The Hindu : Tamil Nadu / Chennai News : Neurology: diagnostic precision `not matched by therapy'

Online edition of India's National Newspaper
Thursday, Aug 19, 2004

Tamil Nadu

Tamil Nadu - Chennai

Neurology: diagnostic precision `not matched by therapy'

By Our Staff Reporter

CHENNAI, AUG. 18. Increased international and interdisciplinary collaboration is fundamentally important to gain a greater understanding of the brain, said David A. Johnson, paediatric neuropsychologist, Department of Child Life and Health, University of Edinburgh.

Delivering the K. Jagannathan Oration on `The next 50 years of neurosciences' under the auspices of the Institute of Neurology, Madras Medical College, Dr. Johnson said the branches of clinical neuroscience, neurology and neurosurgery should take the lead in generating better understanding of the brain after injury and during recovery, rehabilitation and development.

Having worked hard to secure the patient's survival, to contain secondary injury and restore quickly the patient's consciousness, neurologists and neurosurgeons were best placed to guide any interdisciplinary effort, said Dr. Johnson.

According to the neurosciences expert, notwithstanding the advances in medical science and technology that has facilitated survival of patients — from a premature-born 26-week foetus to a child with head injury — there was a substantial and still-growing population of patients with progressive disability. The survival of children with brain injury as well as the ageing population will gradually place greater demands on health, social and welfare services.

Technologies of diagnostic precision that can detect biochemical abnormalities today have come to represent high science in medicine. However, diagnostic sophistication has not been matched by any comparable change of therapy. "Neurological rehabilitation remains far from the forefront of research and service delivery. Indeed, it has been described as the Cinderella of medical, educational and social services."

Many interventions of potential benefit to the neurologically impaired children exist. But they have not been fully understood, investigated or applied. Avoiding risk impeded research on subjects with impaired decision-making capacities. So people did not appreciate the potential benefits and risks were over-stated, said Dr. Johnson. Among children, traumatic brain injury was the most important cause of acquired neuro-developmental handicap. Severe head injuries in children could lead to some form of permanent impairment. Yet clinicians have been blind to or chosen to ignore the reality of recovery and outcome from brain injury in children, he added.

R. Ponnudurai, Head of Psychiatry, Sri Ramachandra Medical College, said more disorders in the realm of psychiatry were being classified as organic disorders under neurosciences. The "pendulum was swinging from psychological principles in the determining of these disorders to biological theory," he said. He called for increased collaboration between neurology and psychiatry specialists.

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