Has a golden era dawned on neurosciences?

Neurosciences is a very dynamic field of medicine known for its great heritage and solid foundations. The pioneers of this field were systematic and ruthless in their approach to clinical problem solving – a tradition which is sacrosanct even to this day for every neurologist. Great men of exceptional vision and calibre have carried the torch through the years to finally bring us into “the golden era “ of this scientific discipline. While the fathers were instrumental in the discovery of the magnificent expanse of neurosciences, we on the other hand have now entered a world of infinite possibilities. Few decades ago, we were able to arrive at great clinical diagnoses but offer only palliative options for various neurological illnesses. But today, we are able to transform the lives of patients through effective treatment options .The diagnostic modalities have also evolved to such an extent that we are able to interrogate every part of the nervous system. I would like to mention few such areas where revolutionary changes are happening :

Epilepsy: About 80-90% of patients with epilepsy can lead normal lives today thanks to the advent of medications without any significant side effects and treatment methods like epilepsy surgery . The latter can be potentially curative in a subset of patients even when medications have failed . Dietary therapies like ketogenic diet, vagus nerve stimulation and deep brain stimulation are also effective methods for controlling seizures. Precision medicine is a new form of treatment where we use genetic diagnosis to guide treatment decisions. The diagnostic tools in epilepsy are also getting upgraded every year .Good MRI protocols, functional imaging studies, invasive EEG methods are some of these advances .

Parkinson’s disease: A disease characterised by tremor, slowness of activities, stiffness and loss of postural stability is relatively common in our population. The disease commonly occurs in patients above fifty years of age but can occur rarely in younger individuals. The use of medications can control the disease in majority but those with progressive disease course can benefit from a form of therapy called deep brain stimulation . In this method , electrodes are implanted into the brain and an external battery is used to adjust the settings. Many patients who would otherwise be totally dependent on others can return to a normal life through this method of treatment.

Stroke medicine : 1 in 6 people are bound to suffer a stroke in their lifetime. A tiny clot lodged in one of the major vessels of the brain can totally disrupt the blood supply to a large area of the brain. The cells once destroyed may not fully recover . A timely intervention in the form of clot lysis using an intravenous medication or a total removal of the clot itself by a procedure called thrombectomy can help restore blood circulation to these brain regions. This form of acute interventions along with the services of a good stroke team and neurorehabilitation can remarkable improve the outcomes of acute stroke.

Sleep medicine: Sleep disorders can be in the form of sleep-disordered breathing, parasomnias ( abnormal behaviours during sleep), insomnia (decreased sleep) or hypersomnia( increased sleep). This subspeciality has given a proper definition and clinical approach to sleep problems thus enabling early and accurate diagnosis followed by a gguideline-basedtreatment strategy. Today we can boldly say that with the help of modern treatment methods, a majority of patients can reclaim sound sleep.

Neuroimmunology: This subspecialty which has emerged at the turn of the millennium is one the fastest advancing and dynamic ones with an array of diagnostic and treatment options opening up every year. Several young patients stricken with diseases like multiple sclerosis, neuromyelitis optica and autoimmune encephalitis can now walk out of the pit of hopelessness into total freedom.

Neurogenetics: Genetics-based treatment approaches are the future of Neurology and medicine at large. It is so exciting even to imagine that several “untreatable” and disabling medical conditions can be partially or totally reversed by targeting the genetic abnormalities. Moreover, the understanding of the genetic basis and pathomechanisms will empower us to make better choices in the treatment of a host of diseases.

There are several other advances and aspects of Neurosciences which cannot be covered in this article. One other important shift that is taking place is the emergence of a team-based approach as opposed to an individual-driven one. When neurologists, neurosurgeons, electrophysiologists, emergency physicians, paediatricians, radiologists, psychiatrists, psychologists, nutritionists, physiatrists, nurses, social workers and other members of the medical family work together in unison, great results can be achieved. The clinical and research teams are the pillars on which this glorious discipline will thrive in the years to come.

(Dr Sachin Sureshbabu is Head of Neurology, Meitra Hospital, Kozhikode)