Yashoda Hospitals, Hyderabad, successfully treated a 2-year-old boy with drug-resistant focal epilepsy due to a developmental anomaly using an advanced neurosurgical technique. The child, Mast. Abhinav Reddy, had been experiencing daily seizure episodes since the age of 18 months, significantly affecting his development and daily functioning is fully recovered now.
Epilepsy is a neurological condition characterized by recurrent unprovoked seizures due to abnormal electrical activity in the brain. Most patients respond to antiepileptic drugs, but a subset, referred to as drug-resistant epilepsy (DRE), fails to achieve seizure control despite trials of appropriate medications. DRE is defined when seizures persist despite adequate trials of two or more appropriately chosen and tolerated antiepileptic drugs. 2
In pediatric populations, structural abnormalities of the brain such as malformations of cortical development (MCD), including occipital lobar dysplasia are common underlying causes of drug-resistant seizures. 3 Such malformations interfere with normal neuronal circuits and often lead to persistent focal seizures that are unresponsive to medication.
Advanced neuroimaging like magnetic resonance imaging (MRI) is crucial for identifying these lesions. Posterior quadrantic dysplasia, involving the parietal, temporal, and occipital cortices of one hemisphere, accounts for a smaller fraction of multilobar cortical dysplasia cases but is a recognized cause of refractory epilepsy. 1
Occipital lobar dysplasia refers to a form of cortical malformation affecting the occipital region of the brain, a key area for visual processing and network connections to other lobes. In children, such dysplasia often leads to focal seizures that may originate in or propagate through affected occipital networks and are resistant to standard drug therapy. Neuroimaging techniques, including MRI and PET scans, help delineate the extent of the dysplastic tissue and locate the epileptogenic focus, the brain region where seizures begin.1
Given the severity of daily seizures and failure of medical management, Abhinav underwent a Left Parieto-Temporal Craniotomy with Posterior Quadrantic Disconnection performed on February 20, 2025 under the leadership of Dr. Sagari Gullapalli, Senior Consultant Neurologist & Epileptologist. The multidisciplinary team also included Dr. Ravinder Goud Jangampally (Consultant Paediatrician & Neonatologist) and Dr. Bala Raja Sekhar Chandray (Senior Consultant Neuro & Spine Surgeon).
Posterior quadrant disconnection (PQD) is a functional neurosurgical procedure designed to isolate the epileptogenic zone in the posterior quadrant, comprising the parietal, temporal, and occipital lobes while sparing surrounding healthy motor cortex and neural pathways. Unlike extensive resections that remove large volumes of brain tissue, disconnection surgery severs the pathways that allow seizure activity to spread, thereby reducing or eliminating seizures while preserving neurological function.4
Total PQD has been reported in multiple clinical series to result in seizure freedom for a substantial proportion of carefully selected pediatric patients.
After the posterior quadrantic disconnection, Abhinav responded positively:
No postoperative complications were reported
The child was discharged in stable condition on February 24, 2025
Subsequent follow-up for a year showed that he was seizure-free and on a trajectory toward improved neurological development in all aspects.
“Drug-resistant epilepsy in very young children can severely impact brain development and daily functioning. In Abhinav’s case, timely diagnosis and advanced neuro-surgical intervention were crucial. Posterior quadrantic disconnection is a highly specialized procedure, and we are pleased that the child is now seizure-free and on the path to improved neurological development. Early intervention truly changes lives.”Dr. Sagari Gullapalli, Senior Consultant Neurologist & Epileptologist, Hyderabad
Epilepsy surgery, including resective and disconnective procedures, aims to identify and treat the epileptogenic zone, the brain tissue necessary and sufficient to generate seizures without inducing new neurological deficits.
References
Pillai, Jay J., Richard B. Hessler, J. Douglas Allison, Young D. Park, Min R. Lee, and Thomas Lavin. 2002. “Advanced MR Imaging of Cortical Dysplasia with or without Neoplasm: A Report of Two Cases.” American Journal of Neuroradiology 23 (10): 1686–1691. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8185833/.
Mesraoua, Boulenouar, Francesco Brigo, Simona Lattanzi, Bassel Abou-Khalil, Hassan Al Hail, and Ali A. Asadi-Pooya. “Drug-Resistant Epilepsy: Definition, Pathophysiology, and Management.” Seizure 108 (2023): 27–36. https://doi.org/10.1016/j.seizure.2023.04.003.
Severino, Maria, Ana Filipa Geraldo, Nadja Utz, Domenico Tortora, Ivana Pogledic, Wojciech Klonowski, Fabio Triulzi, et al. “Definitions and Classification of Malformations of Cortical Development: Practical Guidelines.” Brain 143, no. 10 (October 1, 2020): 2874–2894. https://doi.org/10.1093/brain/awaa174.
Doddamani, Ramesh S., Manjari Tripathi, Raghu Samala, Mohit Agarwal, Bhargavi Ramanujan, and Sarat P. Chandra. “Posterior Quadrant Disconnection for Sub-Hemispheric Drug Refractory Epilepsy.” Neurology India 68, no. 2 (March–April 2020): 270–273. https://doi.org/10.4103/0028-3886.284358