Post by Mohit Agrawal

Functional neurosurgery is increasingly being built around implants most of our patients can’t afford. That has to change. Across India, and much of the world, a family walks into clinic with a child who has spastic diplegia, or a young adult with drug-resistant epilepsy, or a farmer with disabling tremor. The modern answer we increasingly offer them is an implant: a baclofen pump, a stimulator, an electrode array with a battery. Elegant technology. Often the right choice in the right patient. But for the majority of patients we actually see in LMICs, that creates a new problem - lifelong financial and logistical dependence on hardware, refills, programming visits, and battery replacements they cannot sustain. When the money runs out, so does the treatment. We have under-invested in the durable, one-time alternatives: ▪️ SDR instead of a baclofen pump, for spasticity ▪️ Resective epilepsy surgery — a shot at cure — before neuromodulation, when the focus is resectable ▪️ A rigorous non-invasive workup before reaching for SEEG ▪️ Lesioning (pallidotomy, thalamotomy) instead of DBS, where a stimulator can’t be sustained It is about cost-effectiveness and access. Implant-heavy care concentrates benefit in the few who can pay indefinitely. Lesioning, resection, and optimised non-invasive evaluation deliver durable outcomes without recurring costs - and scale to the patients who actually need them. None of this is anti-technology. But we should build capacity where it changes the most lives: more centres skilled in lesioning and resective surgery, more fellowship training in these techniques, and honest patient selection over device-driven defaults. #Neurosurgery #FunctionalNeurosurgery #EpilepsySurgery #MovementDisorders #GlobalHealth #HealthEquity #Neurology