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Neurology: Neurofeedback therapy offers hope to patients battling a vast array of brain disorders
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On the road to recovery: Dr Pradeep Shabnam with his wife, Neeru, at Nimhans in Bangalore. Photo by Bhanu Prakash Chandra
On the road to recovery: Dr Pradeep Shabnam with his wife, Neeru, at Nimhans in Bangalore. Photo by Bhanu Prakash Chandra

Lorie the ladybug, Harold the housefly and Randy the cockroach are all set for the race.
Dr Pradeep Shabnam, a patient from Nahan in Himachal Pradesh, has electrodes fixed to his head. A set of wires from the electrodes is connected to an electroencephalograph that records the electrical activity of the brain and evaluates brain disorders. He is asked to look at Lorie on the computer screen in front of him. The ladybug keeps going up when his gaze is fixed on her! As Lorie is about to reach the finishing line, Pradeep's attention gets diverted and he looks at Randy. Then Randy starts moving and Pradeep loses his points.
The 53-year-old loves playing bug race as part of a neurofeedback session at the National Institute of Mental Health and Neuro Sciences (Nimhans) in Bangalore. A senior veterinary officer in the Himachal state service, Pradeep was a diligent worker and a complete family man who would share domestic work. “He would get up at 4.30 a.m. and make tea for me, too,” recalls his wife, Neeru Shabnam, who is a doctor working for the Himachal government. “Then he would put the kneading machine on and cut the vegetables. Sometimes, by the time I came back home, the dinner would be ready. Chicken fry was his speciality.''
That was three years ago, before tragedy struck the family. He began suffering from excessive sleepiness and was admitted to a hospital in Chandigarh. Doctors there found that he had a cyst in the brain and a hydrocephalus condition (fluid accumulation in the brain) due to it.
The excess fluid was putting pressure on the other areas of the brain and thereby affecting the overall functioning. Pradeep underwent surgery to remove the cyst, but soon the right side of his body was paralysed. His cognitive functions were also badly affected. Thanks to the therapy, he is now taking baby steps towards life, holding onto his wife's hand like a child. He can now remember the names of the animals he had treated.
“The neurofeedback sessions at Nimhans have helped Pradeep get back to life,” says Neeru, who brought her husband to Bangalore for the sessions. “He is more independent now. His gait is almost normal. Sometimes, he talks to me and opens up, as he used to earlier, which means a lot to me. His orientation and attention have also improved a lot, though it is not as good as his pre-morbid days. He now takes up simple tasks, too.”
The therapy has been a blessing for patients like Pradeep. “Neurofeedback can treat a vast array of brain disorders,'' says Dr Jamuna Rajeswaran, associate professor at the neuropsychology unit of the department of clinical psychology at Nimhans. “Our studies have shown the effectiveness of neurofeedback in alcoholics and patients with brain injury. We looked at the changes in the patients' brain pre- and post- neurofeedback and have seen a significant improvement in stroke patients and autistic children suffering from attention deficit hyperactivity disorder (ADHD).”
That the patient doesn't have to take any medicines, which may have side effects, is a major attraction of this therapy, says Rajeswaran. “One of our patients, a 16-year-old autistic girl who underwent 60 sessions of neurofeedback, could even clear her open school exams and has started working now.''
Developed in the west in the 1960s, neurofeedback was introduced in India in 2006 by Nimhans. “Through games, the therapy modifies brain activity to a specification controlled by a trained professional using an EEG. The therapy can modify amplitude, frequency and even coherency of one's brain waves,'' explains Rajeswaran. Even people in good health can take the therapy to sharpen their brain. And it is affordable, too.
Despite Nimhans claiming it to be a huge success, not everyone is convinced. Dr Vinay Goyal, additional professor, department of neurology at the All India Institute of Medical Sciences says there are more exciting advancements in mainstream neurology. “For instance, deep brain stimulation (implanting a brain pacemaker), which is one of the most advanced treatments for Parkinson's disease, reduces the requirement of drugs and improves symptoms significantly,'' says Goyal.
Then there are wonder drugs like recombinant tissue plasminogen activator (r-tPA) which is highly effective against acute ischaemic stroke (artery to the brain is blocked). “If injected within three to four and a half hours of the onset of an ischaemic stroke, r-tPA can prevent damage due to blood clot significantly,” says Goyal. “Since it dissolves the clot, it is known as a clot buster.”
But if given beyond the window period, it can lead to fatal brain haemorrhage, he warns. Nimhans will soon have a helipad so that patients can be flown in to the hospital during the golden hour.
Advancements in the field have given a new lease on life to epilepsy patients. A majority of epilepsy cases can now be cured—the area of the brain that causes the disorder is identified and removed surgically.

Whats New
* The University of Michigan is developing a polymer nano-fibre technology to help advance neurological disease treatment. It will help understand how nerves are formed, why they do not reconnect after injury and what can be done to slow or prevent damage.
* Brain pacemaker. The brain stimulator is effective in treating Parkinson's disease for at least three years. But the downside is decline in cognitive abilities and other health problems that could affect quality of life.
* Researchers are working to replace dying brain cells, as in the case of Alzheimer's disease, with stem cells. Scientists have already made neurons and other brain cells from stem cells but getting these to function in hosts is posing problems.

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