Dr. Keni Ravish Rajiv is a Consultant Neurologist and Epileptologist in the Department of Neurosciences at Aster Hospitals, Bengaluru. He has vast experience in treating various complex and difficult to manage patients with epilepsy. He is an expert in the field of epilepsy and is one of the few certified epileptologists in India.
He completed his MBBS from Goa Medical College in 2007 and MD in General Medicine from PESIMSR, Kuppam in 2013. Subsequently, he underwent Super-specialty training in Neurology at the prestigious Sree Chitra Tirunal Institute of Medical Sciences & Technology (SCTIMST), Thiruvananthapuram, Kerala from 2015-2017. After successfully completing his DM Neurology course, he underwent a one-year Epilepsy Fellowship in the prestigious R. Madhavan Nair Center for Comprehensive Epilepsy Care of the same institute in 2018.
Experience in Epileptology:
He has experience of reporting more than 1000 video EEGs and more than 150 intra-operative electrocorticography. He is well-versed in treating both adult and pediatric complex epilepsy cases. After the completion of his Epilepsy Fellowship, he joined Narayana Medical College, Nellore as the in-charge epileptologist and was instrumental in setting up the Comprehensive Epilepsy Care Center (first of its kind in Andhra Pradesh). Under his guidance epilepsy surgery was successfully carried out for 27 patients within a short span of 1 year. He has a special interest in the management of Epilepsy in Women and management of status epilepticus and also has several publications on these topics.
Major Academic Achievements:
Apart from being an astute clinician, he is an eminent academician. Looking at his academic performances he is regarded as one the most promising Neurologist and Epileptologist. He was the South-Zone winner for Torrent Neurology Young Scholar Award in 2017. He has several research publications pertaining to Epilepsy in renowned international journals to his credit. In recognition of his research work, he was granted the prestigious International Scholarship Award 2019, by the American Academy of Neurology. Apart from authorship, he has the privilege of being selected as a reviewer for several Neurology and Epilepsy indexed journals such as (Clinical EEG and Neuroscience, Neurology India, Annals of Indian Academy of Neurology, Journal of Neurology in Rural Practice, BMJ Case Reports). He was invited as a faculty for teaching EEG analysis for budding neurologists during the Indian Epilepsy School in 2018 and A-Z of EEG workshop organized by Karnataka Neurosciences Academy in 2020.
Associate member of American Academic of Neurology
Indian Academy of Neurology
Indian Epilepsy Society
Publications: 20 journal articles and 7 book chapters.
Rajiv KR, Srivastava S, Varghese P. A rare case of anterior circulation thrombus resulting in posterior circulation stroke. IJBAMR. 2014; Vol.-3, Issue- 4: 61-64.
Sankar U, Varghese P, Rajiv KR. Hoffmann’s syndrome: An atypical neurological manifestation of hypothyroidism. IJBAMR. 2015; Vol.-4, Issue- 2: 409-413.
Nair M, Menon R, Hassan H, Rajiv KR, Menon D, and Radhakrishnan A. An audit of the predictors of results in status epilepticus from a resource-poor country: A comparison with developed countries. Epileptic Disord in June 2016. 1;18(2):163-72.
Radhakrishnan A and Rajiv KR. Status epilepticus in pregnancy: Etiology, maintenance & clinical results. Epilepsy & Behavior 2017; 76:114-119.
Jose M, Sarma S, Keni RR, Thomas SV. Teratogenicity of antiepileptic dual therapy like dose-dependent and drug-specific or both? Neurology in February 2018. 27;90(9):e790-e796.
Cherian A, Sukumaran S, Thomas SV, Nair M, Menon RN, Rajiv KR, and Radhakrishnan A. Status epilepticus linked to pregnancy: devising a protocol for use in the intensive care division. Neurology India in 2018; Volume 66(6); 1629-1633.
Radhakrishnan A and Rajiv KR. Status epilepticus in pregnancy - Can we make a uniform treatment protocol? Epilepsy Behav in 2019, July 12:106376.
Chandran A, Rajiv KR, Menon R, Radhakrishnan A, Thomas SV, Baishya J, and Mitta N. How safe is bone health in patients upon newer or enzyme inhibitor antiepileptic drugs? - J Neurol Sci in 2019, October 15;405:116422.
Durango-Espinosa Y, García-Ballestas E, Mendoza-Flórez R, Moscote-Salazar LR, Keni R, Deora H and Agrawal A. The puzzle of spontaneous versus traumatic subarachnoid hemorrhage. Apollo Med. in 2019;16:141-7.
LR Moscote-Salazar LR, Agrawal A, and Keni R. Non-narcotic ways of pain management: A Neurosurgeon’s Point of View. Indian Journal Of Clinical Practice. 2019 Sept; 30(4).
Keni RR, Jose M, A SR, Baishya J, Sankara Sarma P and Thomas SV. Anti-epileptic drug and folic acid usage in pregnancy time, seizure and malformation results: Changes over two decades in the Kerala Registry of Epilepsy and Pregnancy. Epilepsy Res. 2020 Jan;159:106250.
Deora H, Florez WA, Martinez-Perez R, Galwankar S, Keni R, Menon GR, Agrawal A, Garcia-Ballestas E, Joaquim A, and Moscote-Salazar LR. Patients with intracranial hypertension with aneurysmal subarachnoid hemorrhage: A well-organized review and meta-analysis. Neurosurgery Rev. February 2020. 1. doi: 10.1007/s10143-020-01248-9.
Keni RR and Thomas SV. Bridging The Gap in Epilepsy Treatment in A Resource-Limited Setting. AIAN. 2020 Feb. DOI: 10.4103/aian.AIAN_608_19
LR Moscote-Salazar, Agrawal A, and Keni R. Brain Activation in Patients who are not responsive with Acute Brain Injury: Words of Caution. Indian Journal of Clinical Practice, Vol. 30, No. 10, March 2020.
Baishya J, Unnithan G, Menon RN, Rajiv KR, Chandran A, Thomas SV, Radhakrishnan A. Personality diseases in temporal lobe epilepsy: What do they signify? Acta Neurol Scand. 2020 May 9. doi: 10.1111/ane.13259.
Quinones-Ossa GA, Moscote-Salazar LR, Durango-Espinosa Y, Padilla-Zambrano H, Keni RR, Deora H, and Agrawal A. The puzzle of spontaneous versus traumatic intracranial hemorrhage. Egypt J Neurosurg. 2020; 35(13). DOI: 10.1186/s41984-020-00084-9.
Keni RR, Licchetta L, Ignjatova L, Mostacci B, Kiteva-Trencevska G, Thomas SV, Meador KJ. Women’s issue. Epileptic Disorders. July 2020 [Epub ahead of print]. DOI:10.1684/epd.2020.1173
Bonilla-Mendoza C, Moscote-Salazar L, Keni R, Garcia-Ballestas E, Pacheco-Hernandez A, and Agrawal A. Mitochondrial Dysfunction in Traumatic Brain Injury: Management Strategies. Indian Journal of Neurotrauma. 2020;17(01):37-41. DOI:10.1055/s-0040-1713457
Rajiv KR, Menon D, Radhakrishnan A. PLEDs and NCSE: To lump or Split them Together? Acta Scientific Neurology. 2020; 3(9).
Rajiv KR, S Raghavendra. First-line Therapy in Status Epilepticus. In Status Epilepticus: Practical Guidelines in Management. Jaypee Publishers.First Edition: 2017.
Rajiv KR, Agarwal V. Newer anti-epileptic drugs in pediatric epilepsy syndromes. In Pediatric Epilepsy Syndromes: Seizures, Syndromes, Approach, and Management. Jaypee Publishers. First edition: 2018.
Keni RR, Deora H, Agrawal A. Normal Pressure Hydrocephalus. In New Insight into Cerebrovascular Diseases: An Updated Comprehensive Review. Intech Open Publishers. 2019. DOI: 10.5772/intechopen.92058
Singh S, Deora H, Keni RR, Agrawal A. Changing Paradigms in the Pathophysiology of CSF Dynamics. In: Advances in Health and Disease. Nova Publishers. Volume 21. June 2020.
Rajiv KR, Agrawal A. Post-cerebral infarction seizures. In: Advances in Health and Disease. Nova Science Publishers. Volume 21. June 2020.
Keni RR, Thomas SV. Managing Epilepsy in Women. In: The 5-Minute Clinical Consult 2020 South Asian Edition. Wolters Kluwer India Pvt Ltd.; 2020:Lippincot Gurukul e-content.
Rajiv KR, Kumar NS. TB Meningitis. Textbook Of Tuberculosis & Nontuberculous Mycobacterial Diseases. Jaypee Publishers (In press).
Papers presented at Scientific conferences: 6 oral and 7 poster presentations
A case of resistant JME in women of child-bearing age group. Ask The Experts Sessions-Women’ s Issues. Search Results. 33rd International Epilepsy Congress Bangkok 2019.
Auto-immune encephalitis presenting as status epilepticus. ECON Patna 2017.
Teratogenicity of AED dual therapy: dose-dependent or drug-specific. SCTIMST, Science fete 2017.
Malformation risk of antiepileptic dual therapy in women with epilepsy. KAN annual conference. Kozhikode 2016.
Super-refractory status epilepticus (SRSE): Can we draw conclusions and predict the outcome?Conference on ‘Epilepsy in Clinical Practice’. Vikram Hospital Bangalore 2016.
Role of elevated cardiac troponin in critically ill patients- AP APICON 2012.
Trends in AED, folic acid usage, and MCM outcomes over two decades in KREP. AAN conference, Philadelphia 2019.
McGurk effect in left versus right hemispheric epilepsy. Asia-Oceania Congress of Epilepsy, Hong Kong 2016.
Reversible Myocardial Dysfunction In The Critically Ill- APICON 2013
Anterior Circulation Thrombus with Posterior Circulation Stroke- APICON 2013
Addison Disease with extra pontine myelinolysis- APICON 2012
A provider and person with epilepsy can do several things to stop or lessen seizures.
The most common treatments for epilepsy are:
Medicine. Anti-seizure drugs are medicines that limit the spread of seizures in the brain. A health care provider will change the amount of medicine or prescribe a new drug if needed to find the best treatment plan. Medicines act for around 2 in 3 people with epilepsy.
Surgery. When seizures arise from a single area of the brain (focal seizures), the surgery to exclude that area may stop future seizures or make them easier to manage with medicine. Epilepsy surgery is mostly used when the seizure focus is located in the temporal lobe of the brain.
Other treatments. When medicines fail to work and surgery is not possible, then other treatments can help. It includes vagus nerve stimulation in which an electrical device is placed or implanted, under the skin on the upper chest to transfer signals to a large nerve in the neck. Another option is the ketogenic diet, high fat and low carbohydrate diet with restricted calories.
2. What can I do to manage my epilepsy?
Self-management is what one should do to take care of self. You can learn how to manage seizures and keep an active and full life. Begin with these tips:
Take your medicine.
Discuss with your doctor or nurse when you have questions.
Recognize seizure triggers (such as flashing or bright lights).
Keep a record of your seizures.
Get enough sleep.
3. How can I prevent epilepsy?
Sometimes we can prevent epilepsy. The most common ways to reduce your risk of developing epilepsy are:
Have a healthy pregnancy. Some problems during pregnancy and childbirth may lead to epilepsy. Follow a prenatal care plan with your healthcare provider to keep you and your baby healthy.
Prevent head injuries
Lower the chances of stroke and heart disease.
Be up-to-date on your vaccinations.
Wash your hands and prepare food safely to prevent worm infections such as cysticercosis
4. What is an Epilepsy Monitoring Unit (EMU?)
It is a specialized unit in the hospital for constant monitoring of brain activity using EEG and Video, where a patient is admitted for 3-5 days.
This will provide your doctor with better knowledge about your seizures by observing how your brain functions and what are you doing physically during the event.
5. What are EEG and video EEG and their necessity?
Video EEG is nothing but a simultaneous recording of EEG along with a video camera focused on you all the time. You will be admitted and EEG leads will be connected to you. You will be under the camera for 24 hours while your EEG on. When you will have a seizure, it will record the exact movements you do during your seizure activity and simultaneous EEG recordings. This will provide us with the exact idea of the area of your brain accountable for producing these seizures. Generally, we 3-10 episodes of seizure will be recorded and so patients usually stay for 5-7 days in the hospital. We generally stop your drugs so that more seizures can be obtained in a short time. It is secure as you are having seizures in a controlled environment of the hospital, supported with doctors and nurses all the time.
6. How do I prepare for the EMU Admission?
To prepare for an EMU Admission:
Wash your hair the night before or the day of the test, but do not apply any conditioners, hair creams, sprays or styling gels to your hairs. Hair products use should be avoided as it can make tougher for the sticky patches that are used to hold the electrodes to adhere to your scalp. If you have weaves or braids, need to be removed before a test is completed.
Wear loose-fitting clothes
Follow your physician’s instructions regarding your medication.
Arrive at the hospital on scheduled time, delays can occur if you are late.
You may bring electronics like a laptop to use during your stay.
Visitors are allowed during your EMU admission. A family member or loved one who is familiar with the seizure is asked to stay along with the patient at the hospital.
7. What to Expect During your EMU Visit?
You can expect the following during an EMU Admission:
To help you have a seizure or event your medications are typically reduced before or the same day of your admission (Follow Doctor's Instructions).
During your hospital stay, an EMU doctor who is specially trained in EEG/Epilepsy will be accountable for your care and will be examining your video-EEG recording daily. Typically, the physician would record many of your seizures to properly assess the type and location of seizures. The EMU doctor will let you know how many seizures are required.
Sleep deprivation (staying awake for 24 hours), hyperventilation (breathing exercise), and photic stimulation (strobe lights) may be practiced to help induce an event. Whenever your brain is tired, this event is more likely seen.
During an event, a technologist will arrive at your room quickly to keep you safe, see the event, and alert the nursing staff. The nursing staff will enter the room and perform their evaluations (blood pressure, oxygen level, etc..)
At your bedside, a nurse alarm and an event button attached to the EEG Equipment. If you have a feeling that you are likely to have a seizure, "Push the Event Button". If your event happens suddenly, then your family member may press the button for you. The technologist will go along these steps with you when you arrive.
Our EEG Technologists inspect the electrodes daily to reapply or fix them as required. During your EMU admission, you will not be able to wash your hair or shower.
If you go to sit in a different part of the room, the camera will be adjusted accordingly. Please let a nurse or the technologist know when you need to use the restroom. A family member or nurse can assist you to go to the bathroom.
The recorder device is attached to a strap. It will go around your neck and the wires can be worn inside or outside of your clothing. The video will record 24 hours a day and it will not follow you into the bathroom.
Once the electrodes are in position, your head will be covered with gauze to help keep the electrodes in place during EMU Admission.
A technician connects flat metal discs (electrodes) to your scalp with the use of a special adhesive. Sometimes, an elastic cap attached to electrodes is used instead. The electrodes are fixed with wires to an instrument that amplifies and makes bigger - the brain waves and records it on the computer device.
A technician measures your head and takes note of your scalp with a special pencil. And to show where to attach the electrodes. These spots marked on your scalp may be scrubbed with a gritty cream to improve the quality of the recording.