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|NI FEATURE - COMMENTARY: TIMELESS REVERBERATIONS
|Year : 2018 | Volume
| Issue : 7 | Page : 3-4
Movement disorders: The genesis and progression in India: Neurological perspective
Department of Neurology, Fortis Flt. Lt. Rajan Dhall Hospital, Vasant Kunj; Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
|Date of Web Publication||1-Mar-2018|
Dr. Madhuri Behari
Department of Neurology, Fortis Flt. Lt. Rajan Dhall Hospital, Vasant Kunj, New Delhi
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Behari M. Movement disorders: The genesis and progression in India: Neurological perspective. Neurol India 2018;66, Suppl S1:3-4
The development of movement disorders as an organised subspecialty of Neurology in India is a rather recent event. The first movement disorder clinic in India was started by Dr. Rajshekhar Nair in 1983, the Head of the Department in the Government Medical College Hospital, Trivandrum, Kerala.
The second movement disorder clinic in India and the first one with dedicated doctors and focused clinical and scientific endeavour in the field of movement disorders was started in 1989 at the All India Institute of Medical Sciences, New Delhi. This was started by me after I had undergone an year of training in the subspecialty at the Institute of Neurology and Neurosurgery, Queen's Square, London, UK under the mentorship of Prof. C.D. Marsden. This provided a much needed impetus and direction to this rather neglected field at that time in Neurology. I was supported by two of my most dedicated and responsible lieutenants, Dr. Sumit Singh and Dr. Vinay Goyal. Both of these doctors are movement disorders specialists in their own capacity and carry on the mantle of this specialty to this day. At the clinic, the patients having movement disorders were diagnosed according to the established international criteria and the severity of their disorder was assessed according to the approved evaluating scales. We, under this umbrella, carried out patient-oriented studies to start with, and later performed some physiological and genetic research as well. The first movement disorder workshop was held in 1991 at AIIMS, New Delhi, where two international speakers participated and live workshops were held, defining the role of electro-physiological changes in movement disorders as well as the role of botulinum toxin injection for the treatment of focal dystonia. Subsequently, the second to fifth movement disorder workshops were also organized by us in Delhi. Further, to spread the message and involve other movement disorder specialists who had returned to the country after their overseas training, we urged them to organize these workshops in other parts of the country. All these doctors returned to India to initiate focused movement disorder clinics in their respective cities. The doctors included Dr. Uday Muthane, who trained at Columbia University, New York, under Dr. Stanley Fahn and returned to India to start the initiative at National Institute of Mental Health and Neurosciences (NIMHANS), Banglore; Dr. Mohit Bhatt, who trained at University of British Columbia, Vancouver, Canada under Dr. Donald Calne to start the movement disorder clinic at Jaslok Hospital, Mumbai; and, Dr. Rupam Borgohain, who trained at National Hospital for Neurology and Neurosurgery at Queen's Square, London under Dr. C.D. Marsden and focused on this subspecialty in Nizam's Institute of Medical Sciences (NIMS), Hyderabad. These three individuals organized the subsequently held workshops in Bangalore, Mumbai and Hyderabad, respectively.
Later on, Dr. Asha Kishore at Sree Chithra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Trivandrum, Kerala, and Dr. S.K. Das as well as Dr. K.B. Bhattacharya at Bangur Institute of Neurology (BIN), Kolkata, West Bengal, started the movement disorder clinics in their respective cities. With more than half a dozen of neurologists of the country practicing predominantly in the arena of movement disorders after undergoing specialized training in the field, the soil was fertile for the development of the subspeciality of movement disorders in the country. Meanwhile, Dr. Uday Muthane conducted courses for residents on movement disorders, on similar lines as the Epson course conducted in the USA. This was performed in collaboration with Drs. Stanly Fahn, Joseph Jancowich, Mark Halett, Kailash Bhatia. Most of us were members of the International Movement Disorders and Parkinson Disease Society (MDS). Due to the active participation from India, some of the pioneering members of the Indian initiative on movement disorders subsequently became office bearers of the Asia-Oceania section (AOS) of MDS. Dr. B.S. Singhal became the President of the AOS-MDS in 2009. During same year, I became an executive member of AOS-MDS for three years. In 2009, we also organized the Second AOS-MDS Congress in New Delhi, along with Congress for Persons with Parkinson's disease. Following this congress, I was elected as a member of Education Committee of AOS-MDS, and then, took charge as the co-chair and the chair of the Education Committee of AOS MDS. During my association with the education committee of AOS–MDS, several MDS educational programs were organised in various cities of Indian including Kannur, Kerala; Varanasi, Uttar Pradesh; Ludhiana, Punjab; Delhi; Jaipur, Rajasthan; and, Vadodara, Gujarat. This exposed a large number of Indian neurologists to the subspecialty of movement disorders by the utilization of didactic lectures and video session. Subsequently, Drs. Asha Kishore, Uday Muthane, Vinay Goyal, Pramod Pal and Rupam Borgohain have been inducted as office bearers of the AOS-MDS. In Jaslok Hospital, Mumbai, the first patient suffering from a movement disorder, underwent the DBS procedure in India. In the year 2000, we performed the first DBS procedure in AIIMS, Delhi on a patient suffering from Parkinson's disease with the predominant manifestation of movement disorder. Thereafter, many centres in India have performed this procedure, with some of the predominant ones in this field being NIMHANS, Bangalore, NIMS, Hyderabad; SCTIMST, Trivandrum; Kokilaben Dhirubhai Ambani Hospital, Mumbai; Dr. Ram Manohar Lohia Hospital, New Delhi; and, Army Research and Rehabilitation Hospital, New Delhi. Other notable names who have also done commendable work in the field of movement disorders include Dr. Meena Gupta from Delhi; Dr. Charulatha Sankhla from Mumbai; Dr. Sujith Ovalath from Kannur, Kerala; Dr. Pettarusp Wadia from Mumbai; Dr. LK Prashantha from Bangalore; and, Dr. Hrishikesh Kumar from Kolkata. In 2006, the Indian neurologists focusing on movement disorders organized themselves as the Parkinson Research Alliance of India (PRAI), with Dr. Kapil Sethi of USA acting as the catalyst. Later, in 2012, with an National Institutes of Health (USA) grant, I in collaboration with Dr Karl D. Keiburtz, the Robert J. Joynt Professor in Neurology, Senior Associate Dean for Clinical Research, and Director of the Clinical and Translational Science Institute at the University of Rochester Medical Center, USA, developed a consortium of US-India Collaborative Partnership in Parkinson Disease (CPPD), which was aimed at forming an alliance that would help Indian specialists focusing on Parkinson's disease establish a research collaboration between the Indian and US neurologists. This would enable both doctors in India and USA, to work out modalities for sending and receiving medications for conducting clinical trials, and biological material for more meaningful research, on the same lines as has been carried out by the Parkinson Study Group (PSG). This project was conducted over two years during which time, several problems were ironed out, which culminated in the registration of the PRAI at Hyderabad in 2014. Under the aegis of PRAI, the Indian movement disorder specialists have undertaken to carry on the first multi-centric collaborative research project in India in this field entitled “Genetics of Parkinson's disease in India (GOPI)- for young-onset Parkinson's disease (YOPD)”.
More recently, Drs. Neeraj Kumar and Sanjay Pandey received training at Canada and USA, respectively, and are doing commendable research and clinical work in the field of movement disorders. In addition, several neurologists trained by the first generation of movement disorder specialists from India are also focusing on movement disorders in India. Some of them are Drs. Vinay Goyal, Sumit Singh, Ravi Yadav, Karni Singh, SP Gorthi, and Geeta Khwaja among several others in this field. In the year 2014, Parkinson Disease and Movement Disorders Society of India (MDSI) was registered at Bangalore as a non-government, non-profit scientific society to encourage and uplift the specialty in India and to increase awareness, hold workshops, and encourage young students and neurologists to better understand the specialty, and treat patients and undertake research in the field. Dr. Pramod Pal became its first Secretary and I became the first President of the Society. Since its inception, two successful annual congresses of MDSI have been held at Chennai and Bangalore in 2016 and 2017, respectively. MDSI has been affiliated with the AOS-MDS in 2016. The specialty is attracting a large number of neurologists, allied persons and basic scientists, who are doing planned and focused research in the area.
It is my pleasure to note that the MDSI is holding a very successful annual conference every year; the constituent members are doing meaningful research in the area of movement disorders; several new neurologists are opting for movement disorders as their chosen field of interest and research; and, many centres are carrying out DBS, botulinum toxin injection and other modalities of therapy on a routine basis. Not only the neurologists but basic scientists, neurosurgeons, physiotherapists and nurses are choosing to exclusively work in the field of movement disorders.
The momentum of movement disorders in India has picked up pace and Indian neuroscientists are making their appearance felt in the arena of movement disorders as well.