Graphics by Sabrina Lee
My name is Arun Naia. I am a science editor at The Stony Brook Press and recently graduated from Stony Brook where I studied neuroscience and creative writing. I am a young man with severe disabilities.
In 2009, I returned from a two-year tour in Iraq with no visible injuries. At first she was in a coma for a month, moved from hospital to hospital, and finally returned to his parents’ home on the Queens-Nassau County border. Veterans Day that year. When in that coma, he had a stroke on the left side of his brain and when he woke up his right side was paralyzed. After months of physical therapy, he underwent deep brain stimulation (DBS) surgery in 2014. This was because his relatively young age and good health made him well suited for this invasive surgery. It made a huge impact on my life. After intensive physical therapy, DBS, and some additional treatments, I regained enough movement and control to return to school in the summer of 2017.
This summer, I found out that two doctors (one a pediatric neurologist, the other a neurosurgeon) live on the second floor of my aunt in Brooklyn. Dr Lekshmi Peringaserry Sateesh and her Dr Vinayak Narayan are from the same state of Kerala as my family in India and both doctors have experience with her DBS.
The three of us talked about this procedure and the whole field of neurology while sharing breakfast and coffee at my aunt’s dining room table.
I know that NYU Langone does the deep brain stimulation I received. Is it where you work or do you work elsewhere?
Dr. Narayan: Yes, I work at NYU Langone.
Dr. Satish: I work at SUNY Downstate and am a Pediatric Neurology Resident. I am in my fourth year of school. It’s a 5 year program.
What sparked your interest in neurosurgery?
Dr. Narayan: During medical school, I was really fascinated by the anatomy of the brain and spinal cord. When I started seeing patients, I was interested in seeing neurological problems. At the same time, my interest began to grow and I saw surgery and performed some basic minor surgeries. Did.
What sparked your interest in pediatric neurology?
Dr. Satish: I love children and I love helping them. I like pediatrics. I also like neurology. That’s why I wanted to do pediatric neurology – I like both specialties. Internal medicine is a very interesting specialty. It’s like a puzzle. I always liked solving puzzles.
What role do neurology and neurosurgery play in human life?
Dr. Narayan: The brain is the most important organ in the human body. There are many diseases that affect the brain. So the types of ailments that can be treated with surgery are treated by a group of doctors called neurosurgeons, and the specific ailments that can be treated with drugs are treated by neurologists or neurologists. work is flourishing.
Dr. Satish: brain [has] supreme control over all other organs; it constitutes the topmost part of your body and controls your emotions and even your emotions. People think emotions come from the heart, but they don’t. They actually come from specific parts of the brain. And that is why it is so important in our lives.
Basically, what is deep brain stimulation and how is it performed?
Dr. Narayan: Deep brain stimulation is a very complex type of neurosurgery that, as the name suggests, stimulates very specific deep tissue within the brain by implanting a pacemaker in the brain. This pacemaker in the brain is externally connected to a battery that constantly supplies some electricity to the electrodes of the pacemaker to stimulate brain structures.
How was the technology developed?
Dr. Narayan: Deep Brain Stimulation was developed many years ago, the concept considers the head in stereotaxic space, and based on that stereotaxic dimension, people “can focus on one particular point in a coordinate system.” I started thinking. So, on that basis, specific areas or specific nuclei in the brain can be precisely targeted and stimulation of that structure can bring significant benefits to the patient. We pioneered and developed the system. …no one was aware of such a cure. Many changes and fixes have been made to the system. DBS is now able to provide very advanced treatments. It’s very beneficial — actually amazing.
What are its strengths and limitations?
Dr. Narayan: Deep brain stimulation therapy can be used for people with Parkinson’s who have very severe tremors and stiffness. It can be done for essential tremor, a truly severe tremor that affects a person’s quality of life. DBS is also used to treat certain types of epilepsy and seizure disorders. Today, it is also used for mental disorders such as depression, obsessive-compulsive disorder, and addiction.
A limitation is that many tests must be done before the procedure. There are very few suitable candidates. Second, patients are highly motivated and need strong support for these patients. After surgery, you will still need a lot of help in hospital, treatment, and everything else. These patients therefore need a strong support group and either respond to certain types of medications or are willing to take some medications even after surgery. patient is not eligible for her DBS.
I had a stroke resulting in DBS. What do people who have had a stroke do to regain normal function?
Dr. Narayan: If a person has had a stroke, the most important thing needed to restore normal functioning is courage and a strong heart to get back in his life. am. All of this is very important when supported by other types of ongoing treatment such as appropriate rehabilitative treatment, speech therapy if there is a speech impairment, and physical rehabilitation treatment. At the same time, it is very important to prevent another stroke by treating risk factors.
What can be done for the fetus or mother if the fetus is found to have neurological problems?
Dr. Narayan: Problems with the fetus can be detected to some extent by doing blood tests on the mother. It may be detectable in the first few months of pregnancy. For some problems that can be predicted in utero, there are neurosurgical treatment options. However, in many cases these problems are quite serious.What we can do to prevent those problems [try to] conduct. One of the things we can do for her is advise her mother to take necessary medications, such as certain types of vitamins and iron tablets. But of course we have to accept the fact that some genetic problems are unavoidable and have a poor prognosis.
Dr. Satish: There are certain genetic conditions that can be detected very early in the first and second trimester blood tests. For example, there are diseases with a very poor prognosis that can occur before birth, such as spinal muscular atrophy. Treatment is limited, but there are advanced treatments called intrauterine procedures and intrauterine intrathecal therapy. Again, the prognosis is poor in any case.
What is the future of deep brain stimulation therapy? Are there other technologies in development that could complement or improve it?
Dr. Narayan: I think it has robust applications for deep brain stimulation. It is mainly used today for tremor, Parkinson’s disease and epilepsy, but in the future it will be used for depression, obsessive-compulsive disorder and addictive medications. An emphasis may be placed on psychiatric disorders such as addiction in resistant patients. Some of the advanced technology we have today is deep brain stimulation, like tractography, which is very safe. … Therefore, in these developments, DBS is highly safe and highly effective in the management and treatment of many of these neurosurgical problems in future care.
Tell us about a challenging or unique experience you’ve had.
Dr. Narayan: One of the unique experiences I had was when I was in Ohio. I saw a patient with a very debilitating tremor who had suffered for over 40 years, he was a gentleman over his 75 years old who could not do anything because of his tremor. He couldn’t hold the spoon himself. He cannot drink water himself. That led him to a treatment called MRI-guided focused ultrasound ablation. This is a surgical procedure and takes about 2-3 hours.
finished [his] Procedure in a span of 3 hours. After the surgery, my tremor was almost completely cured and I can now drink and eat alone. His life changed completely. It seems that his treatment has turned him 180 degrees. At the end of those few hours, he felt magical, [it was] One of the most important things that happened in his life. It’s been a very unique experience for me, and in our field, it’s like patient happiness, and it’s very rewarding.
Dr. Satish: During my residency, I encountered some difficult cases. One of his cases was a newborn born to a normal mother, a normal family, and had no other risk factors. However, the baby had significant head-to-toe abnormalities, with significant facial deformities and limb abnormalities.
It was very difficult to find out what the baby had. It was very interesting and challenging. So we did all sorts of neurological investigations: imaging, EEG, electromyography. Finally, a genetic test came back positive, revealing a very rare genetic abnormality in the baby. I believe it was his second case of this kind in the United States. So we couldn’t even find much maintenance around this genetic anomaly. But the problem is, even if we were eventually able to find a diagnosis, there weren’t many treatments for the disease, so we couldn’t help the baby beyond supportive measures. The sad part. But luckily, at least I was able to figure out what the cause was.
