Marengo Asia Hospital Gurugram doctors perform key hole surgery to treat 30-year-old man with Refractory PTSD and Dyscognitive Epilepsy

Gurugram: A 30-year-old man suffering from multiple traumatic experiences till he attained 16 years of age due to domestic abuse was successfully treated by the doctors at the Marengo Asia Hospitals Gurugram through a key hole surgery.

The comprehensive approach taken by Marengo Asia Hospitals Gurugram, led by Dr Himanshu Champaneri, highlights the importance of a multidisciplinary team in addressing such cases.

He developed symptoms of post-traumatic stress disorder from the time he turned 17 years of age. *Dr Himanshu Champaneri, Sr Consultant, Neurosurgery, Marengo Asia Hospitals Gurugram treated the patient.

The patient was diagnosed with Refractory PTSD with Dyscognitive epilepsy. Refractory PTSD with dyscognitive epilepsy refers to a complex medical condition where an individual experiences both post-traumatic stress disorder (PTSD) and dyscognitive epilepsy that does not respond well to conventional treatments.

The patient had sought medical therapies before coming to India which helped him for a certain time, when the symptoms recurred. But this affected his daily life, education, and ability to learn/concentrate. He even attempted suicide two times and was treated with medical therapy, psychotherapy, and EMDR (eye movement desensitization and reprocessing), but his symptoms continued.

He developed dyscognitive epilepsy in which he would have sudden episodes of blankness when he would lose the ability to respond to his surroundings, questions, or any dangers. Such episodes would occur anytime when he was traveling, standing at the subway station, in class, or even alone and affected his daily life as he was unable to pursue any growth in his education/profession.

When he sought treatment at Marengo Asia Hospitals Gurugram, he was evaluated by a team of psychiatrists, functional neurosurgeons, and Neurologists. When asked to revisit his traumatic memories, the functional MRI showed active signals in the right amygdala, which is expected in cases of severe refractory post-traumatic stress disorder. The non-dominant side was confirmed as right side. The rationale for intervention was to intervene at the non-dominant amygdala, which is a center for memory and fear. In cases of refractory PTSD, the non-dominant amygdala becomes hyperactive, leading to memory intrusions and giving rise to dyscognitive seizures.

The keyhole surgery was performed using stereotactic radiofrequency ablation. This procedure is performed by identifying the hyperactive target, the right amygdala in this case. The surgery is performed while the patient is awake to ensure that we have reached the right target and that there are no neurological side effects.

During the surgery, when the amygdala was stimulated and ablated, the patient felt sudden relief of tension, he felt happy memories and relaxation of muscles which he had not experienced for many years. This confirmed the success of the surgery and ablation of the right area. A post-operative MRI scan additionally confirmed this.

According to an IANS report, After the surgery, the patient remained in a very relaxed and happy state and was able to focus on tasks that had not been possible before. He was able to read books, focus on videos, and think about his future with such clarity, which he had not experienced for many years. He did not have any episodes of dyscognitive seizures after the surgery and he had complete relief from the post-traumatic stress disorder.

Dr Himanshu Champaneri, Senior Consultant Neurosurgeon, at Marengo Asia Hospital Gurugram, said,, “When someone has both refractory PTSD and dyscognitive epilepsy, it can pose significant challenges in diagnosis and treatment. The presence of one condition can exacerbate the symptoms of the other, leading to a complex clinical picture. Managing this condition typically involves a multidisciplinary approach, including mental health professionals, neurologists, and possibly other specialists, to address both the psychiatric and neurological aspects of the disorder. Treatment may involve a combination of medication, psychotherapy, and possibly other interventions such as neuromodulation or lifestyle modifications.”

Neeta Rajwar, Facility Director, Marengo Asia Hospitals Gurugram says, “Our clinicians constantly endeavor to break the ceiling to go beyond borders to treat patients who come to us. Within the comprehensive realm of health and wellness, prioritizing mental health is equally vital to physical well-being. These facets are intertwined, each influencing the other's welfare. While research findings may differ, data from India indicates that approximately 20% of adults grapple with various mental health challenges. Globally, mental health is swiftly becoming a growing area of concern. Unchecked mental disorders can lead to disastrous diseases such as epilepsy”, reports IANS.

WHO studies estimated that the burden of mental health problems in India is 2443 disability-adjusted life years (DALYs) per 100 000 population; the age-adjusted suicide rate per 100 000 population is 21.1. close to 60 to 70 million people in India suffer from common to severe mental disorders. A study has shown that children who have experienced child abuse or neglect are four times more likely to develop serious mental illness. And yet, there are many reasons why people do not seek treatment for mental illness, including stigma, lack of awareness still very low even among the literate, and lack of access to resources.