Dr. Jayanti Mani

AREA(S) OF INTEREST:

Epilepsy

TREATMENTS/PROCEDURES OFFERED:

Epilepsy and Neurology Outpatient and inpatient services: expertise in complex and drug resistant epilepsy, Routine Outpatient EEG, Video EEG monitoring (short and long term), Presurgical evaluation

FELLOWSHIPS:

Fellowship in Clinical Epilepsy and Neurophysiology at Cleveland Clinic Foundation

Dr. Jayanti Mani has set up the Epilepsy Programme at Kokilaben Hospital. She has expertise in the medical management of all the patients with seizures and epilepsy and also the selection of patients who will benefit from epilepsy surgery.

Dr. Mani had her entire medical training at the GS Medical College and KEM Hospitals in Mumbai. After completing the DM degree in Neurology, she worked as a lecturer in Neurology at the twin institutes for two years. During this period she was a visiting fellow at the Department of EEG and Clinical Neurophysiology, Kings College London with Dr. Colin Binnie and Dr. Charles Polkey.

Her interest in epilepsy then took her to the Cleveland Clinic Foundation where she completed a two year fellowship in Clinical Epilepsy and Neurophysiology during years 2003-2005. Dr. Mani trained with stalwarts in the field of adult and paediatric epilepsy like Dr. Hans Luders and Dr. Elaine Wyllie. She won awards for her research during this period.

After her return to India in 2005, Dr. Mani was a Consultant Neurologist and Epileptologist in Mumbai with attachments at Bombay Hospital and Medical Research Centre and at Wockhardt Hospitals, Mulund. She set up the video EEG monitoring and Epilepsy Program at the Bombay Hospital in Mumbai. She facilitated several surgeries for intractable epilepsy during this period.

KDAH Experience

Dr Jayanti has been part of Kokilaben Hospital since 2009 and she is responsible for setting up the epilepsy program at Kokilaben Hospital. She reviews over 4000 patients of epilepsy every year. Under her stewardship, the Epilepsy and EEG service has performed presurgical evaluations of nearly 400 patients with drug resistant epilepsy and conducted 80 epilepsy surgeries so far, with excellent results. This includes complex surgeries needing intraoperative electrical mapping and awake craniotomies for surgeries near eloquent areas of the brain.

Academics/Research/Awards

Dr Mani has spent almost her entire clinical career in teaching hospitals in India and abroad. She has maintained a keen academic and research interest in Neurology and Neurophysiology and has publications in national and international journals like Neurology, Neurology India and Seizure, and has also contributed chapters to international textbooks in Epilepsy.

Her interest in teaching has found her an affiliation as an Honorary Visiting Consultant in the Department of Medicine, Lokmanya Tilak Memorial Medical College and General

Hospital, Mumbai.

Dr Jayanti is a member of several national and international organisations including the Indian Academy of Neurology, Indian Epilepsy Association, American Academy of Neurology and the American Epilepsy Society.

Dr Jayanti is on the Editorial board of the International Journal of Epilepsy, and is a reviewer for Journal of Association of Physicians of India

Key Publications

• Proposal: Different types of loss and alteration of consciousness in Epilepsy. Controversies in Epilepsy Luders H, et al Epilepsia, 55(8):1140–1144, 2014
• Surgery for Epilepsy : General Principles: Bhaskar Malla, Jayanti Mani, pp 2229-2243 in Ramamurthi & Tandon's Textbook of Neurosurgery, 3rd edition, eds PN Tandon and R Ramamurthi, Jaypee Medical Publishers Pvt Ltd 2012.
• Surgery for Temporal Lobe Epilepsy : Bhaskar Malla, Jayanti Mani, pp 2244-2257 in Ramamurthi & Tandon's Textbook of Neurosurgery, 3rd edition, eds PN Tandon and R Ramamurthi, Jaypee Medical Publishers Pvt Ltd 2012.
• Modern technology Modern technology calls for a modern approach to classification of epileptic seizures and the epilepsies. Lüders HO, Amina S, Baumgartner C, Benbadis S, Bermeo-Ovalle A, Devereaux M, Diehl B, Edwards J, Baca-Vaca GF, Hamer H, Ikeda A, Kaiboriboon K,Kellinghaus C, Koubeissi M, Lardizabal D, Lhatoo S, Lüders J, Mani J, Mayor LC, Miller J, Noachtar S, Pestana E, Rosenow F, Sakamoto A, Shahid A, Steinhoff BJ, Syed T, Tanner A, Tsuji S. Epilepsia. 2012 Mar;53(3):405-411
• Lesional Mesial Temporal Epilepsy: Case Discussions. J Mani, I Najm. In Text Book of Epilepsy Surgery Edited by Prof Hans Luders, Informa Press 2008
• Evidence for a Basal Temporal Visual Language Center: Cortical stimulation producing pure alexia: J.Mani, B.Diehl, Z. Piao, S. Schuele, E. Lapresto, P Liu, D. Nair, D. S. Dinner, and H. O. Luders . Neurology. 2008 Nov 11;71(20):1621-7.
• Postoperative seizures after extratemporal resections and hemispherectomy in pediatric epilepsy. J. Mani, A. Gupta, E. Mascha, D. Lachhwani, K. Prakash, W. Bingaman, and E. Wyllie Neurology 2006;66 1038-1043
• Post traumatic Epilepsy: in Textbook of epilepsy eds E Wyllie D Lachhwani & A Gupta, Lippincott William & Wilkins 2005.
• Noninvasive Correlates of Subdural Grid Electrographic Outcome : Kalamangalam, G P.; Morris, H. H. III; Mani, J. Lachhwani, Deepak K.; Visweswaran, S; Bingaman, W M. Journal of Clinical Neurophysiology: October 2009 - Volume 26 - Issue 5 - pp 333-341
• Childhood Absence Epilepsy with Tonic Clonic seizures and EEG 3-4 Hz Spike and MultiSpike –Slow Wave Complexes; Linkage to Chromosome 8q24, G C Fong, P U Shah, M N Gee, J M Serratosa, I P Castroviejo, S Khan, S H Ravat, J Mani, Y Huang, H Z Zhao, M T Medina, L J Treiman, G Pineda, and A V Delgado-Escueta Am J of Human Genet Oct 63 (4) 1117- 29, 1998.
• Multiple sclerosis in the Neuro imaging era from Western India, J Mani, N Chaudhary, SH Ravat PU Shah, Neurology India, Vol 47:1,1999 p8-11
• Subacute Encephalopathy with Seizures in Alcoholism : A Case report J Mani, S.Sitajayalakshmi, R Borgohain S. Mohandas Seizure: European J for Epilepsy Vol 12 (2) pp 126-129.

Achievements

• Poster presentation won the best paper award at the National Epilepsy Conference in 2015
• Poster accepted for presentation at the American Epilepsy Society meeting in December 2016.

Dr Jayanti is currently the Joint Secretary of SAMMAN an NGO which is the Mumbai Branch of the Indian Epilepsy Association. SAMMAN is actively involved in the spreading of awareness about epilepsy through school and hospital based programs and also conducts in rural medical camps for epilepsy patients

Dr Jayanti Mani: Pre surgical neuropsychological evaluation of a 23 year old man with h/o seizure disorder

Nishit had his first seizure at 6 years of age, he had headache, retching, head turning to the  righ followed by whole body shaking and loss of consciousness.  He was taken to a GP and by that time he had a generalized convulsion. He was started on AED therapy but the drug compliance was poor. Mom chose to opt for homeopathy.  After 1 ½ year, he had an episode where he complained of inability to see followed by eyes and head version to right and unresponsiveness for few minutes. This time she consulted an allopath and anti epileptic medications were started. AED's were started regularly after this episode.

Several medications were tried over the years.  Nishit continued to have brief spells of visual blurring and vomiting once or twice a month, rarely in clusters of 3-4 a day.  Over the years, his seizure intensity and frequency have decreased with medications but complete seizure control has not been achieved. Currently, he gets 1-3 events per month and at times they occur in clusters. His current seizures are described as beginning with an aura (he cannot describe the sensation) followed by coughing and feeling of nausea with hand automatisms; he is drowsy post ictally.
He is presently on 3 different medicines for his seizures: T .Levipil 1500mg BID, T Valance 500-0-750,  Oxetal 600mg BID

The mother had taken Nishit to several  senior medical professionals in Mumbai and Delhi.  He also underwent a video EEGin 2009  to evaluate the seizures. Surgery was suggested but not  strongly recommended and he was continued on medications. Nishit and his mother finally came to the Epilepsy centre at KDAH in early 2014.

Educational and Occupational History
Nishit was reported to be a low average student through his school years. He was given some concessions in school in view of his recurrent seizures. He dropped out of college in his second year of graduation as he was finding it effortful to cope with academics. He is currently doing accounts work in an office and reports of no significant difficulties at work.

Psycho- Social History
Nishit's mother reported that he a stubborn and short tempered individual. He is an introvert person and does not socialize much. He is mistrustful and insecure and takes long to get along with people.

Medical Details Of  The Treatment
Nishit underwent a comprehensive presurgical evaluation at KDAH.  Brain MRI showed a subtle lesion in the right temporal region of the brain.  While this lesion was not very clearly visualised on MRI. The Video EEG, ictal SPECT and PET brain scans  and the neuropsychological assessment for memory all pointed to the same area as the seizure focus.  The epilepsy team in KDAH reviewed all the tests and offered him a temporal lobectomy.

Surgery was done in October 2014.  Nishit has been seizure free since surgery till date (June 2016).  He is now on tapering doses of the medication and is a seizure free life.