Information from the departments of Interim Hospital Facility is available currently

Faculty Members: Dr Shri Ram Sharma Asst. Prof Neurology E mail: DEPARTMENT OF NEUROLOGY FACULTY: Professor :                         1 Post  :Vacant Associate Professor :      1 Post   Vacant Assistant Professor        2 posts 1.Dr. Shri Ram Sharma 2.Vacant   Senior Resident Doctor -Vacant           There has been a progressive expansion in the dept of neurology since the time of inception in 2008. The OPD attendance has gone up (5536), as in the indoor services, which have also increase several fold. The specialty clinic have been introduced gradually since 2008 to provide more focused  and multidisciplinary patient care services in the field of Epilepsy, Headache Movement disorder, Dementia, Neuro behavior disorder, neuromuscular disorder and Mental Retardation. This Department is situated at 3rd floor with 3 consultations chamber and 1 EEG, NCV Lab  OPD services: 5 days a week, from Mon to Friday, daily average attendance is 30 new cases  Specialty Clinics Epilepsy clinics (once a week), every Tuesday, 2pm to 4pm Movement disorder clinic (once a week), every Wednesday, 2.00pm to 4pm Neuro behavior clinic (once a week) every Friday, 2.00pm to 4.00pm Neuromuscular clinic (once a week), last Saturday of every month 9am to 11am Headache clinic (once a week) every Thrusday, 2.00pm to 4.00pm Emergency services- round the clock emergency services Indoor services- 32 bedded Neurology ward Electrophysiology lab services The lab is equipped with digital EMG/EP system digital video EEG. Daily averages of test being conducted are 3-4 EEGs, (1-3) EMG, NCV, EP Community outreach services in collaboration with psychiatry department. Awareness program at NEIGRIHMS in the community for Neurological disorders like Epilepsy, dementia, stroke etc. Envisioned addition to be made in existing patient care services are: IN PATIENT HEADACHE 25 SEIZURE DISORDER 50 PERIPHERAL NEUROPATHY 25 CVA 109 Dementia 41 Myelopathy 72 LBA 120 Others 28 Movement disorders 39 Total 509  Death ---------------------------------------29 Patients. OUT PATIENT NEW PATIENT 1227 OLD PATIENT 2087 REFERRED 417 Total 3731 DIAGNOSIS HEADACHE 444 SEIZURE DISORDER 536 PERI PHERAL NEUROOATHY 55 CVA 128 Dementia 250 Movement disorders 619 LBA 650 Others 266 Muscular Destrophy 212 Cranial Neuropathy 200 Myelopathy 371 Total 3731 NEUROLOGY ELECTROPHYSIOLOGY  LAB:- EEG 2324 NCV 860 EMG 145 VAERA 85 VEP 63 RMS 11   Academics:-publications 1. Acute subarachnoid hemorrhage as initial presentation of dural sinus thrombosis .JNRP, 2010, vol 1, issue 1 2. An acquired epileptic aphasia a rare case report, JPN  2010. Paper presentation- 3. Paper presentation at International stroke conference ISA 2010., AIIMS, New Delhi.   CME organization- 4. Mid term CME of the association of neuroscientists of Eastern India, 17th April  2010 ORGANISIZING COMMETTEE- organizes CME and delivered a session over  Approach and management of peripheral neuropathies   Inpatient services Number of beds to be increase to 50 in phase manner along with Emergency services and critical care services:        Total                          50        General                      32        Private ward               8        ICU                            10 Stroke Unit  A 6 bedded specialized Stroke Unit will be established to take care of stroke patient. Such unit need to be manage by a term comprising of Neuro-Physician in Neurosurgeon interventional neuro-radiologist and other trained nursing and technical staff. The back up supports are by Neuro imaging (CT, MRI, TCD, DSA), Laboratory services and are very co-operative. Stroke unit will be followed with written protocols for the management of the patient. Patient will avail advance therapies like thrombolitic therapy. Physiotherapy, speech therapy & Occupational therapy will also be a part of the stroke rehabilitation. This will reduce morbidity and mortality among the stroke patient.   Expansion and up gradation of ICU The numbers of beds will be increase to 5 plus 2 high dependency units beds (HDU) for the stroke unit. ICU will be quipped with all the latest equipments along with central monitoring system, central pipeline for oxygen and suction. Plasmapheresis machine will be installed to take care of various immune mediated neurological disorders like gullain Barre Syndrome, Myasthenia gravis etc. For the letter we already have liaison with the regional blood bank at civil hospital.   Up gradation of neurology emergency services To take care of various neurological emergency like stroke, gullain barre Syndrome, encephalitis, meningitis etc The emergency department would be equipped with the life support equipments like cardiac monitors, defibrillator and ventilators along with the trained  nursing and technical staff, well versed in critical care working.   Emergency department would be supported by 24 hrs emergency laboratory services needed for stroke unit as well as others neurological problems.   Emergency Diagnostic services In the long run emergency lab offering all necessary diagnostic facilities round-the clock will be stared. The services would include radiological facilities like ambulatory X-ray, CT Scan, MRI, DSA and emergency interventional procedure such as thrombolysis along with all essential routine investigation like serum electrolytes, blood sugar, haemogram, CSF examination etc. To begin with the following investigation will be provided:       -         Blood sugar -         Blood urea -         S. electrolytes, calcium -         CSF-sugar, protein, gram stain, cytology. -         Peripheral smear for malaria parasite.    The services would be offered as per as the following time schedule -         On working days 4.00 p.m. to 8.00 am the next day. -         Sundays and holidays 9.00 A.M to 8.00 A.M the next  day. Diagnostic Services: Neurology.   Upgradation of Electrophysiological Services : It is proposed to upgrade the existing electro physiology services as follows: -         Portable EEG machine for critically ill patient in ICU especially for patients with non-convulsive status and patients on ventilator. -         Long term video EEG monitoring/ video telemetry for evaluation of patients with medically refractory epilepsy/ psychogenic seizure. -         Additional EMG/EP system with a least 4 channels -         Additional diagnostic services -         Sleep lab- polysomnography for sleep related problems -         SPECTS especially for the stroke unit for functional disorders -         Single fiber EMG for evaluation of disorders of neuromuscular junction.   Epilepsy Clinic   NEIGRIHMS is already running an Epilepsy clinic once a week (every Tuesday). It is a multidisciplinary clinic managed by neurologist, focus of management is to provide comprehensive Epilepsy care i.e. Diagnostic Facilities; Accurate diagnosis of type of Epilepsy/Epileptic Syndrome as per as ILAE classification based on clinical evaluation, Supported by lab investigation like video EEG and Neuro imaging (dedicated MRI scan with epilepsy protocols) It is further planned to upgrade the existing diagnostic facilities to have: Long term video EEG monitoring for diagnosis of non-convulsive status epileptics, psychogenic seizures and others non-epileptic attack disorders. This will also be used for pre-surgical evaluations of patient for epilepsy surgery. Neuro imaging with MRS MRI SPECTS Medical Treatment: Medical treatment is aimed at providing appropriate AEDs according to the seizure type to control Seizure & optimized QOL. Many patient           (20-30%), who don’t respond to first line AEDs are given second line AEDs. AEDs level monitoring is done to ensure compliance and to achieve adequate therapeutic drug levels.   Surgical Treatment; Patient with medically refractory epilepsy who are candidates for epilepsy surgery would be subjected to surgery once neurosurgical services are available. For pre-surgical evaluation facilities like long term video monitoring, MRI, brain SPECT, neuro-psychological assessment would be available in epilepsy surgery unit. Facilities for vagal nerve stimulation would also available.   Awareness programmed and support groups: Awareness programmed are being conducted by a team of neurologist, Support groups are made so that patient can interact with each other and share there experiences. With the help of NGOs such services would be extended to the community and schools. With the help of Anthropologist more emphasis would be given on cultural & psycho-social aspect of epilepsy including health seeking behavior of the people. This would also focus on preventive aspects of epilepsy like, Tuberculosis, Trauma, Stroke, and Birth Trauma. Preventive will be started with the help of anthropologist & obstetrician from Civil Hospital to provide appropriate antenatal & prenatal case. Effort is also being made to identify the causes of medically refractory epilepsy so that these patients can be closely monitored & subjected to surgery at appropriate time if medicated. It is proposed to start Epilepsy register to focus on causes of epilepsy, problems associated wit Pregnancy and Epilepsy: and posttraumatic epilepsy. Rehabilitation of Epilepsy patients- Vocational training – day care Research: It is also planned to established genetic lab and to undertake genetic studies to identify various known genetic markers & some new genes if any in Indian population. One such study to evaluate the pharmacogenomics of first Line Anti Epileptic Drugs (AEDs) is already going on.  Liaison with employing agencies and NGOs.   Movements disorder clinic. At NEIGRIHMS, movement Disorder Clinic is running for last 1 yrs on every Wednesday afternoon from 2:00 to 4:00 P.M. and there has been steady increase in number of patients attending the clinic. Being Neurology Institute, many patients of drugs induced extra paramedical disorder attend the clinic. It is further planned to expand the scope of this clinic by measures following. -Video monitoring of movement disorder patients especially drug induced extra pyramidal syndrome, Parkinson’s diseases and follow up. -Genetic study of patients with Parkinson diseases and correlate with our idiopathic young Parkinson’s disease patients. - To include various movement disorders in the community outreach programmed. - To incorporate movement disorder surgery once neurosurgery services are started. -To administering Botulinum toxin under EMG guidance. Neuro behavior clinic  The field of Neuro behaviour clinic will be expanded to include the research in the field of normal human cognition and to develop Neuro cognitive laboratory. Our aim is to develop standard protocols for cognitive assessment in Indian context. Patients with degenerative disorders like dementia, Neuro-psychiatric disorders and drug abuse related neurological disorders require a multi disciplinary care from the neurologist, psychiatrist, clinical psychologist, social workers speech therapists, occupational therapist & physiotherapists. Patient with attention deficit hyperactivity disorder, personality disorder and behaviour problems associated with neurological diseases like epilepsy, stroke, Parkinson’s dieses require multi disciplinary approach at some or other point in there treatment that will be provided by this clinic. Rehabilitation services will be focused in addition to the motor deficit. It is proposed to make caregiver’s support groups and train them for looking after  such patients. Help line for such patients will also been started. Neuro Muscular Clinic  Multidisciplinary neuro muscular clinic has been started (last Saturday of every month). The clinic is managed by a team of Neurologist, pathologist, orthopedic surgeon, psychiatric social workers, occupation therapist & physiotherapist.  Patient with neuro muscular disorders are provided comprehensive care, supported by clinical evaluation, molecular diagnosis, rehabilitation and counseling. With recent developments in the genetics of the neuromuscular disorders, patients in neuromuscular clinic are subjected to a detailed diagnostic workup comprising of immunohistochemistry, PCR etc. to achieve the definite diagnosis. Genetic counseling for the patient and the family would be provided by expert in the field of genetic. It is also proposed to start facilities for research in the field of diagnostic and therapeutic neuro-genetics (gene therapy/stem cell therapy)   Neuro vascular clinic:  The clinic will take care of patients with stroke and those at high risk for stroke for providing primary and secondary prevention along with rehabilitation services. Patient with stroke who will be presenting to out patient department of our institute will be managed in the neurovascular clinic.   Headache clinic; It aims at providing holistic care to patient with chronic primary headache like migraine tension type headache, chronic daily headache and cluster headache. Multi-disciplinary team comprising of neurologist, clinical psychologist, and Yoga expert will take care of such patient. The therapeutic armamentarium for headache has been expanded these days so we plan to incorporate therapies like biofeedback, cognitive behaviour Therapy (CBT), yoga etc.   Neurology There are some ongoing research project in the field of epilepsy, Mental retardation, dementia and pharmacogenomics. It is proposed to continue the research activities in the form of; -         In house hospital based studies -         Community studies   The various fields of interest for future research are; -         Genetic of various neurological disorders -         Epilepsy / Parkinson’s diseases / dementia/ ataxias / muscular -         Dystrophies / neuromuscular disorders -         Neuro cognitive and neuro behaviour disorders -         Neuro- tuberculosis -          Movement disorders -         Stroke -         Wilson’s diseases -         Headache -         Peripheral neuropathy especially toxic neuropathies     Neurology   Rehabilitation centre: Department of neurology aims to established a state of art of neurorehablition centre for the comprehensive treatment, training and research in the field. Since, neurorehabilitation have now become an integral part of the management of the neurological disabled patients, it requires an established centre. The centre will consist of group of neurologist, neuroscientist and physical therapist from rehabilitation Medicine, otolaryngology, and andorthepedics. In addition we propose to have following. -Neuro habilitation specialist -Neuro habilitation specialist nurses -Neuro habilitation assistants.   Department of Neurology aims to develop extensive neurorehabilitation programme both for cognitive as well as neuro-muscular rehabilitation. Rehabilitation programme will be divided into three groups. -         General neuro- rehabilitation -         Pediatric neuro- rehabilitation -         Geriatric neuro- rehabilitation The Neuro rehabilitation program would cover the following disorders:  -Disorders of cognition  - Disorders of thought and mind  -Disorders of speech  - Disorders of neuromuscular system  -Disorders of neurovascular system  -Disorders of dizziness and balance.   Cognitive rehabilitation; Functional neuro-imaging is a neuro scientific research activity that has been a key growth area. The interest has been not only in fundamental neuroscience but also in mechanisms and treatment of neuropsychiatry disorders. The neurology department has been a vital player in this field, interest in which spans a variety of departments, neurologist, neuroscientist and physical therapist such as occupational therapists, speech therapist, clinic psychologist and psychiatric social workers. This will enhance the neurorehabilitation management of the large number of the demented and cognitively disabled who are, registered at NEIGRIHMS.   Neurology services at community level. It is proposed to extend the neurology services at community level as on going Urban Mental health Programme. The purpose of these community services is to improve public awareness about various disorders and to remove various myths prevailing in the community associated with diseases like epilepsy, dementia and other neurological disorders. By such visits, the local interaction of various communities with doctors and the nursing staff will develop which will help these people to shed there common myths and misbelieves, some of which are dangerous and life threatening. These will also facilitate the epidemiological studies..   Neurology Tele-neurology: In the new era of medical communication systems, it has become pertinent for our institute to enter the zone of Tele-neurology. Exchange of knowledge with various specialists all over country and abroad, will allow all of us, to boost our information. Aim: -         To set up telemedicine OPD for small localities, all over Shillong and the neighboring state to provide online consultation for neurological disorders to physician, pediatrician etc. -         To establish help line services for online consultation. -         Disaster management can be tackled by direct telemedicine connective from any part of Shillong.  (a)    Contract to be given to a company of excellence in telemedicine services. (b)    Equipment: -         4 computers -         1 telemedicine unit hard ware -         4 cameras -         DVD projectors with screen -         Broad band fast internet connection -         2-ISDN Lines. (c)    Advantages: -         Telemedicine remote OPD can be set up for small localities, all over Shillong the Neighboring states to provide online consultation for neurologic disorders to physicians, pediatrician etc. -         To establish help line services for online consultation.   Stroke unit proposal Stroke is one of the foremost causes of high mortality and morbidity and is  the second most common cause of death. The recent study have shown that the early management in dedicated stroke units can decrease mortality and improve the quality of life in stroke survivors. Hence, it is proposed to start a 5 bedded stroke unit in the department of neurology. Objectives 1.      Specific management of stroke patients 2.      Assisted management of stroke patients though allied branches of neurosciences 3.      Specialized management of complications of stroke.   Goals 1.      To optimize function of neurological care, minimize disability, complications & stroke recurrence, promote care giver satisfaction. 2.      Increase understanding of risk factors & stroke prevention. 3.      To promote research and increase knowledge about stroke through dissemination of information.   Staff required: 1.      Neurologist: Expertise in dealing with stroke patient 2.      . Neurosurgeon :Expertise in dealing with stroke patient 3.      Nursing staff     :Nursing staff – 15x45 % against leave vacancy 4.       Assistant nursing staff          : 5.      Occupational therapist              : 1 6.      Physiotherapist                         : 1 7.      Social workers                         : 1 8.      Nutrition specialist:   can be taken by Institute’s dietician & pharmacist   Equipment required: (1)  Ventilators                                     : 2 (1)  Bedside monitors                           : 2 (3)   pulse oximeter\                              : 2  (4)  electro cardiography machine         : 1 (5) Mobile X-ray Unit                           : 1     Side Laboratory: For Hematological & Biochemical test. SUB: Requirement of equipments for stroke Unit. Stroke is one of the foremost causes of high mortality and morbidity and is the second most common causes of death. The research studies have shown that the early management in dedicated stroke  unit can decrease mortality and improve the quality of life in stroke survivors. The major development in acute stroke management is intravenous Tissue plasminogen activator given with in 3 hrs of onset of stroke. The organized inpatient stroke care unit is required for the administration of same. Approximately 5-10 new cases of stroke get registered every month at NEIGRIHMS. Hence , it is proposed to start a 5 bedded stroke unit in the department of Neurology and the following equipment are required for the same.                                                                                                   Equipment   S.NO    Name of equipment                    Qty.reqd                 Cost(approx)   1.        Ventilators with pulse oximater            2                   18 lacs each 2.        Bedside monitors                                2                     8 lacs each 3.        Electro cardiography machine             1                    25 thousand 4.        Miscellaneaus                                                           20 Thousand   Submitted for approval please.                                                                                                        SUB: Requirement of an ambulance as a part of mobile stroke team for organization acute stroke programmed at NEIGRIHMS. Stroke is the third major cause of death world wide. The epidemiological studies in India during the last decade shows the age adjusted prevalence rate of stroke was between 250-350/1, 00,000.  There   has been a definite increase in incidences & prevalence of stroke in India. Stroke is related with major mortality & morbidity. Data is available for stroke related mortality in India. Approximately 2.4% of all deaths are attributed to stroke. The major development in acute stroke management is intravenous TPA activator given with in window period (3 hrs). The organized impatient stroke care unit is required for management of stroke patient with TPA with window period. It has been seen in review with acute stroke patient management that patients who receive organized stroke unit care are more likely to survive their stroke return home and make a good recover. Organized stroke unit care is provided by a multidisciplinary team which includes a full time Neurologist, radiologist, nurses, Paramedical staff e.g. who manages the stroke patients is dedicated stroke Unit from community nearby hospitals as early as possible to give the advantage of TPA with in period. Transportation of the patient to the stroke Unit will be main focus in optimizing the stroke outcome in the organized acute stroke.