In 2023, 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.

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].

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:

1. 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.
2. 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.

So, when calculating the epilepsy surgery cost in India, we need to calculate the cost of evaluation + the cost of the surgery itself.

Let us first talk about the cost of epilepsy surgery evaluation 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.

1. 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.

   

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.

   

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.

   

4. Functional MRI (fMRI) scan:
   Functional MRI is a special MRI. Functional MRI (fMRI) shows which brain part is processing language, controlling movement etc.

   

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:

In the best-case scenario, the results of all of these tests are consistent:

1. MRI-PET shows a single small abnormal brain area
2. Video-EEG recording is consistent (“Concordant”): Uncontrolled electrical storms (seizures) are seen to be starting from the same area.
3. Low risk: Other tests indicate that removal of this abnormal area will not cause severe problems.

In this case, you can go directly for surgery. In these simple cases, the small abnormal part of the brain is quickly removed (see the description of “resective surgery” below).

B. Complex Epilepsy surgery evaluation cost in India

Sometimes, epilepsy surgery evaluation is not so straightforward.

For example:

1. The MRI is normal.
2. The abnormality seen on MRI is too large to be removed completely.
3. The MRI shows many abnormal brain areas, which may produce seizures.
4. The video EEG results and MRI results don’t match up. The video EEG indicates that the seizures may come from a different brain part.
5. The fMRI indicates that speech or movement may be affected by the removal.

In these cases, additional tests are needed. These determine the exact brain area that needs to be removed.

The additional tests to be done are different for each patient. The tests chosen depend on approximate location based on the MRI and video-EEG results.

The two most common additional tests are – MEG scan & SPECT scan.

1. MEG scan:

A MEG scan is not needed in all cases. A MEG detects abnormal magnetic fields, produced by abnormal activity inside the brain. It helps us to detect the abnormal area.

Although it is primarily meant for neurologists, you might like to read a review paper I wrote on the use of MEG for epilepsy surgery [Magnetoencephalography in the presurgical evaluation of epilepsy: Authors: Dr. Siddharth Kharkar and Dr. Robert Knowlton].

This particular publication has been cited in numerous guidelines for how MEG scanning should be used for Epilepsy surgery evaluation.

2. SPECT scan:

A SPECT scan is not needed in cases.

A SPECT scan measures blood flow to the brain during a seizure. A radioactive dye is injected within a few seconds of the seizure starting.

This is a very, very difficult test to do logistically.

The approximate cost of these tests for Epilepsy surgery in India are described below:

C. Very complex Epilepsy surgery evaluation cost in India

All the tests described so far are non-invasive. In other words, they can be done without surgery.

Extremely complex evaluation for Epilepsy surgery in India is done by Stereo-EEG. Stereo-EEG is different. It is a new, extremely powerful technique.

• First, a “CT angiogram” scan is done before the procedure to mark the location of important blood vessels.
• Then, Multiple stiff wires (called “electrodes”) are inserted into the brain through very small holes. This is done very carefully.
• Lastly, the patient is monitored in the same way as “Video EEG” monitoring.

Stereo EEG is a tremendous technique. It may enable the removal of a very small brain part (up to 1 cm cube), with complete seizure freedom!

However, monitoring a patient with stereo EEG is very costly. The costs include the cost of the equipment, surgical cost and the monitoring cost.

Each patient will need a different number of EEG electrodes. On average, about 5 electrodes are needed. However, sometimes only 3 are needed. Sometimes, 7-8 electrodes may be needed in some cases.

But only about 1 in 10 cases need Stereo-EEG. Thankfully, this means that epilepsy surgery in India in most cases is not that costly.

As I had mentioned earlier, there are different kinds of Epilepsy surgeries. It is not possible to describe each surgery type in detail. It would make this article very long!

But about 80-90% of patients eventually get either resective (removal) epilepsy surgery or Vagus Nerve Stimulator (VNS) epilepsy surgery.

Let me describe these 2 surgeries to you.

Resective (Removal) Epilepsy surgery cost in India

Removal of the brain is called Resective (removal) Epilepsy surgery. This is the best epilepsy surgery in India, or anywhere in the world.

It is also the simplest to understand. We identify and remove the small brain part causing seizures. This stops seizures.

Intraoperative Electrocorticography:

Ideally, continuous EEG monitoring should be done during the surgery. A neurologist looks at the EEG, and guides the neurosurgeon so that the smallest possible part is removed.

This is called intra-operative Electrocorticography (Ecog). It should not be skipped in most cases.

The approximate cost of each of these parts is as follows:

Vagus Nerve Stimulator (VNS) Epilepsy surgery cost in India

Sometimes, epilepsy surgery evaluation reveals that resective (removal) epilepsy surgery cannot be done. In these cases, VNS epilepsy surgery can still be done.

VNS is a special electronic device that decreases seizures.  The VNS device is a very small & sophisticated battery.

A small procedure is done to connect it to the left vagus nerve, which lies just below the neck skin. The small battery is kept below the chest skin.

The surgery itself is fairly simple. But the device is manufactured only in the USA. It is therefore expensive.

The exact cost of Vagus Nerve Stimulation (VNS) epilepsy surgery in India depends on the type of device selected. There are many types of VNS devices. But only 3 VNS devices are currently (Dec 2022) being used in India: Demipulse, Aspire SR and Sentiva.

I will describe the advantages of each VNS device type in another article. For now, just remember that – for most patients – the middle device (Aspire SR) is the best balance between features and cost.

Patients need to be carefully selected for VNS epilepsy surgery. This is because the surgery is so costly!

Cost of other epilepsy surgeries in India

Let me quickly share the cost and peculiarities of other epilepsy surgeries which can be done in India.

1) Corpus Callosotomy:

It is a major brain surgery. The two parts of the brain are partially disconnected from each other. This prevents seizures from spreading from one side to the other.

It is useful for the same set of patients as VNS.

Efficacy is similar to VNS, but the cost is much lower.

2) Deep brain stimulation:

DBS or deep brain stimulation is a device that is usually used for Parkinson’s. You can read more here. More recently, it was recently approved for use in Epilepsy.

For most patients, VNS efficacy is similar. VNS is a less costly and less complicated surgery.

3) Responsive Neurostimulation:

This is an extremely promising new device. It is implanted in the skull. When it detects a seizure, it sends a small shock to that part and stops the seizure from spreading.

You can see a video of it in action here:

It is extremely costly. Currently, the efficacy is similar to VNS (Dec 2022), but future software upgrades may make it much more effective.

4) Multiple subpial transections (MST):

If the abnormal area producing seizures is very close to critical brain areas, a small needle is used to carefully disrupt nerve fibres in this area. This may prevent uncontrolled electricity from spreading.

Hence, it may prevent big seizures.

Although many patients become seizure-free after surgery, recurrence rates are on the higher side.

RNS is not currently available in India (as of January 2023). Let us discuss the cost of these Epilepsy surgeries in India:

What is the minimum cost of Epilepsy surgery in India?

Let us calculate the minimum cost of Epilepsy surgery in India.

Simple evaluation & surgery costs less money.

Let’s say that we do the basic set of tests (MRI, video-EEG monitoring, PET, fMRI and neuropsychological testing).

And let’s say everything turns out to be very simple and straightforward!

The MRI-PET locates a small abnormal part in your brain. We record 2-3 seizures in 2 days. The Video-EEG confirms that the seizures are originating from that area. The fMRI and neuropsychological testing indicate it’s safe to remove this part.

In this kind of simple epilepsy surgery, the cost would be minimal. In a private hospital like Nanavati where our team does Epilepsy surgery in India, these would be the total costs:

Calculation sheet for Total Epilepsy surgery cost in India:

For epilepsy surgeries, you can calculate the approximate cost by using the Sheet below.

Click on the sheet to download it. List the proposed tests and surgery. You can then add up the costs, to budget for the total cost of Epilepsy surgery in India.

Epilepsy Surgery Cost in India – Calculation sheet

Please note that you need these details from your doctor. Once you have the details, you can input them into the calculator to calculate Epilepsy surgery cost in India.

Summary: Epilepsy surgery cost in India

1. Epilepsy surgery cost in India is between 3.5 and 15 lakh.
2. Epilepsy surgery cost in India is variable. This is because each patient needs customized evaluation and surgery.
3. Epilepsy surgery in India is done in two steps. Step 1 is evaluation, Step 2 is the surgery itself. The cost of these two steps needs to be added to calculate the total cost.
4. Simple, complex or very complex evaluation for epilepsy surgery may be needed. Simpler evaluations are cheaper.
5. The most common Epilepsy surgeries are resective surgery and Vagus Nerve Stimulation (VNS) surgery.
6. Total Epilepsy surgery cost in India can be calculated by adding the cost of step 1 & step 2.