Q: My brother is 40 years old, weighing 82kg and has a height of 5.9. He is suffering from epilepsy since the last 20 years with no obvious reason. He has taken about all anticonvulsive medicines in the last 7 years, even 2 medicines at a time that too at upper dose limits but he is still suffering from minor seizures many times in a day. A doctor here advised us to go in for surgery even though there is no lesion. He said that it is good to perform surgery than terrorising the patient from one drug to another and there is no drug left now to prescribe him. He referred us to a very reputed book of medicine: Harrison's Book of Medicine. Before going in for surgery, I want to know the possible side effects? What will be the approximate expenditure? Is this surgery (temporal lobectomy) done in India, if yes, please give full address?

A:Your brother has unfortunately not responded to the many anti-convulsant drugs available at present and continues to get fits despite full doses of a combination of drugs. I suggest you take him to the nearest large neurology-neurosurgery centre in your state. I list a few of the centres that are carrying out excellent work on epilepsy: 1. All India Institute of Medical Sciences, New Delhi 2. Postgraduate Institute of Medical Sciences, Chandigarh 3. Sri Chitra Institute of Medical Sciences, Trivandrum 4. Christian Medical College and Hospital, Vellore 5. National Institute of Mental Health and Neurosciences, Bangalore. The experts at these centres are skilled in the management of patients such as your brother. They will carry out tests to determine the site in the brain whence the epilepsy impulses arise. If they can improve upon the existing regimen of drugs, they will do so. If no further medical treatment is possible, they will advise your brother whether this epileptic focus can be eliminated surgically. They will explain to your brother, yourself and other family members on the possible risks and outcomes of such operations. Since all these are public sector institutions, the cost is likely to be much less than at any private hospital.