The Hindu Business Line : ‘Soon neurology will occupy centrestage’

Neurologist Dr B. Biswakumar is unusual for someone who is a leading professional in his challenging field. He devotes 10 hours daily attending to over 20 patients and spends two hours at the Internet keeping abreast of new developments and advances. He is both an M.D. in general medicine and a D.M. in neurology. His stint in the Army Medical Corps before he moved to civil practice has inculcated a sense of discipline and a brisk and methodical approach to patients.

Dr Biswakumar responds to phone calls and email from all over the world, as he believes in the therapeutic value of counselling, the reassurance and peace of mind that come from a doctor being accessible to those in need of advice. In the same spirit, he does not say no to requests for house calls during emergencies. He is a member of the order of Free Masonry and associated with a number of charitable organisations.

Can neurology be said to be an exact science? What are its special characteristics?

Neurology is an unusual, if not unpredictable, field of medicine. Human ingenuity and scientific advances have not yet succeeded in making the human brain and the nervous system yield all their secrets. Yes, considerable progress has been made in mapping out the brain, and the body’s communications pathways, but there is no dearth of surprises.

This is because of the difficulty in pinpointing the correlation between cause and effect in this line, since most neurological problems have their genesis in general ailments such as diabetes, hypertension, cardiac failure, malnutrition. That is why a neurologist should not look at just symptoms and complaints, but should go behind them and take a holistic view, preferably consulting other branches of medicine too.

That is why therapeutic advances in neurology have been slow in coming, and professional expertise and textbook knowledge count only 50 per cent, with 20 per cent each drawn on experience and intuition, and the balance 10 per cent beyond any rational comprehension.

I admit that only in 10 per cent of cases can a doctor effect what can be termed a full-fledged cure in the sense of rooting out the problem once and for all.

Another complicating factor is the insidious onset of most neurological ailments, because of which the symptoms go either unrecognised or undiagnosed; by the time the patient or the doctor comes to grips with it, the disease has progressed to an irreversible stage or, at the minimum, the quality of life has been compromised. A sudden slurring while speaking, numbness in any part of the body, occasional tremors or twitching of muscle (fasciculation), difficulty in recalling well-known names, words or phrases, a passing unsteadiness of gait, blurring of vision, a sudden blackout — all of these may take a very grave course, if not investigated at the time of occurrence.

They may be the early warnings of a whole cornucopia of disorders — stroke (brain attack), tumour, multiple sclerosis, Parkinsonism, dementia, motor neuron disease, neuro-cysticercosis (tapeworm infestation of the brain), or Alzheimer’s. But to the person affected by these signs, they may carry no particular significance, as they were fleeting and caused no perceptible discomfort; he tends to ignore them until they reappear at some other time without any predisposing causative factor, in a more disabling manner.

Are all neuro disorders common to all regions of the world, or are there any specific to a particular country?

All known neurological disorders are common all over the world, though the proportion of the people under each category may differ. As far as India is concerned, on a rough estimate, stroke constitutes 40 per cent, epilepsy and headache 20 per cent each, dementia, Parkinsonism and Alzheimer’s the balance. Ten per cent of the cases in Chennai relate to Parkinsonism.

There are some afflictions specific to India arising from nutritional deficiency, pollution and toxicity. Notable among them are neuro-tuberculosis, tapeworm infestation of the brain, abnormal non-organic headache in infotech professionals and head injuries from scooter/motorcycle accidents. The last, in fact, makes up a good proportion of cases in Tamil Nadu, in general, and Chennai, in particular.

How about the professional competence of doctors and quality of medical care here?

There should be no doubt about the competence of all categories of medical personnel in this country. In their ability and skills, they are equal, if not superior to, talent found anywhere in the world. But there are deficiencies. For instance, the organisational facilities for care-giving, quality of services in hospitals so that patients do not have to spend more time than necessary, attention to psychological and physical rehabilitation after recovering from illness or disability and incentives for research and development need improvement.

How do you view the emerging scenario in India in the matter of coping with neuro disorders?

Neurology will soon assume critical importance in India. There is every possibility of the much-touted demographic dividend evaporating in the next 20 years, with an increase in the population of the elderly. This is precisely the geriatric segment that will be vulnerable to various neurological problems. Thus, neurology will occupy the centre stage in the years to come.

Is neurology popular with the student community?

To the contrary, neurology is at the bottom of students’ preference in India, despite its intrinsic importance next only to cardiology and its compelling relevance in the Indian context, both current and emerging. This is because it is difficult to acquire proficiency in it without acquiring a comparable mastery of anatomy, physiology, cardiology and nephrology. The effort required scares away students from taking it up as the preferred subject.

What is the likely fallout of rising numbers of patients in the coming years?

The scenario in regard to taking care of neurological patients in advanced stages of dementia, Alzheimer’s, Parkinsonism or multiple sclerosis, is far grimmer than the numbers affected. Joint families are breaking down and facilities such as hospices to whose care patients can be entrusted are unavailable. The burden of looking after bedridden older family members totally dependent on others’ help both day and night, can be devastating and sometimes financially ruin the family.

Should we think seriously of legalising euthanasia as a possible mode of deliverance for both the patients and the family members, of course, with ample safeguards against taking recourse to it in a hasty or improper manner?

I would say ‘yes’ without a moment’s hesitation. In fact, you can quote me saying that I myself have left written instructions not to keep me on life-support system when the prospect of recovery is slim. Many in advanced countries similarly leave a ‘living will’ to save money and effort on prolonging a vegetable-like existence. May be, it is time to encourage the practice in India also.

More Stories on : Interview | Health

Article E-Mail :: Comment :: Syndication :: Printer Friendly Page

Stories in this Section
Karim’s kebabs

Fight phobia fitness first

Sapphire-rich Kashmir

Who’s watching?

Woman with a skullcap

‘Soon neurology will occupy centrestage’

Take a long view of life

Kiss and tell!