Correspondence Address: Source of Support: None, Conflict of Interest: None DOI: 10.4103/0028-3886.166553
Source of Support: None, Conflict of Interest: None
All India Institute of Medical Sciences (AIIMS), New Delhi is considered as the apex healthcare institute of the country. The Department of Neurology was established in the 1960's and continues to be a leader in the country, in providing quality health care, in teaching, and also in conducting cutting edge research. The article traces the history of the Department of Neurology at AIIMS from its inception to the present day.
Keywords: All India Institute of Medical Sciences; neurology; neurosciences
History is important because it helps us understand the present. Studying history and tracing the genesis of events of the past considerably helps in coping with the present day issues. Based on the congent twin pillars of good clinical practice and sound science, the custodians of the Department of Neurology at All India Institute of Medical Sciences (AIIMS) shaped the current face of neurology and what it stands for today.
When neurology was started in the 1960s, general neurology was the backbone of clinical care and teaching. The largest outpatient consultation was devoted to general neurology, and in the wards, the general neurologists cared for the patients. Subspecialty training was mainly centered on the acquisition of knowledge and skills required for mastering specific neurophysiological techniques.
The senior neurologists at AIIMS were always strong proponents of general neurology. The specialized areas such as stroke, epilepsy, movement disorders, headache, neuromuscular diseases, multiple sclerosis, and dementias were created subsequently due to the enormous advances in our understanding of these diseases and also triggered by the research interests of individual neurologists. There are multiple reasons why at AIIMS, the principles and practice of general neurology have always been considered as being of paramount importance and have never been given a second place till date. First, the overall management of patients requires the background of general neurology. Diagnosis cannot be made solely on the basis of investigations. The lead provided, at least in the initial phases of the diagnostic process, by a well-trained neurologist leads to a much faster diagnosis and is considerably less expensive than the sequential consultation of different specialists. Second, in more remote and less privileged areas of the country, sound clinical science can compensate for the lack of technological expertise. Third, diseases of the nervous system do not respect the classifications of neurologists. Recent fundamental and novel insights into a number of neurodegenerative syndromes have provided an unsuspected overlap between subspecialties. Finally, general neurology probably represents the best chance we have to keep the entire discipline of neurology together and to maintain a holistic approach towards the care of our patients. Being a teaching center, besides a research hub, it is imperative that this sense of “responsible” clinical evaluation be imparted to all our students from generation to generation. Teaching of medical students and neurology residents requires the necessary and careful use of the art of simplification. Our senior neurologists mastered this art.
The Department of Neurology is inspired by the vision that it delivers world class care for its patients, imparts education of highest standards and conducts high-quality research in areas relevant to the national needs and confirming to the international context. Neurology is an important specialty of medical science and encompasses various sub-domains. Developing them further is essential for the enhancement of clinical services and research. An integrated framework of clinical, laboratory, rehabilitative, educational, and research services is mandatory. With advancing knowledge, it is imperative to have state-of-the-art care in stroke, movement disorders, epilepsy, neuromuscular diseases, multiple sclerosis, sleep disorders, neuroinfections, etc. There is a need to train super-specialists through fellowship programs in these subspecialties. The Department of Neurology at AIIMS has been a forerunner and torch-bearer in many of these aspects and currently holds an enviable number one position in most of these subspecialties.
Neurology was one of the earliest super-specialties to develop at the institute. Dr. James Austin, a Visiting Professor of Neurology from Oregon, USA started a nucleus of Neurology services in the Department of Medicine in the year 1961–1963. In 1965, Dr. Sushila Nayar, then Union Health Minister, invited Prof. Baldev Singh, (one of the founder members of Neurological Society of India) to start a Department of Neurology at AIIMS. When Prof. Baldev Singh moved to neurophysiology on his retirement, the department was headed by Dr. S. N. Pathak, and then by Dr. Vimla Virani in the year 1975. After Prof. Vimla Virmani's retirement, Prof. M. C. Maheshwari took charge of the department in 1978. The department was shifted to the Cardiothoracic and Neurosciences Centre in the year 1985. In the year 2001, Prof. M. Behari took over the mantle of leadership. In the year 2013, Prof. Kameshwar Prasad took over as Head of the Department.
Around the same time that the Department of Neurology was created, the Department of Neurosurgery was started in March 1965 with Prof. P. N. Tandon and Prof. A. K. Banerji joining the institute within a few months of each other. With their dedicated efforts and sincerity, the Department of Neurosurgery made great progress. The two departments celebrate the golden jubilee year of the inception of neurosciences in AIIMS in 2015. They have come a long way from their humble beginnings to being centers of excellence of international repute. The department of Neurology has trained several neurologists since the initiation of the DM training program in the 1960s. The training provided here is considered one of the best in the country, as evaluated by independent assessment systems.
AIIMS had a broad base of basic sciences since its inception. The first two professors in the Department of Physiology, Prof. B. K. Anand and Prof. A. S. Paintal were undisputed leaders of neurophysiology in the country. Prof. Keswani, the Chief of Anatomy, was primarily interested in neuroanatomy. Prof. G. P. Talwar was undoubtedly a luminary in neurochemistry. Dr. Sriramachari, Deputy Director of Indian Council of Medical Research (ICMR) provided his unstinted support for all neuropathological work till Prof. Subimal Roy took over the responsibility several years later. This extremely close interaction and congeniality amongst the stalwarts of different subspecialties within the neurosciences field, as well as an enviable camaraderie and understanding between the basic scientists and clinicians, helped to build up this strong citadel which we have now proudly inherited.
The process of starting the Departments of Neurosurgery and Neurology began from sharing space and beds within medicine and pediatrics. Initially, space was allotted on the first floor by the side of anatomy lecture theater. The Neurosurgery department got a separate outpatient clinic on the 4th floor of Rajkumari Amrit Kaur building after 2 years. Prof. K. L. Wig and the pediatricians generously allowed the usage of their beds both for neurology and neurosurgery. The department settled in when, by 1968, it had a ward in the out-patient department (OPD) block. In 1969, Neuroradiology was taken over by Dr. R. K. Goulatia, and in the mid-70's, Dr. S. S. Saini was persuaded to join Neuroanesthesia and this started the nucleus of a comprehensive clinical setup.
By the mid-70's, both the Departments of Neurosurgery and Neurology had been relocated to the 4th floor of the main hospital, where both the departments had independent wards. The facilities at that time were rudimentary. There was one operation theater but no specialized neurosurgical operation table and no Intensive Care Unit (ICU). The neuroradiology set up consisted of a skull table without an automatic changer for angiography, and there were neither facilities for tomography nor a dedicated unit for myelography. Isotope encephalometry, then a routine diagnostic investigation abroad, was nonexistent. The department had an electroencephalogram (EEG) machine, but no facilities for electromyogram or nerve conduction. Nonetheless, the departments were facing increasing demands for patient care from all over the country and also from neighboring countries. Meanwhile, the department had started the DM course in 1966.
By July 1984, the built up area included the basement, OPD, the receiving station, noninvasive laboratories, a radiology wing, 8 operation theatres (Neuro 3, Cardiac 4, Common 1) along with ICUs and postoperative wards.
Reminiscences of the very first DM resident of neurology from this department, and the person who rose to the zenith of clinical and academic excellence, Prof. Gourie Devi, also called the “Queen of Neurology,” are worth reading. She is the quintessence of an outstanding neurologist from India who has experienced first hand, the exciting formative years of the department. Prof. Gourie Devi joined AIIMS in 1962 as a postgraduate student in medicine. She continued as a registrar in 1965. Prof. Gourie Devi reminisces, “In those days Dr. James Austin, a Visiting Professor of Neurology from Oregon University, Portland, USA used to be a part of the Neurology Department. His teaching methods used to attract many postgraduate students of medicine, and I was one of the many students attracted to the subject and neurology as a career choice due to the interest kindled by Dr. James Austin."
“When I joined the Department of Neurology as a registrar and enrolled for the DM course in 1966, the faculty members included Prof. Baldev Singh, Dr. Virmani, Dr. P C Gupta, and Dr. Nounihal Singh. My colleague residents were Dr. B B Sawhney and Col M L Suri. During those days, the wards were in the old nurses' hostel. In the initial years, residents used to go to the anatomy department to get trained in EEG under the guidance of Prof. Chacko. The EEG, at that time, was recorded using ink pens. Routinely, after the day's work, we used to flush out ink from the pens so that the pen would not get blocked. The EEG machine was later procured by the Department of Neurology and Prof. Baldev Singh established the EEG laboratory. Prof. Gourie recalls that Dr. Baldev Singh was a very popular neurologist and patients used to throng to the hospital to consult him. It used be said that “there was no patient with a neurological disorder in North India who would not have consulted him.”
Prof. Gourie recalls, “Dr. Virmani was an excellent clinician and a compassionate human being. She trained us how to perform muscle biopsies and guided us on the ward rounds. In those days, there were Delhi Neurology Club Meetings which were held every month and Dr. Virmani used to take me along, treat me to a sumptuous lunch at her home at Golf links, and then escort me to the meeting.”
“We were imparted training on how to perform a carotid and vertebral angiography and pneumoencephalography. These procedures required us to be very quick and agile. The presence of space occupying lesions like tumors was ascertained using the change in the course of major intracranial vessels such as the anterior, middle, and posterior cerebral arteries. There were regular neuropathology and neuroradiology sessions and combined rounds along with the faculty of the Department of Neurosurgery. There was a lot of emphasis on integrating basic science teaching along with clinical neurology teaching. The dissertations also had some component of basic sciences integrated into them.”
“When I appeared for my DM exit exam in 1968, Prof. TK Ghosh, and Prof. Eddie Barucha had come as examiners. I clearly remember there was a question on the epileptogenic focus, and I had ended the note with a poem from Penfield. The examiners were really happy with the answers given and appreciated the nice touch of poetry to the scientific manuscript.”
(These details have been compiled by inputs from the Neurosurgery Department of AIIMS).
The idea of establishing a “Brain Research Centre” at AIIMS had been envisaged by Prof. B. K. Anand (neurophysiologist) even before the clinical departments came into existence. He requested the director in 1964 to initiate steps for developing a Brain Research Centre with the existing Indian Council of Medical Research (ICMR) neurophysiology unit as its nucleus.
In 1968, when the institute was to formulate its development plans for the fourth five-year plan of the Government of India, Prof. P N Tandon, Prof. B K Anand, and Prof. Baldev Singh had several informal discussions in an attempt to revive the proposal for a Brain Research Centre. While the Department of Neurosurgery was heavily constrained with clinical work due to limited diagnostic and operative facilities, Prof. P N Tandon, along with Prof. B K Anand, brought up the proposal for a “Brain Research Centre” to strengthen the patient care services through the development plan for the institute. The Development Committee approved the proposal in principle, but owing to financial constraints, no concrete steps were taken.
Meanwhile in 1971, Prof. Gopinath (Professor of Cardiac Surgery) submitted the proposal for the “Cardio-thoracic center.” Once again, to address the patient overload, clinical and research work, Prof. P. N. Tandon persisted with efforts to have a comprehensive neuroscience center, including the parallel development of basic neurosciences and clinical disciplines. Prof. P. N. Tandon, in consultation with Prof. Sumedha Pathak (Professor and Head of Department of Neurology) and on the advice of Prof. Baldev Singh and Prof. A K Banerji, prepared a plan for a dedicated clinical center. A draft proposal was thus submitted on July 16, 1971 to the Dean. Decision was taken to change the name from Brain Research Centre to Neurosciences Centre. Detailed and somewhat ambitious plans were formulated. Although the plans were ready, there was no obvious source of funding for it. Prof. P. N. Tandon could arrange the meeting with the personal secretary to the Hon'ble Minister of Health, Shri Uma Shankar Dixit. The meeting was encouraging and resulted in progress toward the establishment of the Neurosciences Centre.
On August 2, 1972, a copy of the formal proposal of “Neuroscience Center” was duly sent to the then health secretary Shri K. K. Das by the director and the proposal was discussed at the institute body meeting held on September 12, 1972. Recognizing the strengths already incorporated for the development of neurosciences within the document, the institute body approved the proposal in principle to set up a center for neurological sciences at AIIMS and decided that not only it be included in the proposal for the fifth five-year plan of AIIMS, but the possibility of an advance action in the fourth five-year plan itself should also be seriously explored. It was accordingly decided that the matter be considered by the Finance Committee in greater detail. However, the battle was not won yet, and there was a shortage of fund. In a subsequent development, due to financial constraints, Dr. Banwari Lal, Chief of Health division, the Planning Commission, rejected the idea of a comprehensive center and only suggested the incorporation of the proposal for establishing clinical services while excluding the basic neurosciences in the proposed centre. As the proposal for a separate cardiothoracic center was also put forward by Prof. Gopinath, the erstwhile Minister Shri. Khadilkar, advised the presentation of a new combined proposal for a neuroscience as well as a cardiac science center. Thus, Prof. P. N. Tandon and Prof. Gopinath carried out another exercise maintaining the basic character of the two independent centers and yet sharing some common areas and support laboratories. On August 2, 1973, a new draft proposal was forwarded to the director.
As a result of the vigorous pursuit and unshakable determination of Prof. P. N. Tandon, Prof. A. K. Banerji and Prof. Gopinath, the Cardiac and Neuroscience Center soon became a reality. With regard to the proposals for the two centers, the Planning Commission ultimately decided to allocate separate funds for “the development of super specialties.” On July 22, 1975, a formal letter from the Ministry of Health and Family Welfare communicated to the institute, the notification regarding the allocation of Rs. 188.37 lacs for the super-specialties (including both centers) for the fifth five-year plan. In July 1976, the Estate Committee formally appointed M/s. Pradhan Ghosh and Associates as the architects. On April 14, 1978, the President of India, Shri. Neelam Sanjiva Reddy laid the foundation stone of the twin centers. In his welcome address, Dr. Ramalingaswami, the then Director of AIIMS stated, “Our vision of the centers is that they will be centers both of public service and of higher learning at the same time.” He pointed out that, “The greatest and deepest need of a center is to be needed by society.” Quoting the famous economist Francis Delaisi, he said, “The purpose of an institution is to supply stability needed for long-term operations. At the same time, institutions must be able to adjust to change. It is our hope that stability, adjustability, and continuity will mix in the centers in appropriate balance."
Five years later, in March 1983, the outpatient clinics of neurology, neurosurgery (and also cardiology and cardiothoracic surgery) moved into the new building, while work continued to complete rest of the building. It was only in 1988–1989 that both the centers became fully functional in their new abode. At that time, neurosciences center had a bed strength of 180, three fully equipped operation theaters, 30 bedded ICUs, intermediate care wards, and full-fledged Departments of Neuroradiology and Neuroanesthesia within its complex.
Professor Baldev Singh, [Figure 1] often referred to as “grandfather neuron” or “papa neuron” was born on April 6, 1904 in Pakistan and after an illustrious career, left for heavenly abode on February 2, 1998. In 1949, the specialty of neurology was yet to be born in India. Therefore, for finding a Guru, Dr. Baldev Singh wrote to an author of an EEG textbook in USA and got acquainted with Prof. Gibbs. Although initially reluctant to have a student who was 45 years old, Prof. Gibbs eventually gave in to the exceptional brilliance and enthusiasm of Dr. Baldev Singh and accepted him as his student. Dr. Baldev Singh had a deep interest in the structure and function of the brain from his graduate days when he used to dissect the brain. He spent a year with Prof. Gibbs working on EEG and experimental studies on cats, examining the role of thalamus on spike and slow wave. It was in USA that Dr. Baldev Singh met Dr. B. K. Anand and got an opportunity to learn about the neurophysiological studies he was conducting at Yale. This acquaintance led to a long and fruitful association later on in India. When in 1964, it was decided to establish the Department of Neurology at AIIMS, Dr. Baldev Singh was an obvious choice for the task. He was invited to join for 3 years as a very special case since he was already past the age of retirement. In those 3 years, he managed to get the Departments of both Neurology and Neurosurgery up and running. The impetus that he gave has now culminated in a comprehensive world-renowned Neurosciences Center at AIIMS. His stay at AIIMS also reunited him with his longtime friend and collaborator, Dr. B. K. Anand. As he confessed later, it was at AIIMS, that for the first time in his life, he felt fulfilled. His interests covered a wide spectrum ranging from high altitude neurophysiology to the health benefits of yoga, intricacies of biofeedback, physiology of sleep, science of consciousness, cerebral edema, epilepsy, and heat hyperpyrexia. Even more than research, his life itself is an inspiration. He used to work for a minimum of 12 h every day in the department. In any scientific meeting, one could count on him for his learned remarks.
The formation of the Neurological Society of India (NSI) in 1951 was a major initiative of the four stalwarts, Dr. Jacob Chandy, Dr. Baldev Singh, Dr. B. Ramamurthy and Dr. S. T. Narasimhan with all specialties of neurosciences involved in the activities and growth of the society. Dr. Baldev Singh has had the rare distinction of having been the President of NSI in 1962 as well as in 1971.
After his retirement in 1968, he was appointed as “Emeritus Professor of Neurophysiology” and continued to guide PhD candidates and do research in collaboration with Prof. G. S. Chinna in areas of consciousness, sleep, and high altitude physiology until 1991, after which he moved to his hometown in Amritsar. He was conferred numerous awards including the Amir Chand Award by the ICMR, Air Marshal Subroto Mukherjee award, and was appointed an honorary Brigadier of the Indian Army. The highest award of Padma Bhushan was conferred on him in 1971. As stated by Prof. Gourie Devi, in her memoir, “The footprints of Dr. Baldev Singh will be long lasting for generations of neurologists to emulate his ideas, ideals, and dreams.” Prof. Gourie Devi and Col M. L. Suri were residents of the first DM neurology batch from AIIMS under the tutelage of Prof. Baldev Singh and Dr. Vimla Virmani. Till date, scores of DM students have been trained from AIIMS. Many of them are in various prestigious positions across the world in academic institutions and clinical practice, in both public and private sector [Figure 2] and [Figure 3].
Dr. Vimla Virmani [Figure 4] was born on April 12, 1919. She was one of the pioneers involved in establishing and expanding neurosciences in India and in developing a department of international repute with a high academic standard. She had explored various fields of neurology like “speech and cognition” when no sophisticated instruments such as magnetic resonance imaging (MRI) and positron emission tomography were available. She received various award and accolades including the position of the first lady president of NSI. The unique aspect of her training was that except for a one year fellowship at the Institute of Neurology and National Hospital for Nervous disease, Queen Square London, she had no other formal training in neurology.
In London, she worked with Dr. McDonald Critchley and developed an interest in the mechanisms of speech and their disorders as well as in body image disturbances. From these experiences grew a fascination for the neural basis of perceptual disturbances of space and the perception of time. She set up the Department of Neurology with Dr. Baldev Singh in 1964 in AIIMS and continued as a faculty till 1979 when she retired as Professor and Head. She is remembered fondly by many of her students, who themselves are veterans in the field of neurology today. To quote Prof. Mohan Das, another luminary DM graduate from AIIMS and currently the director of Neurosciences in Krishna Institute in Hyderabad, “She will always remain etched as a benevolent and a kind-hearted dictator."
Dr. M. C. Maheshwari [Figure 5] took over the reins of the department in the year 1979. He was born on April 19, 1939. For 10 years, he worked in clinical neurology, neuropathology, spinal injuries, and psychiatry in UK and USA. He retired in 2001 as the Chief of Neurosciences Centre in AIIMS after a very long innings as Head of the Department of Neurology. He wore several hats including that of the Dean of AIIMS besides also serving as the chief of Neurosciences Centre. He had the panache and aptitude to do justice to all positions. During his long tenure at the helm of affairs, he worked with zeal, commitment, and ambition to develop neurology services of excellent quality. With the establishment of the Neurosciences Centre, the department expanded and several sub-specialties developed. Thus, expertise, and excellence in areas such as stroke, epilepsy, movement disorders, etc., developed. The Department of Clinical Neurophysiology was established to serve as an example to other centers in India further reinforcing the legacy provided by Dr. Baldev Singh. Dr. Maheshwari, along with his devoted faculty, trained many students who were pursuing MD in medicine and psychiatry besides those enrolled in DM neurology and MCh neurosurgery courses. A full-fledged PhD program was flagged off during his tenure. Against many odds, he succeeded in forming the Indian Epilepsy Society, which was subsequently affiliated to the International League Against Epilepsy. The 18th International Epilepsy Congress (IEC) was organized by him in 1989 [Figure 6] and with the money saved, he created the Indian Epilepsy Association(IEA)-18th IEC trust to promote the epilepsy movement in India. He supported and worked hard for the development of Asian Oceanian Epilepsy Association in India. He was awarded the prestigious Padmashri in the year 2001.
Dr. Gulshan K. Ahuja [Figure 7] is another towering figure of neurology at AIIMS. Although he did not head the department, his contributions to its growth and excellence have been phenomenal. He mentored and guided innumerable students who have been and continue to be in well-acclaimed positions across the world and continue to pass on his legacy of teaching and training to their students. He was born in 1939 in Rawalpindi. He did his residency under Prof. George Schumacher, and imbibed his qualities of being an excellent clinician and a perfectionist. His clinical acumen, clarity of analysis, ability to arrive at relevant conclusions and to establish paradigms of management protocols for patients was supreme and accurate even in those days when there were no sophisticated diagnostic paraphernalia that we have today. Dr. Ahuja learned the diagnostic skills using an analytical approach and logical thinking. He joined AIIMS as a pool officer and moved to NIMHANS for a brief stint and then moved back to AIIMS in 1976. He took voluntary retirement in the year 1995 as Professor of Neurology. He contributed to strengthening the teaching program and patient care services. His major contribution was his research in myasthenia gravis and cysticercus granuloma. He is a founding fellow of Indian Academy of Neurology. He has also received several other accolades and awards.
The department was started with 25 inpatient beds. There are now 76 beds and 10 additional private ward rooms. The demand for outpatient services and inpatient care has been steadily increasing over the years. The department has maintained an impeccable record of comprehensive patient care, teaching, and training of students and has contributed substantially to the scientific literature. Many guidelines for the diagnosis and management of neurological illnesses have been formulated, validated, and accepted both internationally and nationally, including those for the diagnosis of tuberculous meningitis, the guidelines for the management of epilepsy and the national guidelines for the management of stroke. The department actively pursues clinical care and research activities in the subspecialties of stroke, epilepsy, movement disorders, neuroinfections, neuroimmunology, multiple sclerosis, neuromuscular disorders, sleep medicine, headache, and cognitive disorders among others. Currently, the department is conducting its work with 11 faculty members and 18 senior residents under training. The curriculum for the DM course includes evidence-based patient care in acute neurological emergencies as well as in chronic neurological disorders. The resident's training incorporates a hands-on experience. The department undertakes teaching of undergraduate and postgraduate students of medicine. However, the main teaching program is for DM (neurology), which was started in 1966 as a 2-year program but was subsequently changed to a 3-year course. Till date, more than 100 candidates have earned the degree of DM in Neurology from the Department. The department has an exemplary track record of organizing major academic activities, including national and international symposia, conferences, CME programs besides participating actively, and making its presence felt at international and national forums. Approximately 3500 patients are admitted each year. The outpatient service is 6 days a week with the number of newly registered patients having reached 5000 per month. In addition to the routine neurology clinic, several specialized clinics (movement disorders, pediatric neurology, neuroimmunology, neuromuscular disorders, stroke, cognitive disorders, intractable epilepsy, sleep, and headache clinics) are also run regularly. The Neurology department is among the first to start treatment of focal dystonia by using botulinum toxin injection. Comprehensive epilepsy care,stroke care including acute care, comprehensive rehabilitation and preventive strategies along with surgical and genetic diagnosis in neurological disorders are the other areas of patient service. The department is actively represented in the clinical epidemiology unit of AIIMS. Annually, public awareness programs with public lectures, competitions for school children, and incentives to patients in talent search activities, in the fields of common neurological disorders such as epilepsy, stroke, Parkinson's disease, and headache are organized. Public interest programs are also given periodically on radio, television and press media for a wider dissemination of vital information regarding the preventive aspects of Neurology. Public awareness programs to improve the detection of diseases, as well as focus on better time management and general lifestyle modification are also undertaken.
The neurology service runs outpatient clinics 6 days a week. Specialized clinics for stroke, movement disorders, epilepsy, neuromuscular disorders, neuroimmunology, headache, infections, and pediatric neurology are well established. Patients with neurological disorders are referred from all over India. On an average, about 400 patients are seen per day. [Figure 8] depicts the rising trend in the number of patients seen in the OPD in the past decade.
The neurology inpatient services are extremely busy. Currently, the neurology in-patient has 63 general ward beds, 5 ICU beds, 5 epilepsy monitoring beds, 3 sleep monitoring beds and 10 private ward rooms. Patients are admitted from the outpatient clinic and emergency services daily. At any point, a large number of critically sick patients with various diseases are under the care of neurology services. [Figure 9] depicts the growing trend in the inpatient admissions in the department.
Specialized clinical services
The first movement disorder clinic of the country was started at AIIMS in 1989 and is now a nationally and internationally recognized and acclaimed center for the care of a wide variety of neurological illnesses with movement disorders including Parkinson's disease. Prof. M. Behari has spearheaded the movement disorder super-specialty in the country since 1980 and has been running a dedicated movement disorder clinic. Injecting botulinum toxin for various types of dystonia was started by her in India in 1990. She dedicated herself to the research and education in movement disorders. Towards the fulfilment of this goal, she has conducted several workshops, video seminars, and educational courses. Prof. V. Goyal is the other faculty member involved in this field and has amassed recognition internationally and nationally as one of the pillars of movement disorder momentum in India.
The clinic now has more than 500 registrants annually. For the 1st time in the country, treatment for focal dystonias was started at AIIMS in 1990. The department has India's largest database of patients treated with botulinum toxin. Many deep brain stimulation surgeries have been performed in patients with Parkinson's disease and dystonia. The department is actively involved in the implantation and management of intrathecal baclofen infusion pump in patients with spasticity. The department has also participated in many phase-III international drug trials for Parkinson's disease.
The saga of successful management of cerebrovascular diseases began with the dramatic advances in modern radiology and the availability of acute reperfusion strategies. AIIMS has been the first public sector hospital to launch this service and has provided free-of-cost treatment to the underprivileged strata of society. Acute stroke care protocols are well established in the department. The very first publication from India sharing the experience of thrombolysis in acute ischemic stroke patients with intravenous recombinant tissue plasminogen activator emanated from the department. The department is a comprehensive tertiary stroke care center with an exhaustive list of facilities for stroke care including acute stroke treatment; hyperacute reperfusion strategies; mechanical thrombectomy; surgical treatment for stroke including decompressive hemicraniectomy; stroke prevention; revascularization therapies in collaboration with neuroradiology; stroke rehabilitation, including novel and innovative strategies and research into biomarkers of stroke recovery; neuroplasticity; use of repetitive transcranial magnetic stimulation, etc. Many novel and emerging concepts related to comprehensive stroke management have been explored. The complex and protean mechanisms of neural plasticity and stroke recovery have been explored. A dedicated stroke clinic at the Neurosciences Center, AIIMS, was started in 1996 with an aim to provide effective stroke prevention and stroke rehabilitation services. Our faculty has been amongst the active members of the International Stroke Society and the Indian Stroke Association. Currently, the stroke team consists of Prof. K. Prasad, Prof. M. V. Padma Srivastava, Prof. R. Bhatia, and others. They have held positions of national and international repute including those at the Ministry of Health, National Program for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) and Program for Management of Non-Communicable Diseases (NCD), etc. The national stroke guidelines originated from this department. Research of global repute continues to be pursued under the leadership of Prof. K. Prasad. One of the largest epidemiological studies aimed at exploring the risk factors for stroke and dementia is ongoing under his expert guidance.
Comprehensive epilepsy care
The Department of Neurology, AIIMS, has been running a comprehensive program for epilepsy care, especially for patients with medically refractory epilepsy. The comprehensive epilepsy services startup was largely the brain-child of, and was intiated due to the efforts by Prof. Satish Jain. He joined the department in 1982 as a senior resident. After completing his fellowship in epilepsy from Duke University, USA, he, guided by the benevolent support provided by Prof. M. C. Maheshwari, built up the edifice of epilepsy program as almost a standalone comprehensive clinical service unit at AIIMS. With help from Prof. V. P. Singh from neurosurgery, Prof. Manvir Bhatia from neurophysiology and Prof. S Gaikwad from neuroradiology, the comprehensive epilepsy program rose from strength to strength. A program of epilepsy surgery for refractory patients was initiated in 1995, and the first surgery for intractable epilepsy was conducted in April 1995. Since then, more than 1000 patients have been operated upon with a good surgical outcome in nearly 70–85% patients in various groups of epilepsy, which is comparable or even better than the results at some of the best epilepsy surgery centers of the world. Pre-surgical evaluation includes the following: (a) Clinical evaluation, (b) MRI (epilepsy protocol), (c) interictal EEG, (d) Ictal video EEG (VEEG), (e) single photon emission computed tomography (interictal and/or ictal), and (f) psychometry. Patient management conferences are coordinated by the department for these patients and are attended by members of the epilepsy surgery team which comprises of members from the Departments of neurosurgery, neuroradiology, nuclear medicine, neuropsychology, and neuropathology. These conferences are held weekly and nearly 30–50% patients investigated and discussed are cleared for surgery every month. Almost 200 patients are wait-listed for long-term video-EEG assessment, the backbone workup for these patients, and about 100 patients are waitlisted for surgery, at any point in time, apart from patients with very frequent seizures or frequent status epilepticus, who are also operated on an emergency basis. Currently, the mantle of this program is being borne by Prof. Manjari Tripathi and the epilepsy team has increased to include Prof. Garima Shukla, Dr. Mamta Singh, Prof. Achal Srivastava besides the neurosurgeons, Prof. P. S. Chandra, and Prof. A. Suri. The neuroradiologist is Prof. A. Garg, the specialist from nuclear medicine is Prof. C. S. Bal and the neuropsychologist is Prof. A. Nehra. The Epilepsy Monitoring Unit currently has 5 VEEG beds besides day care services.
National Center of Excellence for difficult-to-treat epilepsy was established at AIIMS with collaboration between National Brain Research Center and AIIMS with Dr. P S Chandra being the in- charge and principle investigator of the project in 2011. This project is funded by Department of Biotechnology, Ministry of Science and Technology, India (DBT). The objective of this national facility is to develop paradigms of epilepsy research and training in India. The center boasts of having magnetoencephalography (first of its kind in India), advanced human electrophysiology and brain mapping techniques, cellular electrophysiology, and molecular research facility. Various advanced surgical procedures are performed for epilepsy. Prof. M. Tripathi is the co-in-charge of this center of excellence for epilepsy. World class research has been done and currently pursued, and one look at the publication list will convince any skeptic as to the level of commitment, depth and pursuit of excellence that the epilepsy team at AIIMS has achieved till now. Dr. Mamta Singh is also involved in the internationally acclaimed outreach program in epilepsy care for the underprivileged across the country and is well known for her travels and contributions in the lifeline express.
The Department of Neurology, AIIMS, since its inception, has made significant contributions to the field of neuromuscular disorders. A state-of-the-art clinical electrophysiology laboratory is present in the department. The electrophysiology lab is equipped with facilities to assist the clinicians in the diagnosis and management of complex neurological disorders. The department is supported by one of the most advanced histopathology laboratories in the country, which has the capacity to provide histopathological diagnosis for some of the most complicated and rare neuromuscular disorders. The pioneer in the field of neuromuscular disorders was Prof. Baldev Singh who was also the founder of the department and the Neurosciences Centre. He also had a keen interest in electrophysiology. Trans-sternal thymectomy, started in early 1970's, which is now getting replaced by video-assisted thoracoscopic surgery (VATS) thymectomy, is often performed for myasthenia gravis, for which the department receives referrals from all parts of the country. Plasma exchange is routinely being done for the care of myasthenia patients. A dedicated neuromuscular disorder clinic formally came into existence in the year 2002. The clinic has grown exponentially in the last 4 years. Nearly 200 VATS and robotic-guided thymectomy have been successfully performed till date. The department has also initiated research on stem cells in the field of neuromuscular disorders. The volume of work done in the department is evident from the bibliography of research papers published in international and national journals.
Sleep medicine program
The Department of Neurology, AIIMS, was the first neurology setup in the country to initiate, in the year 1998, a sleep disorder clinic and start polysomnography studies and other investigations required for patients with sleep disorders. Before this clinic was established, sleep medicine was being practiced almost exclusively by chest physicians in the country. Since then, almost 150 patients with various sleep disorders, including sleep disordered breathing, restless leg syndrome, parasomnias, and insomnia, are registered in the clinic every year; more than double this number of patients with sleep disorders associated with various neurological disorders are also managed in this clinic. 100 polysomnography studies and about 50 multiple sleep latency tests (MSLT) are performed per annum with approximately 50–75 patients waiting for their tests at any given time. However, there is a huge potential for more studies and research based on these investigations, which could materialize with better technical and personnel related resources. Two international symposia on sleep medicine have been hosted by the Department of Neurology in 1998 and 2005, respectively.
The department has been on the forefront in the area of neuro-infections. The department in 1994 established the clinical diagnostic criteria of tubercular meningitis and its validation. Utility of steroids in tubercular meningitis has been studied by Prof. Prasad and guidelines established. The enigma of single enhancing lesions in patients with epilepsy was investigated and several reports were published confirming cysticercosis as the cause for the same. Treatment of neurocysticercosis, especially the role of albendazole, has also been investigated. During the epidemic of meningococcal meningitis, the role of short (7 days) versus usual treatment (14 days) was investigated.
The department is actively involved in the diagnosis, clinical care, and research of multiple sclerosis and other diseases like neuromyelitis optica, autoimmune encephalitis and other inflammatory disorders of the brain. A registry for patients suffering from multiple sclerosis is in place and is continuing to record the details of patients. Plasmapheresis and administration of immunomodulators such as interferons, natalizumab, and rituximab are routinely being performed under the close supervision of the faculty members.
Stem cell research
As a part of the global initiative by the institute to pioneer the research of the decade, “ the cell-based therapies,” the Department of Neurology has initiated and is successfully running several ethically accepted projects on stem cell-based therapies in severe disabling neurological disorders in which currently, no specific treatment strategies are available. These include: (1) Autologous bone-marrow derived stem cell therapy in stroke; (2) autologous bone-marrow derived stem cell therapy in static encephalopathy including cerebral palsy; and, (3) on the anvil of initiation are stem cell therapies in stroke, multiple sclerosis, and ataxias. The department has conducted and proven the safety of bone marrow stromal cells in stroke patients in a randomized controlled trial design.
Neuro degenerative disorders
A cognitive disorder clinic was started in 1996. Several cases of Alzheimer's disease and other forms of dementia are seen. The department participates in several multicentric international trials in dementia. The department is a partner of the Department of Science and Technology major project on genome-wide scan of hereditary ataxias. Two new ataxias have been described from the Indian subcontinent and the promoter gene identified.
Clinical neurophysiology services
A state of art clinical neurophysiology lab is functional since the inception of the department, which has grown in strength over the decades. Rated as one of the best centers in the country and internationally recognized, it has nearly all the different neurophysiological tests and equipment. Besides supporting clinical care, it has an immense research potential and has been successful in contributing to reputed scientific literature.
This article, therefore, traces the history of neurology in AIIMS for the earliest times down to the present day. To encapsulate the achievements of people engaged with neurology over five decades is a daunting task. It is an attempt to provide a glimpse of the contributions of many of our revered senior neurologists who laid the foundation of modern neurology at AIIMS and explored new horizons in this field. These key persons possessed the triumvirate characteristics of enthusiasm, optimism, and contentment. Hence, they could achieve what they set out for and step-by-step built this wonderful citadel of the Department of Neurology at AIIMS.
We are grateful to Prof M Gourie Devi and Prof Satish Jain for contributing details and photographs for the article.
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Conflicts of interest
There are no conflicts of interest.
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