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Saturday Interview | ‘Neurological care is neglected’

I started studying patients as they fell sick and as they recovered. With further reading, I found I needed to do sub-specialisation on stereotactic and functional neurosurgery to deal with people with Parkinson’s disease, with tremor in hands, spastics, pain and psychiatric epilepsy.

Dipankar Chakraborty | New Delhi |

Renowned globally for the ‘awake-brain guitar surgery’ he performed in 2017 to rectify a dysfunctional finger of a guitar player who kept strumming it during the surgery, Prof Dr SHARAN SRINIVASAN — a stereotactic and functional neurosurgeon and head of neurosciences department at Bhagwan Mahaveer Jain Hospital at Bengaluru — is among the country’s leading neurosurgeons.

An articulate medical expert with a heart of gold, Dr Srinivasan passionately advocates the cause of providing high-quality affordable healthcare to common people. He has performed over 8,000 major brain and spine surgeries since he began his career in the 1990s.

In an interview with DIPANKAR CHAKRABORTY, he candidly shares his thoughts on a wide range of issues related to neurological care in the country.

Excerpts:

Q. How would you explain your expertise as a specialist ‘stereotactic and functional neurosurgeon’ to a layman?

A. During my training as a neurosurgeon at main Manipal Hospital between 1994 and 2000, suffering and disability of patients made me think. I experienced three compelling stories that inspired me to do what I am doing today – neuro-rehabilitation and stereotactic surgery…After (these experiences) when I started investigating, subjects like rehabilitation and how to reconnect the brain circuits came before me.

I started studying patients as they fell sick and as they recovered. With further reading, I found I needed to do sub-specialisation on stereotactic and functional neurosurgery to deal with people with Parkinson’s disease, with tremor in hands, spastics, pain and psychiatric epilepsy.

I am one of the few neurosurgeons who have moved from saving people’s lives to improving their quality of life by dealing with brain circuits and making them better.

Q. What is stereotactic surgery?

A. I have to catch circuits in the brain through a hole drilled through the skull. These circuits are very deep seated which MRIs don’t show many times. And I can’t be opening and going in; that can damage the brain.

Stereotactic is a Greek word. How can I find a place deep inside my brain which I can’t see? It is a technique to enter deep inside the brain without harming the superficial areas of the brain to rectify the physical problems. I learnt this technique during my six months stereotactic radiosurgery course at TWMU (Tokyo Women’s Medical University) under the guidance of my guru Prof Takaomi Taira in 2015.

It is God’s work I am doing. For Parkinson’s disease, a pace-maker is put in the brain. The pacemaker costs Rs 8-10 lakhs. Include the cost of surgery etc. — it all comes to Rs 14-15 lakhs. How many people with middle class income in India can afford this kind of money? So I had to find lower cost treatment for my countrymen who can’t afford this.

Prof Taira was burning circuits in the brain which is one-fifth of the cost with the same results. So I thought I should go and learn this technique from him to help my countrymen.

Q. Tell us something about the now famous brain circuit and guitar surgery performed by you. What has been the significance of this surgical procedure for patients?

A. I was rather surprised to see a massive piano lying inside the operation theatre at the Tokyo Women’s Medical University. I quietly ran away from there thinking perhaps I had entered a different OT by mistake. But then when my team came they entered the same room. When I asked about the piano, my guru Taira said the patient to be operated upon was suffering from piano cramp.

It was a totally new experience for me. I was stunned to see my professor burning brain circuit and piano finger improving. There is also something called writer’s cramp.

These are diseases known by their common title of ‘Task-specific Dystonia’. Abnormal movement in any part of the body without the body wanting it is called Dystonia. When some misbehaving brain circuits fire abnormally, it results in such abnormal body part movement.

This happens whenever a writer or a guitarist or a pianist is about to begin their respective tasks, otherwise they have normal body movements. So we have to do an ‘awake brain-surgery’ and make sure the patient demonstrates all the problems he has while performing a task.

We then burn the circuit, 8-10 cm inside the brain through a 14 mm hole in the skull using technology and skill without actually seeing anything while getting into the brain.

The patient is fully awake during the surgery telling doctors what is going on. We keep checking moment to moment as we enter deep into the brain while making sure we are at the right location. And then we burn the circuit in the brain with a special instrument.

The rate of success if done well is close to 100 per cent. The cost of surgery and hospitalisation is Rs 2.25 lakh.

Q. How real is the fear of rising neurological problems among youths adversely impacting India’s demographical advantages and its GDP?

A. Leaving aside the genetically induced problems, the two major things in our control that we can minimise are neuro-trauma including head injuries, spinal cord injuries and strokes because of high BP and diabetes.

As per the statistics released by National Institute of Mental Health and Neuro Sciences or NIMHANS in 2010, nearly 7 lakh Indians are getting disabled every year because of stroke. And, we are having more than 18-20 lakh Indians getting disabled every year due to head injury, predominantly happening due to road accidents.

Roads and vehicles are getting better but not people’s civic sense and sense of discipline on the road. Between head injury, stroke and dementia affecting people in the age category of 16-65 years, every minute seven new Indians are getting disabled.

This country cannot afford disability. With inherent indiscipline the situation is only going to get worse….As per the WHO one fifth of the accidents are happening in India. Today with change in lifestyles we see people in varying age groups of 20, 25, 28 years suffering strokes.

If the young people get disabled who is going to take care of their parents? There are parents telling us their son is not able to wash himself in the bathroom. ‘Who is going to take care of him after we die?’ one parent asks me.

Q. What is your take on the lack of awareness about neurological issues among people?

A. A severe left sided chest pain is generally assumed to be a symptom of heart attack. A flurry of emergency measures follows in its wake. But in 90 per cent of the cases, statistically speaking, this pain is non-cardiac chest pain. Only 10 per cent of chest pain is cardiac.

But if someone wakes up at midnight complaining about a headache, nobody takes it seriously. That is where the difference is – heart is important, not the brain. Brain problems are so complex, unconnected with the brain many times, that people don’t know how to pick it up.

It is not one plus one equals two. The same guitarist with finger problems first went to an orthopedic surgeon. For one year he underwent treatment till someone told him to see a neurologist. He came to me for treatment and got fully cured subsequently.

Problem is many doctors are also not well aware of neurological symptoms at all; this adds to the problem. After the guitarist’s surgery went viral, a girl from Varanasi with a similar problem came to me. She got cured as well but not before umpteen visits spanning seven years to AIIMS in Delhi where she was told that there was no treatment for her ailment.

I am not blaming anyone. We should not brush health problems under the carpet. There is a constant need to create awareness. I want to help people get better. I hope I can help people reach out to me through this interview.

Q. What needs to be done to provide quality and affordable treatment to patients suffering from neurological problems?

A. I need to bring in processes and efficiency in place so I can provide affordable treatment to all sections of society. I have not bought any expensive international equipment. They are too expensive. I cannot put the cost burden on my patients. In the rush for corporatisation of healthcare in the country, the patient is forgotten.

What patients need is a good ambience and world class healthcare, not AC premises with Wi-Fi, marble floors, huge infrastructure. I can’t look at my patient as an iPhone or a potato. For me emotion is the key. You need money but you can’t make a killing.

Q. What are your plans for the future?

A. I want to dedicate the next two decades of my life to the twin fields of neuro-modulation and neuro-rehabilitation. Neuro-modulation is functional neurosurgery and neuro-rehabilitation is getting disabled people get back on their feet.

If I can help disabled people across the country by doing lowcost surgery, low-cost innovation and rehabilitate patients then we can have an all pervasive impact on families, society and country. I would like to spread the message and set up centres across the country.

And, I need help. Neurological healthcare is a neglected area and nobody has a clue about the problem.