Neurological Sciences

The Neurology unit handles general neurological problems (acute and chronic) and has specialty clinics for epilepsy and neuromuscular disorders. The Neuromuscular Clinic is being jointly held with the Physical Medicine and Rehabilitation department where complex neuromuscular problems are seen and management problems chalked out. There is a gait analysis laboratory where patients with Limb Girdle syndrome are sent and an attempt is made to assess response to treatment. The department has a dedicated Electrophysiology laboratory with EEG including telemetry, evoked potentials and electromyography. The machines are all state of the art and the new development is to read EEGs online. A total of 2784 EMGs are done every year and the lab does quantitative EMG, Single fiber EMG and root stimulation studies. A total of 3900 EEGs and 1000 telemetric EEGs are done annually. A total of 400 evoked potential studies are done annually.

The neurosurgical units caters to the complete range of major and minor neurosurgical operations such as for brain tumors, vascular diseases such as aneurysm, AVMs, congenital anomalies, spinal disorders and functional procedures. Acute and emergency care is provided round the clock.

Neurosurgery has 12 operating room full day sessions per week. There are 4 operating microscopes, the latest acquisition being a Zeiss NC4 microscope. There are 3 high-speed drills and craniotomes (Midas Rex and Aesculap). Endoscopes (Storz and Aesculap) are available and are routinely used. There are 2 ultrasonic aspirators including CUSA Excel.

In addition, conventional stereotactic surgery was initiated in the department in 1960 with a Bertrand stereotactic frame, the modern era of image guided stereotactic surgery using the Brown Robert Wells (BRW) system was introduced in 1987. Since then over 1800 stereotactic surgeries have been performed in the Department. There are 2 stereotactic frames (BRW and CRW) and an MR compatible frame (CRW) and lesion generator (Radionics RFG 3B).

Stereotactic Radiosurgery (SRS) and Stereotactic Radiotherapy (SRT) were introduced for the first time in India in June 1995 using the X Knife, LINAC based system, Since then over 500 SRS and SRT procedures have been done. This program offers the most economical package for these procedures.

Functional stereotactic procedures for Parkinson’s disease and other movement disorders (thalamotomy and pallidotomy) are also routinely being performed in the Department since 1987.

Education is a high priority activity in the ICU. There are regular academic sessions for the nursing staff and seminars for the residents, and the ICU nursing and technical staff are acknowledged to be among the best in the hospital. In addition all fresh casualty medical officers receive training in head injury assessment. The ICU and HDA maintain a comprehensive computer database on all patients admitted, which has proved useful in obtaining data for research purposes.

Intra-operative monitoring (IOM) procedures were started in 1991. At present, facilities and expertise are available to monitor patients who are considered to be at risk during neurosurgical procedures.

There are 27 nodes in our Departmental LAN, which provides 24-hour database service for patient care. We have 2 fileservers running on Windows NT 4 and Novell 4.1 operating systems and one Oracle server. We have a GUI based program Clinical Workstation (Discharge Summary, Operation Notes, Clinical Neurophysiology Labs, etc.), which has Oracle as backend. 24 hour Internet service is available on our department network.

Research interests of the department have been

The interest has been on immune mediated neurological disorders, neuro-infections especially SSPE, cerebrovascular disorders, dementia and neuromuscular disorders.

The Department conducted the Third International symposium on SSPE in 1989. A symposium on Mycobacterial infections and Tropical demyelinations was held in 1995. The first national symposium on Intractable epilepsy was held in 1996.

In neurosurgery, clinical research is being pursued in the fields of cervical spine, craniovertebral junction anomalies, pituitary tumors, CNS tuberculosis, intraoperative monitoring and neurocysticercosis (solitary cysticercus granuloma).

The Neurochemistry Laboratory is a protein biochemistry/enzymology laboratory with ongoing research on the cholinesterases, in neuro-infections and inborn errors of metabolism. Currently we are studying cholinesterase inhibition looking at organophosphate poisoning and mechanisms that underlie accompanying complications of paralysis.

The main area of interest in neurophysiology is on the hand and its sensori-motor organization, with particular interest in spasticity. Currently developing techniques to assess functions of the hand in normal subjects and patients with various neurological dysfunctions, using precision grip and transcranial stimulation methods. These procedures are recorded on digital video camera for documentation and analysis.