Dr K E Turel, President, Neurological Society of India discusses the oft-noticed neurological disorders
“The decision makers of health policies are ‘babus’ and not doctors; hence, health management can tend to be skewed”says Dr K E Turel, President, Neurological Society of India. He discussed the oft-noticed neurological disorders all over the world and the serious concerns associated with them.
What are the major concerns as far as neurological disorders in an ageing population are concerned?
In an ageing population the problems of brain stroke (leading to paralysis), chronic subdural haematoma (brain clot), adult or normal pressure hydrocephalus (presenting as a classical triad of memory and personality changes, gait disturbance and urinary incontinence), Parkinson’s disease, Alzheimer’s disease and dementias, metastatic brain tumours, osteoporosis of the spine resulting in severe spinal pain and occasionally even cord compression are commonplace.
Major concerns regarding these disorders are that they already have co-morbidities (various other medical ailments such as diabetes, hypertension, heart disease and lung and kidney complications, diminished vision and hearing also tends to disconnect them from their surroundings) that make them at risk for withstanding aggressive medical treatment, physiotherapy or surgery. Since age recovery is a slow process, enthusiasm from family members is often muted with compounded anxiety. Also, these disorders take a toll on the reserves of time, money and energy and many of the patients are left with caretakers, with their family being abroad quite often.
Social or government support is practically nil (unlike the western countries) as many of the patients are not even insured or accepted by insurance companies.
What are the concerns pertaining to neurological disorders in children?
Neurological problems in children are;
i) At birth: Hypoxic brain injury (lack of oxygen reaching the brain due to the child not being able to breathe, or swallowing amniotic fluid during delivery), brachial-plexus injury due to forced pulling of the child down the vaginal passage, resulting in paralysis of the upper limbs. Also, there are cases of brain injury due to crude forceps application resulting in paralysis and later on epilepsy
ii) During infancy: (1-30 days) Neonatal jaundice can occur due to blood group incompatibility. This may cause transient or permanent brain damage.
iii)Meningomyelocoel: Malformation of spinal cord and midline spine structures presenting as a swelling in the spine, usually lower back, causing paraplegia and incontinence of bladder and bowel are caused. This is usually due to folic acid deficiency in the mother at the time of conception.
iv) Developmental abnormalities:
Delayed milestones, physical and mental retardation, learning disabilities, genetic problems, craniosynostosis (premature fusion of skull sutures preventing the brain from expanding, resulting in cosmetic defect of the head, epilepsy and retardation, atlanto-axial dislocation causing a wry neck and spinal cord compression are the common noticed illness.
Others are meningitis (viral, bacterial, tuberculous) & encephalitis, hydrocephalus congenital or post meningitic), head injuries, epilepsy, autism, cerebral palsy (a spastic child with a disobedient body in a nearly normal mind), behavioural disorders, metabolic disorders (often genetic), brain tumours in children (children could be born with brain tumours. Tumours detected at birth are highly malignant and tumours developing later in childhood could be of low malignancy or high malignancy. Tumours also affect the spinal cord in children). Children cannot express their suffering; this is the biggest concern!
State the concerns in case of adults.
The common noticed disorders in adults are head injury, brain tumours (benign and malignant), brain stroke (ischemic and haemorrhagic), neuralgias, slipped disks and spondylitis, spine injuries and spine tumours. Also, there are cases of headache, neck pain and backache especially with the executive and secretarial staff due to faulty postures, weak muscles and total ignorance of the biomechanics of the spine.
Everyone knows about diabetes, high blood pressure and heart disease, but does anyone know about the brain and the spine? There are multiple cases of demyelinating disease and multiple sclerosis, stress and environment-related neurological disorders. Concerns are, unfortunately these are often unforgiving diseases affecting a person in the prime of his life. Early diagnosis and rational treatment is warranted.
What is the mortality rate in neurological disorders?
The mortality rate in neurological disorders is 11.67 per cent.
How does government help in order to bring improvement?
The government is too preoccupied with vaccination and family planning programmes. The 70 per cent of our nation lives in villages; most of them are ignorant or have no access to healthcare. The government should reach out to these remote areas and have a referral system. Telemedicine could be a very effective way of communicating. Today, more work is being done by various NGOs than by our government. Further, looking at the other side, lot of government funds allocated for health projects are not utilised. So quite often our development is lopsided and irrational. The decision makers of health policies are ‘babus’ and not doctors; hence, health management can tend to be skewed. Thus, the government should develop a number of good primary health centres who have direct access to secondary and tertiary and even quaternary centres of excellence. This is the way balance has to be maintained. Allocated funds for health (as for education) is abysmal and is one of the lowest in the world in terms of Gross Domestic Product (GDP).
What are the common disorders in India?
The common disorders in India are infections. Neurotuberculosis is number one. Others are cysticercosis, fungal bacterial, viral infections, brain tumours, head injuries and generative spine diseases (cervical spondylitis and slipped disk).
State the initiatives by Neurological Society of India (NSI).
The main aim of the organisation is to maintain close association and co-operation by devoting full time to any branch of neurological sciences within and outside India. NSI tries to maintain the highest standard of ethics and practice in all the fields of neurological sciences. The NSI should have data of every neuroscience practitioner in the country (whether he is a member or not). Further, all the diseases seen by practitioners should be recorded and reported. This helps in statistical data collection (epidemiology) and treatment outcomes.