Treating brain disorders without drugs

It was a fairly popular treatment for brain injuries in the West in the 1960s and it came to India only almost fifty years later.

The origin of this treatment goes back almost to ninety years when a German psychiatrist connected electrodes to a patient’s scalp and tries to measure the electrical waves.

The instrument used to measure the electric waves was a galvanometer. To him goes the credit of recording the first ever human EEG. The initial results of his experiment led the psychiatrist to carry out more research in the years to follow on electroencephalogram (EEGs).

The psychiatrist was Hans Berger (1873-1941) and he had carried out his experiment on electrodes on 1924. Subsequently, he published a series of papers on EEG between 1929 and 1934 and even today our knowledge on the middle frequencies is based on Berger and his research. He also invented the electroencephalogram.

Today, much of the facts that we know of middle frequencies in EEG is ascribed to Berger. His discoveries on EEG were first confirmed by British scientists Edgar Douglas Adrian and B. H. C. Matthews in 1934 and they also published some of his material in the magazine Brain.         

Many decades later, Joe Kamiya came up with what is today called neurofeedback therapy. He based this on his experiments on alpha brain wave that he had been conducting in the 1960s.

The results of these experiments were first published in Psychology Today in 1968.

Since then, neurofeedback became popular in the West and neurofeedback training (NFT) became a part of treating brain disorders. It was only in 2006 that this method of treatment came to India, thanks to NIMHANS.  

In NFT, an individual is made to modify the amplitude, frequency or coherence of the electrical activity. The patient is then taught to influence the electrical activity of their brain. Thus, an individual is helped to normalise the abnormal EEG frequencies.

The treatment has benefitted patients with traumatic brain injuries (mainly caused by accidents) and helped them regulate brain activity.

The treatment makes use of both EEG and o homoencephalography (HEG) to illustrate brain activity and teach self-regulation. EEG neurofeedback uses sensors that are placed on the scalp to measure brain waves, while HEG neurofeedback uses infrared (IR) sensors to measure brain blood flow. This leads to a signal which can be used for self regulation.

Now, neurofeedback is taking a second look at deep states. Alpha-theta training has been used in the treatment of alcoholism and anxiety.

NIMHANS now conducts regular neurofeedback sessions to treat a wide array of brain disorders. It has even used this system for treating patients who have suffered road accidents and have brain injuries.  

NIMAHS is also using neurofeedback in patients suffering from stroke and autistic children suffering from attention deficit hyperactivity disorder (ADHD).
One of the major advantages of this system is that the patient does not have to take any medicines, which generally have side effects.  It can be used for Irritable Bowel Syndrome(IBS), asthma, constipation, drug addiction, headaches, Arthritis, attention deficit disorder/ hyperactivity disorder, non-cardiac chest pain, hypertension, insomnia,  low back pain, knee pain and even breathing problems, urinary elimination disorders.

Though NIMHANS says the system has worked successfully, other neurologists say deep brain stimulation in which a pacemaker is implanted in a brain, is one of the most advanced treatments. It has been found to be more effective in treating Parkinson's disease and it also substantially reduces the need for drugs.

The irreversible stroke

What happens when you have a stroke and why is the damage to the brain extensive or irreversible..

Here are some answers.

A stroke is a medical condition where the brain cells suddenly die because of a lack of oxygen. The cells die a natural death when there is an obstruction in the blood flow or a rupture of an artery that feeds blood to the brain.

The average human brain generally weighs three pounds or 1.35 kilograms and it contains anything between 10 billion to 100 billion neurons and even a larger count of glial cells.

When a person is affected by stroke, close to two million cells die  and the person may suddenly lose the ability to speak, think or walk, talk. There may also be memory problems or one or two sides  of the body can become paralyzed.
The blocked cell form a clot and it is this clot that stops circulation of blood to the tissue in the brain, leading to neurological damages. The stoppage in the flow of oxygen and blood to the brain is a deadly Natural act which requires to be reversed if the damage is to be undone or lessened.

An unfortunate fallout of a stroke is paralysis and this kills lakhs of people all over the world. In US alone, paralysis in stroke victims kills one and a half million or thereabouts every year.

There is some good news though. Half the victims of stroke do survive with varying and often deteriorating degree of paralysis.

A stroke in nothing but a brain attack. Just as there is a heart attack, there is also a brain attack and this is called stroke which is the third leading cause of death in the United States. Approximately 20 million people each year will suffer from stroke and of these five million will not survive.  In developed countries, stroke is the first leading cause for disability, second leading cause of dementia and third leading cause of death. By 2015, India will report 1.6 million cases of stroke annually, at least one-third of whom will be disabled.

Stroke is also classified as a major cause for loss of life, limbs and speech in India, with the Indian Council of Medical Research estimating that in 2004, there were 9.3 lakh cases of stroke and 6.4 lakh deaths due to stroke in India. What is tragic is that most of these people are 45 years old or less.

The World Health organization says  by 2050, nearly 80 per cent  stroke cases in the world would occur in low and middle income countries including India China and Brazil.

This is the main reason why India has now come out with national guidelines for stroke management. This guideline has been Prepared by Dr Kameshwar Prasad, director of the clinical epidemiology unit of the All India Institute of Medical Sciences, doctors from Nizam's Institute of Medical Sciences, Hyderabad, Command Hospital in Lucknow and PGI in Chandigarh.

The guidelines are fairly comprehensive and they cover the management of stroke from onset to chronic care.

Stroke has a propensity for people with high blood pressure, diabetes and high blood fat, which is also called as cholesterol. What makes Indians more vulnerable to stroke is that 16 per cent or more above 20 years of age suffer from high blood pressure (BP). Shockingly, Fifty per cent of those with high BP are not even aware of it. Of those who are aware, only 50 per cent take measures to control it, and even among those only 50 per cent  are adequately controlled. This, means just about 12.5 per cent of patients with high BP are adequately controlled against stroke.

The guidelines make it mandatory for hospitals to set up a Acute Stroke Team, written care protocols for such patients and an emergency department whose personnel should be trained to diagnose and treat all types of stroke.

Early and timely diagnosis of stroke can help in a large way in the treatment and further spread or deterioration of paralysis.

The National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, has done far reaching studies on several aspects of neurological disorders, stroke, brain related diseases and other related aspects. More about them in the coming posts.

(The next post is on a net to fish blood clots and thus reverse brain damage and paralysis).

These children are special

Two of the greatest scientists of all times suffered from it. They, however, overcame this disability and went on to make monumental discoveries which changed the path of mankind.

Both the scientists showed symptoms of this debility from an young age. If one of them was Sir Issac Newton, the other was Albert Einstein and both suffered from Autism.

Latest research suggests that Einstein, who is credited with developing the theory of relativity, and Newton, who discovered the laws of gravity, had these traits to varying degrees.

Einstein showed signs of Asperger's from a young age and as a child, he was a loner and often repeated sentences obsessively until he was seven years old. He was also a notoriously confusing lecturer.

Researchers at Cambridge and Oxford universities believe both scientists displayed signs of Asperger's Syndrome   

Autism is a disorder of the nerves and it is generally characterised by impaired social interaction, broken communication and repetitive behavior.

Neurologists generally believe that the debility can be cured if it is diagnosed early-before a child attains three years of age. Autism affects information processing in the brain by altering how nerve cells and their synapses connect and organize. Unfortunately, we do not know how this occurs. If this can be found out, the cure to Autism would not be far off.

 Autism is one of three recognised disorders in the autism spectrum (ASDs), the other two being Asperger syndrome and pervasive developmental disorder (commonly abbreviated as PDD-NOS).

Autism has a strong genetic basis and its prevalence is about 1–2 per 1,000 people worldwide.

Unfortunately, the number of people diagnosed with autism has been increasing dramatically since the 1980s, and India is no exception. There has been a six-fold rise in the number of autism cases and from an estimated 20 lakh cases in 2003, there are today  1.36 crore autism patients in India.

Globally, one in every 88 children is born with autism now against a ratio of one in 150 till a few years ago.

Though this life-long disability  manifests itself during the first three years of life, a fairly large number of autistic patients in India continue to go undiagnosed or do not receive the services they need.

This is mainly due to lack of awareness and misunderstanding about autism among the medical professionals. The lack of basic equipment and improper diagnosis of autism has led to increase in autism in India.

Neurologists say early detection of this incurable disease can help a child lead his full potential but many medical professionals are unable to detect the disorder. The less said about the parents the better.

People, including parents, often mistake autism for mental disorder. People suffering from autism may be slow learners but as Albert Einstein and Newton have proven, they do have brilliant minds.

In Bangalore, one of the best centres for treating neurological disorders is NIMHANS.

The child and adolescent psychiatry services of NIMHANS offers a range of services to children suffering from neurological disorders.

Two years ago, scientists from the National Centre for Biological Sciences (NCBS), an affiliate of Tata Institute of Fundamental Research (TIFR), located in Bangalore gave hope to people suffering from autism.

They mapped for the first time in the world  the defective connections between nerve cells in the emotional hub of the brain of mice who had Fragile X Syndrome.

While a fragile X chromosome may be passed from one generation to the other with no debilitating effects, the syndrome does affect one in 4,000 men and one in 6,000 women. Neurologists have said that  20 per cent of boys with autism have the condition due to Fragile X.

The syndrome is the most common inherited cause of intellectual impairment and it is also diagnosed as the most common genetic cause of autism. This chromosome can cause poor emotional response, hyperactivity, LD and attention deficit.

The research found the long-term ravages of autism could be reversed with medication in mice.

A few months ago, yet another research project on autism took off in Bangalore. An Indo-UK project, it aims to develop better diagnostic techniques for brain disorders and to unravel the mystery behind autism.

This research is now being carried out at the  Centre for Brain Development and Repair which is located inside the campus of Institute of Stem Cell Biology and Regenerative Medicine.

The focus of the research is to  study genetic, neural and behavioural components of autism and at the same time find an answer to the disorder.
The centre, however, does not offer any clinical services

The killing fields of Bangalore

This is one distinction that India can do without. It is not only shameful but it also shows the country and its people in bad light. India is now the world capital in the field of road accidents and it also has dubious distinction of having the worst record of accident safety in the world.

One Indian dies every six minutes in road accidents in the country and that makes it 1.2 lakhs deaths and 12.70 lakhs injuries every year. The figure for the world is 120 lakh people killed every year and more than 50 Crore people injured every year.

More shockingly, every day 6600 people doe in accidents and 3300 suffer serious injuries and all of them are due to accidents. Unfortunately India has the dubious distinction of having the worst record of road safety in the world.

The statistics for India are all more alarming. Today, there is one death on Indian road every six minutes and this is expected to go up to one death every three minutes by 2020. Please remember that this is only the tip of the iceberg as in our country, accidents till go unreported in a majority of cases.

Studies by the Institute of Road Traffic Education, New Delhi, NIMHANS of Bangalore, National Transport Planning and Research Centre and the National Crime Records Bureau (NCRB) among others have painted a grim picture of Indian roads and Indian drivers. These studies have revealed that India accounts for about 10 per cent of accident fatalities worldwide.

Even World Health Organisation (WHO) statistics paint an unhealthy picture of the accident scenario in India. Its first report of 2009 stated that more people in India die of road accidents than anywhere else in the world. 

This figure is astounding and alarming as India accounts for only one per cent of the registered motor vehicles. Moreover, the number of accidents per 1000 vehicles in India is as high as 35 while the figures in other countries range from 4 to 10.

The NCRB says the average cost of road accidents in India is approximately Rs.7 lakh crores. This massive figure does not include the economic burden of permanent disability of the more than 10 lakhs people who survive major accidents every year.

Another shocking statistics is that 85 per cent of the victims of road accidents in India are in the age group of 20 to 50 years. A sad fact is that a majority of these men are the bread-winners for their families.

Even minor injuries in road accidents are costly to treat and they need long recuperating periods. Injuries to the brain, spinal cord, limbs and head and neck are difficult to treat and the resultant trauma is difficult to overcome.    

Though there are no exact figures of expenses of spinal cord injuries, it is enormous and Bangalore is fortunate in having world class institutions such as NIMHANS and Sanjay Gandhi Accident Hospital which have really done yeomen service in the field of accident care and rehabilitation.

Unfortunately, there is no safety net in India for patients who have become victims of  accidents. Expenses have to be borne by victims and their families and while the West have taken several strides to cushion victims of accidents and their families, no such facility is available in India.

Drugs to treat victims of accidents in India are costly and the treatment prohibitive. Spinal care, except in cities, is unheard of and accident rehabilitation is still to take off.      

The 2009 Global report on Road Safety published by WHO has  given us valuable data from 178 countries. It shows how developed countries have been able to reduce the rate of accidents. It shows that stricter regulatory measures does play a part in not only reducing accidents but also in minimizing injuries or lessening the intensity of accidents.

It says wearing a seat-belt reduces the risk of death among front-seat passengers by forty to sixty five per cent. Moreover, wearing seat belts can also reduce deaths among rear-seat occupants by twenty five to seventy five per cent.

 The use of child restraints (infant seats, child seats and booster seats) can reduce deaths of children from 54 per cent  and 80 per cent. The WHO report says India lags badly in implementing the seat belt rule.  

Other rules such as compulsory wearing of helmets, following lane discipline, signaling, proper knowledge of rules, not drinking, smoking and talking on the mobile while driving ought to be strictly implemented.   

Though India has a bouquet of laws relating to motor vehicle regulation, it is rarely implemented. No wonder, the number of  road accident fatalities have been growing by eight per cent every year.

A sad pointer of the callous manner in which India takes its health index is that it occupies 86th position in the world in the field of healthcare. It spends just 6.1 per cent of its GDP on healthcare. Even a one per cent increase is likely to give a fillip to healthcare facilities which are woefully inadequate.

The WHO reports says road fatalities have become an epidemic and that it will become the world's fifth biggest killer by 2030 overtaking diabetes and HIV/AIDS.

It said 90 per cent of deaths on the world's roads occur in low and middle-income countries (21.5 and 19.5 per lakh of population, respectively) though they have just 48 per cent of all registered vehicles

The statistics for India are more chilling. At least 13 people die every hour in road accidents in the country, and this is as per the  report of the National Crime Records Bureau.

The Ministry of Surface Transport, Government of India, says in 2001 there were 405637 road accidents leading to 80,888 deaths and 405216 injuries. The figures for subsequent years were 407497 accidents in 2002 with 84,674 fatalities and 408711 injuries, 406,726 accidents and 85,998 deaths and 435122 injuries in 2003.

This number has been going up year by year and in 2010 it stood at   

499,628 accidents with 134,513 deaths and 527,512 injuries.

National Highways accounted for 30 per cent in total road accidents and 36 per cent in total number of persons killed in 2010. State Highways accounted for 24.5 per cent of total accidents and a share of 27.3 per cent in the total number of persons killed in road accidents in 2010.

In Bangalore, the number of accidents and fatalities have been coming down but what about the accidents that leave a victim paralysed or seriously injured. Many such cases go unreported and there needs to be greater emphasis on enforcement and punishment.

Motorists in Bangalore have no fear of the law. Bring back the fear and save the lives of people. Give first of way for a pedestrian or a walker. A motor car should always come after a human being and not before. When will our drivers learn this. If they can’t or won’t learn, pull the out of the roads and never let them drive again.

Today, Bangalore and its suburbs have become killing fields. Rash and negligent driving, drinking and driving, talking on the mobile and reckless drivers have all become part of our City. Do we need such people on the roads. It is neither safe for them nor us. It is the duty of the law to take care of such people as they are a menace to society.

You don’t agree. Then come down to NIMHANS or Sanjay Gandhi and check pout the mental torture, agony and pain that accident victims and their kin endure.      

The brain museum

This should be one of the most unusual museums in India and it is certainly the first in the country.

Though India has museums on history, geography, wildlife, geology and other sciences, it rarely has a museum dedicated solely to medical science. Bangalore has been lucky in having this one in a kind museum and it is worth a visit.

This is the brain museum and it is located in the premises of the National Institute of Mental Health and Neurosciences (NIMHANS), at its sprawling campus just off Hosur Road.

The museum displays over 600 samples of human brain and these samples are increasing year by year.

The museum was the brainchild of Dr S K Shankar, professor and head of department of neuropathology. It was set up after a long and painstaking effort involving close to 30 years of brain donations.

NIMHAS had to seek permission of the next of kin of the dead during autopsy to take parts of their brain for research. The research team later stumbled upon some fascinating revelations that are otherwise generally not revealed through MRI scans.

These brain samples were initially  for teaching students of neuropathology. Later, the idea of educating the public and making them aware of the fascinating aspects of the brain began germinatng and the result was the museum.

The first thing when you step into the vast hall is the many samples displayed in bottles and jars of formalin. Just imagine, these were the very brains that controlled human beings just a few years ago and now they are objects of research and display.

The brains here come in all sizes and shapes. There are brains of people who died a natural death and those who suffered head or brain injury. There are brains which were diagnosed with certain diseases.

The brain that suffered an injury in an accident is perhaps one of the most evocative. The person had suffered a memory loss and this can be verified by the fact that the fibres going to the frontal cortex or frontal lobe was disconnected.

The frontal lobes helps us to recognize future consequences resulting from current actions, to choose between good and bad actions (or better and best), override and suppress socially unacceptable responses, and determine similarities and differences between things or events.

They also help in retaining longer term memories which are not task-based. These are often memories associated with emotions derived from input from the brain's limbic functions. It modifies those emotions to generally fit socially acceptable norms.

A few brains here show traces of intracerebral haemorrage (ICH) and by the way this is the second most common cause for a stroke. In these cases, the haemorrage occurs within the brain tissue rather than outside, making treatment and even recovery that much more difficult.

The risk factors for ICH include: hypertension, diabetes, menopause, current cigarette smoking and alcoholic drinks (≥2/day)

Brains which have faced the problem of cerebral venous thrombosis (blood clot) are also displayed. This is a peculiar phenomenon in north Karnataka where pregnant women are not given enough fluids after delivery. The blood of such women thickens. The clot occurs in the dural venous sinuses, which drain blood from the brain.

Another reason for such clots is consanguineous marriages which are very common in Karnataka, Andhra Pradesh and Haryana. They lead to developmental anomalies of the brain.

There are also samples of brains which were the study for Schizophrenia. Though there is no external manifestation or malfunction, the size of the brain has shrunk, indicating a severe abnormality.

The brains of  people suffering from Alzheimer’s disease too have shrunk. The nerves had withered and it is really a scary sight.

Interestingly, there are brains which have suffered injuries and infections when ears of people were being cleaned with a sharp object such as a pin, pen, pencil or any long object. The infection from the ear quickly spread to the brain and in some cases, the damage was irreversible.

What makes this brain museum interesting is that it has brains of animals too. There are on display the brain of a rat and a duck. It details facts about the brain like anatomy, physiology, psychology, psychiatry, neurology and even neurosurgery.

A single brain can be preserved for twenty years and thus we see more brains coming in to the museum every year.   

The museum is operated by the Department of Neuropathology.

It is open on Saturdays from 10 a.m., to 3 p.m. If you would like to donate your brain, sign a pledge as donor.

The complete address is NIMHANS, Hosur Road, SR Krishnappa Garden, Hombegowda Nagar, Bengalore, Karnataka 560029. You cal also call 080 26995035 for more details.