Biayna Sukhudyan, Head of the Department of Neurology and Epileptology, discussed epilepsy, modern conservative and surgical treatment methods, and their availability in Armenia on the Public TV News program.   https://www.facebook.com/ArabkirJMC/videos/1002150314597872

  The Public TV has highlighted the adoption of a less invasive surgical method for diagnosing and treating children with epilepsy at the "Arabkir" medical center. This advancement in modern medicine, stereotactic electroencephalography, enables precise identification and removal of epileptogenic foci, leading to significant improvements in patients’ quality of life.    Niko Arzumanyan, the head of the Neurosurgery service at the “Arabkir” MC-ICAH, explains, “Through the sequential recording of brain electrical activity from each microelectrode of the implanted electrodes, relevant specialists identify the foci responsible for epileptic seizures in the patient during the study.” Stereo-EEG was performed for the first time on a child with epilepsy in Armenia. This method is considered one of the most modern and complex approaches to treating this condition. It involves a minimally invasive intervention, allowing for the precise identification of the epileptic focus by gathering information about the activity of brain cells.   Niko Arzumanyan explains, “When a specific epileptogenic zone is identified, we immediately conduct radiofrequency ablation of the indicated areas without any incision or damage to the skull. This procedure targets the identified foci, offering patients the opportunity to alleviate their epileptic seizures. For most patients, stereo-EEG provides crucial information, enabling us to identify the epileptogenic zone accurately. Subsequently, we perform open surgery to achieve optimal results.”   Biayna Sukhudyan explains, “Following the intervention, the patient, who previously experienced seizures monthly, remained seizure-free for a month. This outcome indicated the correctness of our decision, and we recognized that complete cessation of seizures was not achievable after the ablation. Another month elapsed before we performed surgery on the patient and surgically removed the identified focus.”   Armenian doctors, in collaboration with Bulgarian colleagues, conducted a stereo-EEG procedure on a 14-year-old child. The doctor elaborates that the intervention is facilitated through the use of a stereotactic system. Neurosurgeon Niko Arzumanyan further explains and demonstrates, “The device features numerous coordinates and angles, aiding us in pinpointing the exact location for electrode insertion into the brain. A 1.5mm incision is made in the skin, followed by a 2mm diameter incision in the skull, through which electrodes are carefully placed deep into the corresponding brain regions.” An epileptology dispensary operates within the "Arabkir" medical center, where approximately 3,800 patients under the age of 18 are registered.   Biayna Gagikovna explains, “It's important to note that surgery is not suitable for all epilepsy patients. Approximately 70% of patients can be effectively treated with medication, while around 30% have drug-resistant forms of the condition. Hence, only about 50% of patients are eligible candidates for epilepsy surgery. Epilepsy, being a chronic disease, can manifest in various ways, from motor to emotional seizures.”   Doctor Sukhudyan elaborates, “In childhood, we primarily encounter hereditary forms of epilepsy, although there are several acquired causes as well. These include infantile cerebral palsy, fetal asphyxiation at a young age, various infectious diseases affecting the brain, tumor diseases, and immune disorders. In other words, there can be numerous underlying reasons.”   If a person is having seizures in a public place, citizens often take the wrong steps when providing first aid, according to the doctor.   Doctor Sukhudyan advises, “It's crucial to avoid taking incorrect actions when providing assistance. Refrain from intervening, attempting to open the patient's mouth, pulling their tongue out, or trying to revive them forcibly, as such actions can be harmful. Instead, the first step is to gently turn the person onto their side and promptly call for emergency assistance.”  

  The team of neurosurgeons and neurologists at the “Arabkir” Medical Center is introducing modern methods for diagnosing and treating epilepsy in Armenia. Collaborating with colleagues from the University Hospital “St. Ivan Rilski” in Sofia, Bulgaria, our specialists recently performed stereo-EEG, a unique intervention that precisely identifies the source of epileptic seizure activity and facilitates coordination for subsequent surgical treatment. Further details can be found in the video on news.am. 14-year-old Eric, who has been dealing with drug-resistant epilepsy since childhood, now has an opportunity to overcome seizures. He underwent a modern examination at the “Arabkir” medical center, specifically stereo-EEG. This diagnostic and, in some cases, treatment method, accurately identifies epileptic seizure foci in the brain - a procedure performed for the first time in Armenia.   Unlike regular electroencephalography, stereo-EEG is a minimally invasive surgical procedure. Special electrodes are placed in deeper areas of the brain using a stereotactic system, recording epileptic activity.  “Firstly, stereo-EEG is primarily considered a diagnostic method. However, based on its results, a minimally invasive surgical treatment of epilepsy can be undertaken. After placing the electrodes, the neurological team examines all contacts. Upon identifying relevant epileptogenic foci, a discussion is held to determine whether to proceed with coagulation or the surgical removal of the area,” says Sevak Badalyan, a neurosurgeon from the “Arabkir” MC.   Eric’s case presented a unique challenge: despite undergoing various examinations, the epileptogenic focus could not be identified. To achieve accurate diagnosis, 12 electrodes have been placed in his brain, and specialists are monitoring the child’s brain electrical activity to decide the course of further treatment.  “The reason we opted for stereo-EEG in this patient was due to uncertainty about the origin of epileptic activity. While an epileptic focus was visible on the MRI, the description, videotape and EEG did not align. Clinicians entertained doubts that this identified focus was the one to be removed. Therefore, electrodes were placed not only in that focus but also in anterior areas that appeared more suspicious of causing the clinical picture of the seizure.By the second day after electrode placement, we were convinced that our hypothesis was correct. The identified area had no connection with Eric’s epilepsy, and seizures were originating from slightly anteriorly located areas on the same side. This allows us to plan the upcoming surgery accurately” says Biayna Sukhudyan, head of the Neurology and Epileptology service at the “Arabkir” MC.     The first stereo-EEG at the “Arabkir” Medical Center was conducted in collaboration with Bulgarian specialists. According to the pediatric neurologist Petia Dimova from Sofia, they have been working in partnership with Biayna Sukhudyan and the Neurosurgical team at the “Arabkir” MC for 15 years.   “It’s a wonderful team. Although this is the first case, they are already well-versed and capable of conducting similar procedures in the future, thereby assisting patients in Armenia. This hospital, under its management, is dedicated to making all modern diagnostics and treatment methods accessible to citizens, particularly children, in Armenia” says Petya Dimova, a pediatric neurologist from Bulgaria. The specialists are currently monitoring the child’s spontaneous seizures and conducting special stimulation to identify contacts for ablation. While small foci can be addressed with a temporary effect, the ultimate solution for treating the disease involves the surgical removal of the epileptogenic focus.

  This time, the Public TV Company visited our little child from Artsakh. They noticed that Monte is missing his mom. We hold onto the hope that the child will recover from this illness without any consequences and will return home with his parents, to his sisters and brothers.   The team of “Arabkir” MC is putting maximum efforts to ensure the well-being of the child.    On June 24, a baby, who was transported by helicopter from Nagorno Karabakh to Armenia in a critical condition, is currently receiving care in the intensive care unit. The baby’s life was saved, and the doctors are now dedicated to helping the child make a complete recovery. Initially, he was diagnosed with tonsillitis, but the virus has affected the baby’s brain. The condition of the baby worsened due to the unavailability of medication caused by the blockade of the Lachin corridor. Monte started crying when he saw his mother. Then he found comfort in his mother’s arms and eventually started to smile. Narine Melkumyan (the mother of the child) - I could not have imagined how it would be, that we would have to move to Armenia and that our child would be saved. Meetings are not held on a daily basis, as the child remains in quarantine within the intensive care unit. Monte is the baby who was airlifted from Nagorno Karabakh to Armenia on June 24th, in an extremely critical condition, accompanied by Russian peacekeepers. The child was diagnosed with tonsillitis, an inflammation of the tonsils, and later it was discovered that the virus had spread to the nervous system, impacting the brain.   Ashot Gyulbudaghyan (the head of the Intensive Care and Resuscitation Service of “Arabkir” Medical Center) - Time was of the essence. Currently, the one-year-old boy is able to drink on his own, move around, and explore us, strangers. Prior to his transfer, the baby was in the “Arevik” Children's Hospital in Stepanakert. During the last two days of his stay, he was in a serious condition. However, due to the road blockade imposed by Azerbaijani side, which included an unauthorized checkpoint on the Hakari bridge and restrictions on Red Cross movement since June 15th, it was challenging to transfer him to Armenia. And only on the morning of June 24th, it was possible to transport the baby by helicopter to Sisian, and from there to Yerevan,using a specially equipped resuscitation vehicle.   Ashot Gyulbudaghyan -  All necessary measures were taken, but the main issue lied in the availability of medication, as there were only two vials of the required treatment. The child remained unconscious, showing no response or reactions, except for movements and reactions to intense pain. The medication administered upon arrival in Yerevan needs to be continued for a duration of 21 days. The medical team is now relieved regarding the child's life, and now they are fighting for his complete recovery, as any delays in treatment may result in disability. Ashot Gyulbudaghyan - The dynamics witnessed over the course of these 16 days provide strong indications that the child is likely to achieve a full and complete recovery.   The medical team anticipates that within 5 days they will be able to remove the label "Monte" from the bed and transfer the baby to a regular ward. Doctor Gyulbudaghyan is confident that the presence of the child's mother will contribute to a faster recovery, given that the issue is related to the nervous system. Monte's mood visibly changed when his mother left, and even his favorite cartoon failed to bring a smile to his face. The neurologist is making efforts to provide comfort and reassurance.   Ani Sharyan (pediatric neurologist) - He looks, follows, and the movements of his hands and legs have fully recovered.   While we were in the intensive care unit, Monte's father waited by the doors of the medical center for the next update.   Karen Grigoryan (the father of the child) - Ehh, you child in front of your eyes…I don’t know… He has not seen his child for 16 days. He is looking at the pictures from Monte’s first birthday party on May 25th, waiting for the moment they can return home to Martakert, where their other two children are waiting for them. In the meantime, when not pacing the hospital corridors, they stay in the accommodation provided by the medical center. The duration of Monte's complete recovery remains uncertain even to the doctors. Even after being transferred to the hospital, it will still take weeks for him to fully recover.

  One-year-old Monte, who was transported from Artsakh to Armenia by helicopter, is showing positive progress and we remain hopeful for his full recovery without any lasting effects.  The team at "Arabkir" Medical Center is dedicated to providing the best possible care for all our patients in need, including little Monte. We would like to highlight that last week, Biayna Sukhudyan, the head of the Neurology and Epileptology service of "Arabkir" MC, returned to Artsakh with the assistance of the Red Cross. She has been in Artsakh for two months since the day before the blockade. There are no pediatric neurologists in Artsakh, while the demand for their services is high. Thank you, dear doctors! Thank you, Azatutyun Radio Station! Monte is still being cared for in the intensive care unit, but what is important is that he has regained consciousness, opened his eyes, is able to move his arms and legs, and sometimes watches cartoons. On June 24th, a one-year-old baby from Artsakh was transported by helicopter in an extremely critical state, with the assistance of Russian peacekeepers. During that time, the Hakari checkpoint was closed by the Azerbaijani side even for seriously ill patients. The helicopter carrying Monte landed in Sisian, where the specially equipped resuscitation vehicle from the "Arabkir" Medical Center was awaiting for his arrival.    "Upon admission, Monte’s condition was severe, presenting with brain inflammation and impaired consciousness and motor functions," explained Ashot Gyulbudaghyan, the head of the intensive care and resuscitation department of the "Arabkir" Medical Center.    According to Gyulbudaghyan, during the child's initial treatment at the "Arevik" Children's Hospital in Stepanakert, attempts were made to manage his condition through remote consultations. However, it eventually became clear that this approach was not feasible. The child was initially admitted with tonsillitis, but the virus later entered the nervous system, affecting the brain.   "This child specifically required antiviral medicine, of which there was only one or two available," stated the head of the resuscitation department of the "Arabkir" Medical Center. "We needed certain specific tests that are only conducted in Armenia," said Ani Sharyan, a pediatric neurologist at the "Arabkir" Medical Center.   The resuscitation, neurology, and rehabilitation specialists have already initiated their work. The doctors of "Arabkir" emphasize that the baby's life is no longer in danger and they hope that a complete recovery will not be delayed. Various specialists approach the small bed named "Monte" one by one, conducting rehabilitation and neurological exercises. In Artsakh, the shortage of neurologists is a particularly pressing issue, as emphasized by pediatric neurologist Ani Sharyan. Since 2011, the specialists of the medical center have been regularly visiting Artsakh for consultations. However, the closure of the roads has further  complicated the situation. A few days ago, Biayna Sukhudyan, the head of the neurological department, arrived in Stepanakert again with the assistance of the Red Cross.   Only parents can truly know what it means to wait hopelessly with a child who has a serious health condition. Monte's father, Karen Grigoryan stated, "In the afternoon, we were informed that the child would be transported to Armenia. We got ready, then we were informed that there are problems on the Azerbaijani side, with the air route not being opened. Negotiations were conducted throughout the night, and at 10 o'clock in the morning, the air route was finally opened. We were then transported to Yerevan by helicopter."   Monte's parents endured a day of waiting in Stepanakert, as their child was already experiencing seizures, hoping for permission from the Azerbaijani side to allow the child to be airlifted to Yerevan. Karen Grigoryan, the father, has yet to see the child in the intensive care unit. He only imagines his face with a smile, reminiscent of happier times before the unfortunate tonsillitis. The medical staff updates the parents twice a day on the child's health condition and occasionally permits the mother to visit her son. "As soon as I utter a word, the child starts crying, and I leave,” said Narine Melkumyan, the mother.    Karen and Narine are waiting for their son's recovery in the accommodation provided by the hospital. They hope that a land or air journey will take the three of them to Martakert in a good mood.

The child from Artsakh, who is one year old, is currently in an extremely critical condition and has been admitted to the "Arabkir" Medical Complex. Earlier today, Russian peacekeepers transported the child by helicopter from Artsakh to Armenia. It is important to note that the child was initially admitted to the "Arevik" Children's Hospital in Stepanakert a few days ago with tonsillitis and rash. However, after a few days of being in the hospital, doctors noticed that the child exhibited drowsiness and unusual, involuntary movements. They contacted their colleagues in the neurology and epileptology service of the "Arabkir" Medical Complex for professional consultation. Currently, there are no pediatric neurologists available in Artsakh, so the medical professionals maintain regular contact with the doctors at "Arabkir" through various remote communication methods.   After conducting multiple video calls and remote observations, the medical team determined that a magnetic resonance imaging (MRI) should be performed due to suspicion that the virus had invaded the nervous system, resulting in viral encephalitis and affecting the brain. The doctors in Artsakh promptly arranged for the examination and the diagnosis was confirmed. However, it was not possible to obtain a more detailed diagnosis specifying the exact virus responsible for the issue. This was due to the complete closure of the road to Artsakh for over a week, and the specialized virus tests can only be conducted in Armenia.   Arranging treatment in Artsakh is currently impossible due to the lack of necessary medications in Stepanakert. The child’s health condition was in significant danger, especially when the MRI revealed another serious problem: aside from inflammation, hemorrhage was also observed in the child's brain. The doctors in Artsakh made urgent and selfless efforts to manage the child's condition in the resuscitation department. However, as the days passed, the child’s condition deteriorated further, making it evident that managing his condition in the besieged Stepanakert was no longer feasible and he should be transferred to Yerevan. The process of organizing the transfer took additional 24 hours, during which the child's condition worsened, leading to the onset of convulsions. Consequently, anticonvulsant medication was prescribed.   The child was initially transferred from Artsakh to Sisian via helicopter. From Sisian, the child was transported to Yerevan by the resuscitation and intensive care team of the "Arabkir" Medical Complex, using a specially equipped resuscitation vehicle. Currently, the baby is in the examination phase to further clarify the previously established diagnosis and determine the subsequent treatment plan. 

News.am's reference to the recently performed complex surgery in the neurosurgical service of the “Arabkir” Medical Center intended to remove a child’s brain tumor and thus prevent epileptic episodes.   The head of the Neurology and Epileptology service Biayna Sukhudyan, and the head of the Neurosurgery service Niko Arzumanyan provided details about the case, the surgery and, as a whole, about this problem and its modern solutions.    In “Arabkir” Medical Center, a surgical treatment of epilepsy was performed on an 8-year old girl, using modern technologies. Studies have shown that the cause of the child’s epileptic seizures over several years was a large tumor, which compressed nearby areas of the brain. During the tumor removal, neuromonitoring was used to bypass the motor nerve fibers and avoid damage to the child’s motor functions. According to Niko Arzumanyan, the head of the Neurosurgery service who spoke with NEWS.am Medicine, the issue in this patient’s case was not the tumor itself, but the compression of nearby areas of the brain by the tumor, resulting in epilepsy.  What is neuromonitoring?  "Neuromonitoring was very important for this surgery, because the tumor was directly adjacent to the motor areas of the brain and cerebral cortex, as well as corresponding pathways. During the removal of every millimeter of the tumor, we use a special tool to stimulate the brain tissue.    Depending on amount of electric current used to stimulate the brain and elicit a response, we estimate how far we are from the corresponding motor nerve fibers. The main goal of this is so that during the surgery and post-operative care we will not have any deficit and will not damage the motor ability of the body," he said.  According to Niko Arzumanyan, surgical treatment of epilepsy with simultaneous monitoring is one of the new directions that is being developed in “Arabkir” Medical Center. Until now such operations were performed here with the participation of foreign partners, but now the doctors of “Arabkir” MC work independently. The surgery lasted almost 10 hours, because the tumor was quite large and solid. It took the doctors multiple efforts and hours to remove it without damaging the vessels and nerves of the brain.    Biayna Sukhudyan, the head of the Neurology and Epileptology service of “Arabkir” Medical Center mentioned, that the child had been under the of doctors at “Arabkir” MC for several years, her illness appeared with seizures. Various examinations such as MRI and video-EEG monitoring were performed and right parietal tumor with epileptic activity were diagnosed.  “For the first time in Armenia, tractography was performed, which allowed us to understand that the tumor does not include important nerve fibers, however, our neurosurgeons chose to use neuromonitoring during surgery to be safer,” she said.    Video EEG Electroencephalography remains as one of the most important diagnostic tests for epilepsy. Video-EEG or video electroencephalography is one of the newest methods used in “Arabkir” MC. It is a study that records the electrical activity of the brain over a long period of time, which significantly increases the chances of accurate diagnosis of epileptic foci.  “Electrodes are attached with special paste to the heads of our children and adults, and the patients remain in the hospital for 24, 48 or 72 hours. Then the doctor deciphers the results and tries to determine where that electrical activity comes from. If a number of studies confirm and coincide, all showing the same epileptogenic focus, then the patient's chances of overcoming the disease with surgical intervention in the future are quite high,” she explained.  The operated child will undergo EEG monitoring again in a few months to check the effectiveness of the surgery. She will take her medicine for several years, after which, the doctors are sure that she will finally get rid of epilepsy and will live a full and healthy life.   Epilepsy Statistics  The head of the service, Biayna Sukhudyan stated that 70% of the epilepsy cases can be managed through medical treatment, while 30% are difficult to control, and 15% require surgical treatment.  All children in Armenia with epilepsy are under the supervision of "Arabkir" Medical Center. Not only children, but many adults with epilepsy and other neurological disorders receive treatment in the hospital, according to Biayna Sukhudyan. “Currently over 3600 children aged 0-18 are under our care, all of whom have some form of epilepsy, whether genetic or acquired.  Today we have adults and children under our control, and the state program includes people up to the age of 40 who may potentially be candidates for surgery. We also receive adults with drug-resistant epilepsy” she explained.

The pediatric neurology service of “Arabkir” MC, with the head of the service Biayna Sukhudyan went to “Arevik” Children’s Hospital in Stepanakert the day before the blockade of Artsakh. Our doctors were visiting Artsakh again, as part of the “Doctors for Artsakh” project by the Fund for Armenian Relief, in cooperation with “Arabkir” MC and “Arevik” Children’s Hospital.  https://www.facebook.com/watch/?v=697527118668200&extid=CL-UNK-UNK-UNK-AN_GK0T-GK1C&mibextid=6IxyOt&ref=sharing   [Biayna Sukhudyan, pediatric neurologist, Arabkir MC] We came here on the 11th and starting from our first working day there was a blockade.   [CivilNet] Biayna Sukhudyan is a neurologist, the head of the pediatric neurology and epileptology service of Arabkir MC, Yerevan. She moved to Artsakh and has since been unable to return to Armenia. Biayna and a group of enthusiastic pediatric neurologists have been visiting Artsakh for health-related consultations on a regular basis since the end of the war.  Now, as the Azerbaijani blockade of the Goris-Stepanakert highway enters the 12th day, she is trapped in Artsakh along with 120.000 other people. Her main concern is the lack of basic medication.    [Biayna Sukhudyan, pediatric neurologist, Arabkir MC] We have seen many acute and chronic conditions, when children are in need of medications which do not exist here, for example painkillers, some antibiotics and antiseizure drugs , which are very important for children with epilepsy. Sooner or later we will have a shortage of baby formula.    [CivilNet] 120.000 people, including 3000 children, remain under a blockade. Families remain separated.   [Ruben Vardanyan, State Minister of Artsakh] We should be ready for this reality and should not lie to ourselves. As the State Minister and the head of the operational headquarters we’ve discussed various solutions for this situation and before making any decision I want to discuss the opportunities and listen to your opinion.    [Biayna Sukhudyan, pediatric neurologist, Arabkir MC] We kept one infant with visceral leishmaniasis. If it was before the blockade, the child would definitely be transferred to Armenia.    [CivilNet] The shelves of grocery and drug stores are half empty. 29 patients including 8 children are under intensive care. Some of them need to be immediately transferred to Armenia to receive timely medical treatment.

“Arabkir” United Children’s Charity Foundation together with University Children’s Hospital of Zurich and Fund for Armenian Relief have gifted a new video-EEG machine to “Arevik” medical association in Artask.   With its technical characteristics it is one of the best machines in the field. This machine will give the opportunity to provide short-term and long-term EEG monitoring, which will contribute to diagnose epilepsy and treat diagnosed cases.   On the device's launch occasion, the neurologists from “Arabkir” MC were in Artsakh. The head of the service Biayna Sukhudyan (who is neurology consultant of the Ministry of Health of the Republic of Artsakh) has adjusted and conducted the first tests with the machine. She gave practical advice to her colleagues as well. The technician who will work on the EEG machine has been trained in “Arabkir” MC.

Last days of winter at winter school. The Neurology Service of the “Arabkir” MC together with Swiss colleagues brought together more than 40 pediatricians, pediatric neurologists, neurosurgeons from different medical institutions of the republic, as well as a group of 3rd year pediatric anesthesiology and intensive care clinical residents.    During the “Neurological issues in pediatrics”  winter school various professional issues were discussed. The purpose is continuous professional development and learning about modern approaches in the field by presenting interesting cases.    According to participants, these 3-day meetings, which have become a tradition for 11 years, are effective not only for professional growth, but for networking and new meetings as well. 

Biayna Sukhudyan, the head of the Neurology Service of “Arabkir” MC held a five-day consultation together with neurologist Mane Tadevosyan at “Arevik” Medical Center, Stepanakert. Our doctors examined over 240 children with different neurologic problems - epileptic symptoms, developmental delay, headaches etc. The specialists prescribed appropriate treatment, and, if necessary, additional tests.    The “Doctors for Artsakh” program, launched by the Ministries of Health of the RA and Artsakh, Fund for Armenian Relief and Progressive Medicine NGO, is about regular visits and has been implemented since March 2021.