REMEMBERING PROF. DEVIKA NAG BY HER LECTURE ON NEUROPATHIES

 

Prof. Devika Nag M.D, F.A.A.N, F.I.A.N.Sc. was our teacher of Medicine, in charge of the Department of Neurolgy in King George’s Medical College in Lucknow. She was a very serious academician and a very good teacher, besides being an extremely graceful lady, and a role model for many Georgians.

 

Prof. Devika Nag lost her father, who was in Army, at young age and later her only younger sister (at UK) due to Subarachnoid Haemorrhage due to ruptured aneurysm. She took good care of her mother till she passed away few years ago. As a child she was keen to become a writer but as destiny desired, she appeared in Premedical test on advice of her mother and topped it. She did MBBS & MD (Medicine) from KGMC and won dozens of awards and medals. Her batch was very bright and gave the Alma mater teachers like Prof. T.C. Goel, Prof. Chandrawati, Prof. A.K. Wahklu and Prof. Indu Wakhlu. She was later trained in Neurology at Boston and other USA & UK institutions.

 

She headed the newly developed Department of Neurology and the department made tremendous progress in all fields, patient care, teaching and research under her leadership. Her consistent efforts led to the start of DM Neurology program in the year 1981, first in state of UP. Prof. Nag served as the Head of the Department from 1977 to 1999 and was a very popular teacher. She later became Professor Emeritus, and served the Department and the speciality in innumerable ways.

 

Neurology and Neurotoxicology were her principal areas of interest and in 1994 the National Academy of Medical Sciences decorated her with their prestigious membership. She served as President of various associations to name a few: Indian Academy of Neurosciences, Neurological Society of India, Indian Academy of Neurology and Indian Epilepsy Association. Her students went on to head various Neorology departments all over the India and even ended up heading their respective institutions as Principals.

She was very punctual, meticulous record keeper, a strict disciplinarian but very soft at heart. Interest of patient was of paramount importance to her. She even declined the offer of becoming the Principal of King George’s Medical College knowing that she will get less time for patient care. She used to take detailed history of all her patients and  perform a proper thorough examination every time. She would take regular evening rounds on Tuesday, the day of her OPD & emergency. This would avoid missing any impending emergency in her newly admitted patients. She was so considerate that she brought home made breakfast for residents sometime when she knew the hostel mess was closed for some reason. She is still serving her patients with devotion even today at Dr KP Singh Memorial (Mayo) hospital at Gomtinagar, Lucknow.

 

There is no better way of remembering a teacher than by remembering what she taught us. This is a one her lectures, on the difficult topic on Neuropathies, which she delivered to our class.

 

The term Neuropathy is short for 'peripheral neuropathy'. It relates to nerve damage suffered by the peripheral nervous system, which is in charge of our nerves outside the brain and spinal cord.   

Causes

Neuropathy is a complication that can be caused by a number of various conditions:

·        Physical trauma

·        Repetitive injury

·        Infections

·        Metabolic diseases

·        Exposure to toxins and some drugs

All these can all lead to peripheral neuropathy. 

 

Signs and symptoms of neuropathy

Neuropathy usually starts as a tingling or burning sensation at our extremities, such as fingers and toes. There is also a loss of sensation at the edge of the nerves that patients have reported feeling like they are wearing a thin stocking or glove on their hands. They can say that the feel pins and needles or ants crawling on their feet. The precise symptoms differ from patient to patient based on the types of nerves affected and how they choose to express themselves.

There are three types of nerves that may be affected by neuropathy, namely sensory, motor and autonomic.

Sensory nerves: Sensory nerves are responsible for collecting sensory information for the body, such as touch, temperature, pain, pressure and vibrations. Neuropathy of the sensory nerves can be expressed as:

·        Spreading numbness and tingling in hands and/or feet (which can spread to the arms and legs)

·        Burning, sharp or electric-like pain

·        Extreme sensitivity to touch

·        Problems with coordination

Motor nerves: Motor nerves are the nerves responsible for activating our muscles and control movements. The involvement of motor nerves present as:

·        Muscle weakness

·        Paralysis

Autonomic nerves: Autonomic nerves are responsible for autonomic functions of the body, such as regulating digestion, heat and blood pressure. Their involvement can present as:

·        Intolerance to heat

·        Problems with digestion, bladder and bowel control

·        Dizziness - brought about by problems with blood pressure.

 

A common cause of neuropathy is Diabetes

Among diabetics, about 50% have minimal neuropathy presenting in some form or the other. They often won't notice the symptoms, and it will stay on a very low level. For the other 50%, however, the symptoms will be unavoidable.

Pain is the most common complaint, usually a 'prickling', 'stabbing' or 'burning' pain, that happens mostly at night. This, along with a numbness that feels as if the limb is 'asleep' - occurs predominantly in the toes, feet and legs. A proper history of the patient’s past illness is mandatory, lest we miss diabetes. Today we end up treating these neuropathy patients with drugs like anti-depressants, anti-convulsants, steroid and cortisone injections, lidocaine and pain killers. These are powerful drugs that address the painful sensations for short and long term relief. However, they have a host of side-effects and must be administered very carefully. Some medical practitioners recommend electrical stimulation of the pain area and of the spine. A lot of research is going on in this area, but progress has been very slow from the medical and drug industry so far.  

 

Natural solutions to neuropathy 

If your patient is suffering from Diabetic neuropathy then you must advice the following:

·        Give up smoking

·        Cut down on alcohol consumption or give it up altogether

·        Maintain a healthy weight

·        Exercise

·        Wear clothing that causes less irritation, such as cotton, covering the sensitive areas with wound dressing or cling film and using cold packs. 

·        Stress relief is also a big help when it comes to neuropathy, and so relaxation techniques such as yoga, and meditation will come in handy.

 

Vitamin therapy

Clinical studies have shown that certain supplements can have a cumulative effect on the symptoms and causes of neuropathy.

1.      Vitamins B1, B2, B6 and B12 Vitamin B deficiency is one of the major causes of neuropathy, and also one of the best natural solutions.

2.      Vitamin B1, usually in its common form of thiamine is helpful. 

3.      Recent natural medications have reverted to using benfotiamine, which has been found to be significantly more effective (almost 3 times) in delivering vitamin B than thiamine.

4.      Stabilized R-Alpha Lipoic Acid (R-ALA) This powerful antioxidant is one of the few, rare materials that can pass through the brain's blood/brain barrier to enter the brain and go directly where it is needed the most.  Most importantly, it has a specific effect on the nerves that eases the pain and numbness associated with neuropathy, and promotes better blood flow and oxygen to the nerves. Recent studies have reported that just by using the R-ALA alone, orally, symptoms of neuropathy were reduced.

Neuropathy support formulas These days, it is common for those suffering from neuropathy to take both medical and vitamin therapies, combining short-term treatment with the cumulative effects of correct nutrition.  The best formulas include vitamins B1, B2 and B12, as well as Vitamin D, R-ALA and materials that relax your nervous system, avoiding over-stimulation.  diabetes patients, this would be a good way to perhaps prevent the onset of neuropathic symptoms.

 

Friends, this was a lecture delivered in 1978-79. Many new things have happened in the field of Neuropathies since then and this field has been much enriched by recent advances. From emerging therapies leveraging stem cells and gene editing to holistic approaches encompassing mind-body techniques and nutritional interventions, the landscape of neuropathy management is rapidly evolving, but the foundation that was laid down by Prof. Devika Nag in our MBBS days has only helped us to understand these recent advances, and not get overwhelmed by them. I have to thank my batch-mate, Prof. Atul Agarwal, who is a retired professor of Neurology from the Department Madam Devika Nag chaired, and an eminent neurologist and epilepsy expert of our country, to help me with this blog.