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Along with the management of patients with neurological disorders, the Neurology Department comprises outdoor-speciality clinics for the following neurological conditions: Movement disorders, headache, epilepsy, paediatric neurology problems and sleep disorders. Also, routine outdoor, indoor, dedicated emergency and neuro-intensive care facilities are available. We also have a paediatric neurologist dedicated for treating neurological problems in children.
As our eminent consultants have special knowledge and interest in specific neurological diseases, subspecialty clinics with dedicated OPDs are set up. The idea behind these clinics is to give more focused attention to patients with frequent neurological disorders, closely monitor their disease, adjust medications and advise alternative therapy when medications fail to control the disease or become refractory. For example, epilepsy surgery for certain refractory epilepsies after careful workup with prolonged inpatient electroencephalogram (EEG) recording (telemetry), special magnetic resonance imaging (MRI) scan etc.; and stereotaxic surgery for advanced Parkinson’s disease and other movement disorders.
Movement Disorders Clinic
The Movement Disorders Clinic established in 1992 is one of the first few clinics of this speciality in India and the first one in Mumbai. Here, we deal with conditions such as Parkinson’s disease (PD), parkinsonism, dystonia, tremors and Wilson’s disease. We offer botulinum toxin therapy—with and without electromyogram (EMG) guidance—for patients with blepharospasm, cervical dystonia and writer’s cramps. We are also actively involved with the functional neurosurgical programme and offer advanced treatments for diseases including Parkinson’s disease, dystonia and tremor. The clinic is open on Monday and Friday from 11:00 a.m. to 1:00 p.m.
Epilepsy Clinic
The Epilepsy Clinic was established in 2000 and is aimed at serving the needs of patients with any form of epilepsy, especially those where seizures are difficult to control even after prescription of multiple anticonvulsant drugs. Here, we offer services including drug harmonisation, counselling on lifestyle and identification of patients whose seizures are not controlled by drugs and who would benefit by surgery. Comprehensive presurgical evaluation and postoperative management is a natural fallout of the aforementioned services. We are open every Thursday from 2:00 p.m. to 4:00 p.m.
The aim of this specialty clinic is to:
o Assess patients with epilepsy
o Verify the diagnosis
o Establish the underlying cause
o Classify the disorder
o Choose or alter medications to the most appropriate ones for the underlying syndrome
o Identify patients with refractory epilepsy who could potentially benefit from surgery
This clinic is a screening centre working towards realising these goals and is run by a neurologist with an abiding interest in epilepsy. Here, we function in concert with a special team especially interested in epilepsy-related problems. This team includes:
o Neurophysiologists
o Neuropsychologist
o Neuroradiologist
o Neurosurgeon with expertise in epilepsy surgery
o Specially trained neurophysiology technicians
o An in-house medical social worker
The time allocated to each patient is suitable towards realising the aforementioned goals in the assessment of a patient with epilepsy. A systematic assessment of patients, guided by a specially designed questionnaire, is the usual screening instrument. Suitable patients subsequently undergo a specially designed epilepsy protocol. This includes MRI, video-telemetry assessment and functional imaging tests such as the ictal single-photon emission computed tomography (SPECT) scan. The video-telemetry unit is closely associated with the screening assessment of patients with poorly controlled epilepsy. Women with epilepsy are counselled about reproduction-related issues in epilepsy and appropriate therapeutic changes are introduced when needed.
Headache Clinic
The first speciality clinic in the country catering to the needs of chronic-headache patients was launched by the Department of Neurology in 1995. Headache is one of the most common problems in medical practice; but still, only a small percentage of headache sufferers seek professional help. Unfortunately, most of them resort to self-medication with over-the-counter analgesics. Chronic headaches are never taken seriously and are not considered a major health problem.
Only a small percentage of chronic headaches are due to serious underlying organic causes including brain tumours. A majority of chronic headaches are due to migraine. But even these benign chronic headaches result in a lot of misery, paralyse normal functioning and are often labelled as psychological, or something that you have to live with—and for which there is no specific treatment available!
Ideal headache management depends on understanding the fact that headaches are of many varieties. Each type of headache has a different cause and hence a different line of treatment. Most headache sufferers can be helped through simple and effective treatment. But still, many continue to suffer in silence without seeking professional help.
The understanding of these benign primary headaches has advanced greatly over the past decade. Researchers have now solved some of the mysteries about these headaches. We know that virtually every type of headache has a biological basis that can be diagnosed and effectively controlled.
It is for this reason that we have started the Headache Clinic so that we can analyse the headache type and try to provide a simple and effective treatment plan, which will improve the functional quality of life and hopefully give the patient freedom from recurrent headaches.
After the initial detailed interview by the consultant, and a thorough clinical examination which decides the type of headache and the need for appropriate further workup, patients are categorised in two groups: First, those needing prophylactic therapy; second, those whose headache can be managed by abortive treatment alone. The principle of approach to the problem at our clinic is:
o To make a proper diagnosis of the specific type of headache and the possible underlying cause
o To encourage the use of specific anti-headache medications rather than habit-forming analgesics
o To encourage acute treatment and lay more stress on preventive treatment which is aimed at reducing the frequency and severity of chronic headache
o To give special advice regarding dietary restrictions and other headache-triggering factors
o To offer psychological support wherever necessary
o To give detailed advice regarding the various drugs prescribed—pharmacotherapy will continually be modified based on periodic follow-up
We have all the latest diagnostic equipment—EEG, CT/MRI scan and SPECT scan—for investigating headaches. We also have the expertise of additional consultants including neurosurgeons, ophthalmologists, ENT (ear, nose and throat) surgeons and dentists—as and when required. Our main aim is to provide continual care for headache patients.
Our goal is to try and provide comprehensive evaluation of the headache, make a proper diagnosis, initiate prophylactic therapy and provide continuity of care.
Paediatric Neurology Clinic
In this clinic, we address all neurological problems seen in newborn babies, infants, children and young adolescents. This clinic was established because special expertise is required while treating neurological diseases in children. We see a huge variety of such disorders including epilepsy, degenerative disorders, cerebral palsy, behavioural issues, attention deficit disorder, autism, nerve or muscle diseases, congenital and genetic disorders etc.
Special expertise is also required to treat children with epilepsy which is not controlled by drugs and requires surgery or a ketogenic diet. Another condition is cerebral palsy, which is managed by a multidisciplinary team.
Sleep Disorders Clinic
Sleep Disorder Clinic is a pioneer clinic established in 2008. It is a comprehensive sleep disorders centre that addresses both adult and paediatric sleep issues. Sleep disorders such as sleep apnoea (including obstructive and central apnoea), obesity hypoventilation syndrome, insomnia, circadian rhythm disorders (such as delayed phase syndrome), restless legs syndrome, periodic limb movement disorder and narcolepsy are among the common disorders seen.
Paediatric obstructive sleep apnoea and paediatric insomnia related to behavioural issues in autism and neurodevelopment delay are assessed and managed.
Sleep studies such as extended EEG video polysomnography (PSG) diagnostic evaluations, PSG titration studies with continuous positive airway pressure (CPAP)—bi-level, average volume-assured pressure support (AVAPs), AdaptoSeroVentilation—devices are performed.
The multiple sleep latency test (MSLT) is performed for excessive sleepiness, i.e., hypersomnias that include daytime assessment for disorders such as narcolepsy and central hypersomnia. Mean wake latency tests are also performed.
Cognitive behavioural therapy is provided alongside pharmacotherapy for a comprehensive approach to insomnia. We provide a comprehensive diagnosis and treatment of over 80 different types of sleep disorders affecting the adult and paediatric population. These include insomnia, sleep apnoea syndrome, disorders related to snoring, sleepwalking, excessive daytime drowsiness/sleep (narcolepsy) and periodic limb movement in sleep (restless legs syndrome).
The sleep laboratory is a part of the Clinical Neurophysiology Department and offers diagnostic, titration and split-night polysomnogram, multiple sleep latency tests, mean wakefulness studies and actigraphy.
Department of Clinical Neurophysiology
This department was established more than 42 years ago and was one of the first such specialised department in the country. Numerous neurologists have undergone training in our department and are now successfully practicing all over India as well as in abroad. We have sophisticated equipment to conduct the following diagnostic procedures daily, except Sundays
o Electroencephalography (EEG) for epilepsy, encephalitis, neurodegenerative disorders, dementias etc.
o Video electroencephalography for short-term and long-term recording for patients with refractory epilepsy to get detailed evaluation of seizure semiology and presurgical evaluation and assessment
o Electromyography (EMG) and nerve conduction studies (NCS) for diagnosing diseases of the peripheral nervous system, peripheral neuropathies (disorders of nerves), myopathies (disorders of muscles) and myasthenia gravis
o Single-fibre electromyography (SFEMG) for special evaluation of patients with certain type of myasthenia gravis and other neuromuscular transmission defects
o Visual evoked potentials (VEP) for optic nerve problems (optic neuritis) in conditions such as multiple sclerosis
o Brainstem electric response audiometry (BERA) for hearing disorders originating in the brain
o Somatosensory evoked potentials (SSEPs) for spinal-cord disorders such as multiple sclerosis; and disorders of the spinal cord with or without compression
o Electroretinogram (ERG) for retinal diseases
o Pattern ERG for evaluation of central retinal function
o Electrooculogram (ECOCHG) for retinal pigment epithelium disorders
o Sympathetic skin response (SSR) for evaluation of small fibre neuropathy
o Sleep study laboratory for diagnosis of sleep disorders such as obstructive sleep apnoea (OSA), narcolepsy etc.
New equipment is installed from time to time to meet the demands of new tests and investigations. While earlier the tests were limited to only routine electroencephalography and electromyography, now a wide range of tests are carried out for cerebral, spinal, peripheral nerve, vision, hearing and autonomic nervous disorders. Patients are referred for these from all over the city and country. Arguably, no other department in Mumbai performs this range of tests and there are only a few other such departments in our country.
Area of expertise
Stroke, Clinical neurophysiology –(EEG/ EMG/Nerve Conduction Study /Evoked Potentials)
Introduction
Having completed neurology training (National Board) at Jaslok under prof Noshir Wadia. I did a fellowship in Cerebrovascular disease (Stroke) with Prof Vladimir Hachinski (Ex president, World federation of Neurology) for 3yeras in Canada. Has presented papers at the International Stroke Conference, European Stroke Conference and Asian Oceanic Congress of Neurology
Awards/Fellowship
"International and National Journal articles. Presentations at National and International conferences.
Investigator in trials such as CASES ( Canadian rTPA), MATCH, PROFESS, DIAS and others "
"* Fellowship in clinical Epileptology 2000 from Cleveland Clinic Foundation, Ohio
* Fellowship in Invasive Epileptology from Montreal Neurological Institute, Canada 2005"
"Dr Joy D. Desai is a consultant neurologist and DNB teacher for Neurology at the Jaslok Hospital and Research Centre. He completed his MBBS and MD in Internal Medicine from the BJ Medical College, Ahmedabad, Gujarat. During this period he was the recipient of three gold medals. He then moved to Mumbai and completed his DNB in Neurology at the Jaslok Hospital and Research Centre. During this period he was trained by Professors Noshir Wadia, Piroja Wadia, Sarosh Katrak, and Anil Desai. He attributes his neurological skills to their tutelage. During this tenure he participated in departmental clinical research.
He then moved to The Royal London Hospital, London, UK for a period of three years for a fellowship in clinical neurology. He participated in clinical research and published extensively. He joined the Jaslok Hospital and Research Centre as Consultant in Neurology in 1999. In 2000, he took a three month fellowship at the Cleveland Clinic Foundation, Cleveland, Ohio, USA. He successfully completed a Comprehensive Epileptology Course conducted by the Cleveland Clinic and passed the examination with an outstanding percentage.
Since 2000 he conducts the weekly specialist Epilepsy Clinic at Jaslok Hospital where he evaluates patients with refractory epilepsy for potential treatments and epilepsy surgery. He is an active participant in the video-EEG evaluation of such patients at Jaslok Hospital. Under his supervision, more than 90 patients have undergone epilepsy surgery after a comprehensive evaluation by the epilepsy evaluation team. More than 5000 patients have been evaluated and many have been rendered seizure free on rationalization of anti-epileptic drug regimes.
Many of his national and international presentations have been a spin-off of this experience. He is currently the secretary of the Mumbai Epilepsy Association. The Epilepsy Clinic at Jaslok Hospital offers services for the comprehensive evaluation of patients with epilepsy and epilepsy mimics. The clinic functions in close association with departments of clinical neurophysiology, radiology, functional imaging, neuropsychology , and stereotactic and functional neurosurgery."
"Awarded 3 gold medals during academic career
* For distinction in Anatomy - 1985
* For distinction in General Medicine - 1987
* For distinction in Internal Medicine - 1991
Research papers:
* Doshi PK, Joy D, Karkera B, Wadia PM. Bilateral pedunculopontine nucleus stimulation for progressive supranuclear palsy; Stereotactic and Functional Neurosurgery 2015;93:59–65
* Desai J and Shah S. Neurological dysfunction in chronic liver disease: an under recognized parkinsonian-plus syndrome. Neurology 2004; Suppl (Abstract)
* Patel AK, Patel KK, Shah HD, Desai J. Immune reconstitution syndrome presenting with cerebral varicella zoster vascultis in HIV-1 infected patient: a case report. J Int Assoc Physicians AIDS Care (Chic III).2006;5:157-160
* Desai J. Epilepsy and Cognition. Invited Review. J Pediatr Neurosci 2008:3(1); 16-29
* Desai J. Perspectives on interactions between antiepileptic drugs (AEDs) and antimicrobial agents. Epilepsia 2008; 49 (Suppl 6):47-49"
Movement Disorders, Botulinum toxin therapy, Deep Brain Stimulation
Dr. Pettarusp M. Wadia completed his neurology training (DNB and DM) from the Topiwala National Medical College. Subsequently he has done a 2 year movement disorder fellowship at the University of Toronto which included 6 months exclusive training in caring and programming patients who have received deep brain stimulation. He has joined the Jaslok Hospital and research center since October 2008. He has published many articles in many international journals and authored 4 book chapters. He has participated in various international research projects. He is currently involved in various research projects including presynaptic dopaminergic imaging in patients with drug induced parkinsonism, higher order gait disorders, spinocerebellar ataxia type II and ‘khat’ induced oromandibular dystonia. He is the founding member of the Movement disorder society of India, on the governing council of Parkinson’s disease and Movement Disorder society (PDMDS) and NGO looking after the welfare of patients with Parkinson’s disease. He is also a member of the international Parkinson’s disease and Movement Disorder Society, Neuromodulation Society, Indian Academy of Neurology, Maharashtra Academy of Neurology and Bombay Neurosciences Association. Dr. Wadia is currently running the movement disorders clinic at Jaslok Hospital since 2008, which specializes in caring for patients with Parkinson’s disease (PD), Parkinsonism, Dystonia, Tremors, Chroea, Wilson’s disease, Tourette’s syndrome, Restless Legs Syndrome and other Movement Disorders since 1992. At the clinic we offer botulinum toxin therapy (with EMG guidance when indicated) to patients with hemifacial spasms, blepharospasm, cervical dystonia, writer’s cramp (focal hand dystonia) and patients with spasticity (commonly post stroke). Dr. Wadia is actively involved with the functional neurosurgical program, offering advanced treatments like deep brain stimulation (for various diseases like PD, dystonia and tremors). He is actively involved in patient selection, intraoperative neurostimulation and also post-operative programming of deep brain stimulators.
"i. Doshi PK, Joy D, Karkera B, Wadia PM. Bilateral pedunculopontine nucleus stimulation for progressive supranuclear palsy; Stereotactic and Functional Neurosurgery 2015;93:59–65
ii. Wadia PM, Howard P, Ribeirro M, Robble J, Asante A, Mikulis D, Lang AE. The value of GRE, ADC and routine MRI in distinguishing parkinsonian disorders, Canadian Journal of Neurol Sciences, 2013; 40: 389-402
iii. Wadia PM, Tan G, Munhoz RP, Fox SH, Lewis SJ, Lang AE. Surgical correction of kyphosis in patients with Camptocormia due to Parkinson’s disease – A retrospective evaluation. J Neurol Neurosurg Psych 2011;82(4):364-368
iv. Wadia PM, Lim SY, Lozano AM, Adams JR, Y Poon, C Torresdiaz, Moro E. Bilateral Pallidal Stimulation for X Linked Dystonia Parkinsonism (XDP). Archives of Neurol 2010;67(8):1012-1015
v. Wadia PM, Lang AE, Moro E. Selecting appropriate dystonic patients for GPi Stimulation. In: Bain P, Aziz T, Liu X, Nandi D, eds. Deep Brain Stimulation. Oxford: Oxford University Press, 2009: 107-125.
vi. Wadia PM, Lang AE. The many faces of corticobasal degeneration. Parkinsonism and Related Disorders 2007: 13; S336-S340. "
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