsy worsened by stress OR if you have PNES – both are real problems with good solutions, but the treatments are different. Considering that 1/4th of patients report a worsening of seizures when they are stressed out, learning stress reduction & relaxation techniques would be an excellent idea. Certain people may be more susceptible to depression and anxiety at certain times of the year. Some people may need a counsellor or psychiatrist to sort out these issues. You can read more about depression and anxiety and methods to reduce them here: [visual-link-preview encoded=”eyJ0eXBlIjoiZXh0ZXJuYWwiLCJwb3N0IjowLCJwb3N0X2xhYmVsIjoiIiwidXJsIjoiaHR0cHM6Ly9lcGlsZXBzeXBhcmtpbnNvbnMuaW4vaWYtaS1oYXZlLWVwaWxlcHN5LWhvdy1jYW4taS1yZWR1Y2UtZGVwcmVzc2lvbi1hbnhpZXR5LyIsImltYWdlX2lkIjotMSwiaW1hZ2VfdXJsIjoiaHR0cHM6Ly9lcGlsZXBzeXBhcmtpbnNvbnMuaW4vd3AtY29udGVudC91cGxvYWRzLzIwMTkvMTAvQ2xpbmljTG9nb1NtYWxsLnN2ZyIsInRpdGxlIjoiSWYgSSBoYXZlIEVwaWxlcHN5LCBob3cgY2FuIEkgcmVkdWNlIERlcHJlc3Npb24gJiBBbnhpZXR5PyIsInN1bW1hcnkiOiJDb21tZW50IiwidGVtcGxhdGUiOiJ1c2VfZGVmYXVsdF9mcm9tX3NldHRpbmdzIn0=”] Can Menses precipitate Seizures? What are “Catamenial Seizures”? Yes. Some, but not all women, may complain of worsening of seizures around their menses. This worsening is due to the high levels of a hormone called “Estrogen” in the body. These seizures are called “Catamenial Seizures”. Some women report that they have seizures around menses. If a lady with Epilepsy is started on anti-epileptics and stops having all seizures, the seizures around Menses may also stop. In some cases, all seizures except those around Menses may stop. These women may need a slight increase in the dosage of their anti-epileptics during these times, for additional protection. Your doctor may use medications called Benzodiazepines (for example, Clobazam) to provide this extra protection. In some of these patients, increasing the anti-epileptic dose may not help either. If traditional anti-epileptics don’t work, certain other medications including Acetazolamide or in rare cases a hormone called “Progesterone” may be helpful. Can missing your Anti-Epileptic medication precipitate Seizures? Well… Yes, of course. I think there are two main reasons for not taking medications on time. 1. Many people don’t like taking their anti-epileptic medications. A lot of people initially have trouble accepting the diagnosis of Epilepsy. This is understandable. It is a somewhat difficult disorder to understand, and the apprehension and complexity of treatments can be overwhelming. This is one of the reasons I wrote this guide. One of the ways we can learn to accept the diagnosis is to increase our knowledge about the disease. Some patients hate their medications! Once we accept the diagnosis, the resentment or apprehension while taking Anti-Epileptic medications disappears. 2. Some people forget to take their medications on time. Please allow me to give you a few tips that I have found helpful with my patients: Take medications at the same time every day: e.g. 9 AM and 9 PM. Use your smartphone to set reminders for this time. OR take your

How long does a seizure last? What is “Status Epilepticus”? Almost all seizures end in about 1 minute. Rarely, seizures may go on for a much longer period of time. If a seizure goes on for more than 5 minutes, the patient is said to be in a condition called “Status Epilepticus”. Status Epilepticus is a medical emergency – the patient needs to be given rescue medications to stop the seizure immediately. Such a patient needs to be rushed to the nearest hospital immediately. When many seizures happen one after the other in rapid succession, then again the person is said to be in Status Epilepticus. This again is a medical emergency. Although any epilepsy patient may get Status Epilepticus, it is uncommon and unlikely to happen if you have not had prolonged seizures before. As mentioned in the first line of this answer, almost all (>90%) of seizures end in about 1 minute or less. What are the 2 most common reasons for harm during a seizure? Most seizures do not result in permanent bodily harm. There are two main reasons for bodily harm during a seizure. These are worth highlighting: Reasons for Bodily Harm During a Seizure 1. Trauma due to hitting body parts 2. Aspiration / Choking The entire concept of first-aid during a seizure is to prevent these two things. What can I do to prevent aspiration? When a foreign body goes into the wind-pipe or lungs, it is called aspiration. If the foreign body is large enough (e.g. a stick or coin) it may block the wind-pipe leading to choking. If it is a liquid – such as the person’s own vomit – then it may go into the lungs and produce an infection of the lungs (pneumonia). In summary: Aspiration is to be prevented at all costs. Thus, for preventing aspiration: Do NOT put anything into the mouth of the patient while he/she is having a seizure. Do NOT put your hand in the patient’s mouth – your fingers could be cut off. Turn him/her to one side, so that any vomit flows out from the mouth. After you are absolutely sure that the seizure has ended completely, you can remove any large food objects in the mouth. Do NOT give the patient any food or water until the seizure ends completely and he/she is completely conscious. What can I do to prevent injuries during a seizure? If the patient has frequent seizures, then some preparation to avoid injuries is justified. Try to avoid furniture with glass or very hard metal corners which can result in injury. Consider carpeted floors or wood floors instead of stone floors. In children who have multiple daily seizures with drop-attacks, consider using a plastic helmet at all times to prevent head injury. As soon as you see a seizure happening: Try to prevent the patient from falling and hitting the ground hard. If possible, ease him/her to the ground. Remove all surrounding hard furniture. Should I video-tape the seizure on my smartphone? The eyes can only see what the mind already knows, and additionally, human memory is fallible. Especially if there are two people around it makes perfect sense to record the seizure in it’s entirety, from beginning to end. While recording, make sure that the entire body is visible. Do not change the camera angle excessively and do not end the video recording before the seizure ends. In fact, even after the seizure ends talk to the patient – ask him/her his/her name, what happened, and ask him/her to name a few things around the house and finally to hold up both arms. A good video recording can provide completely invaluable information to your treating physician. If you bring 2-3 (or even more!) such video recordings to your doctor, the nature of your seizures becomes crytal clear. This helps tremendouly in choosing medications and if required, considering surgery. This is a lot of information! How do I remember this in an emergency? Don’t worry: Click on the image below to download it. Print it and put it up in your home. Epilepsy A4 English Caution: This information is not a substitute for professional care. Do not change your medications/treatment without your doctor’s permission.