During my medical school in Calcutta Medical College, Kolkata, India, I was always fascinated with brain and neuroscience and took detailed interest in analysis of symptoms and localization of lesions. It was clear for me that neurology is perhaps the only field where this is possible, and during this period I was inspired by my first mentor in neurology — Prof. Bhaskar Roychowdhury. I spent one year with him as a house-staff, and then joined the Postgraduate Institute of Medical Education and Research (PGIMER) at Chandigarh to pursue postgraduation (MD) in general medicine. I had the opportunity to meet a neurology giant from India, Dr. JS Chopra, who inspired me to pursue my career in neurology. My dissertation was on Vincristine-induced neuropathy under mentorship of Prof. UK Dhand. Soon after I completed MD, I was selected to pursue DM course in neurology at the National Institute of Mental Health and Neurosciences (NIMHANS), a premier Neurology Institute at Bangalore.
At NIMHANS, I developed interest in neurodegenerative ataxias, an interest kindled by Prof. NH Wadia from Mumbai, who described SCA2. My dissertation was in spinocerebellar ataxias, and after I completed neurology residency, I wanted to pursue my further training in ataxias and movement disorders. I joined as a clinical fellow in movement disorders at the Neurodegenerative Disorders Centre, Vancouver, Canada (1997-1999). My mentors were Dr. Donald Calne, Dr. John Stoessl, and Dr. J Tsui. Apart from being trained in Parkinson’s disease and other movement disorders and PET scan, I had the unique opportunity to study, for the first time, the efficacy of intra-parotid injection of Botulinum toxin for drooling of saliva in PD patients. While there was opportunity to continue my training in Canada, I preferred to return to India and develop the Movement Disorders Centre at the National Institute of Mental Health and Neurosciences (NIMHANS), where I was offered a faculty position. At that time there were only a handful of movement disorders specialists in India, and I realized that my expertise will help to improve the treatment, manpower development, and research in Movement Disorders in India.
I started the movement disorders clinic at NIMHANS in 2000 for providing dedicated services to patients with movement disorders. In next few years, we started the Botulinum toxin clinic and functional neurosurgery (lesional surgeries and DBS) in collaboration with neurosurgery colleagues. Over time, a subspeciality of Parkinson’s Disease and Movement Disorders was formed with collaborations with neurosurgeons, psychiatrists, neuropsychologists, rehabilitation therapists, speech pathologists, neuroradiologists, and geneticists. In 2002-2003, I had further training as a clinical fellow in electrophysiology in movement disorders, human motor control and transcranial magnetic stimulation under the mentorship of Prof. Robert Chen at Toronto Western Hospital, Toronto, Canada. This training helped me to set up the Human Motor Control Lab at NIMHANS. Over time, I started the post-doctoral Movement Disorders Fellowship Course at NIMHANS, of which I am currently the program director.
At NIMHANS, we carry out research in Movement Disorders through several national and internationally funded scientific projects and dissertations of DM and PhD students. My main areas of clinical and research interest include:
- Functional and structural neuroimaging and human motor physiology (including TMS) in patients with ET, tremor dominant PD, writer’s cramp, myoclonus, psychosis, impulse control disorders in PD and spinocerebellar ataxias (SCAs (1,2 and 3)
- Genetics of rare movement disorders, early-onset PD, ataxias and dystonias
- Infection-related movement disorders.
I have been closely associated with more than 100 young neurologists – residents, PhD scholars, fellows, and LEAP recipients – in the capacity of a mentor. I am also a committed researcher with more than 500 peer-reviewed scientific articles and book chapters with a H-index of 56. Over the past 25 years, NIMHANS became one of the well-recognized centres for service, training, and research in Movement Disorders in India.
After returning from Canada, I realized the need for development of the Movement Disorders specialty (in the lines of already established ones like stroke, epilepsy) and training facilities in India. There was limited opportunity, apart from being expensive, for our neurology residents to get fellowship in Movement Disorders in centres outside India. During my involvement as Treasurer and later President of Indian Academy of Neurology (IAN), I revamped the Movement Disorders subsection of IAN. With few enthusiastic colleagues, we moved forward towards creation of a National Society for Movement Disorders. After lot of deliberations, the Movement Disorders Society of India (MDSI) was founded in 2014 with 20 founding members. I played an anchoring role as the Founding Secretary of MDSI for 4 years. Over years, this society grew exponentially (currently with more than 450 members) and was accepted as an Affiliate Society of the MDS-AOS. In 2018, a dedicated journal of the society was started: Annals of Movement Disorders, of which I was the Founding Editor-in-Chief for 6 years.
With my interest in Rare Movement Disorders (RMDs) and the long association with the RMD Study Group of MDS, in 2020, I started the Indian Rare Movement Disorders Consortium (which is currently a part of MDSI), which provided the Movement Disorders specialists, paediatricians, and geneticists to exchange ideas on a common platform and regular discussion of rare movement disorders on a virtual platform. Currently, I am focussing on early-onset Parkinson’s disease (EOPD), which is more common in India than in the West and may have different genetic underpinnings. We have created the National Parkinson Network (a subgroup of MDSI) with aim of studying the epidemiology, genetics, knowledge and attitude about PD, and availability of care for patients with PD. Currently, I am the President-Elect of MDSI and look forward to further contribution to MDSI.
Though India is a large country with a more than 1.4 billion population, there are only few neurologists and a handful of Movement Disorder specialists. Networking among movement specialists is crucial for the development of research strategies. With this in mind, we formed the Parkinson Research Association of India (PRAI). This networking platform helps young clinicians and researchers in India to conduct collaborative research in Movement Disorders. There are very few support groups for patients with PD. Over the past two decades, I have been working with the Parkinson’s Disease Society of Karnataka (most recently as President of this society) and organized several patient and caregiver programs in PD, public awareness, and advocacy.
In 2001, I became a member of the International Parkinson and Movement Disorder Society (MDS). Since then, I have actively contributed to the Society in various capacities. I served as member of the Education Committee of MDS-AOS (2013-2017) and Editorial Board of the Movement Disorders journal (2015-2017).
For four years, I was in the executive Committee of MDS-AOS, initially as Secretary-Elect (2017-2019) and then as Secretary (2019-2021). During this time, I had the opportunity to closely interact with the leaders in Movement Disorders in different AOS regions, and also understand the gaps and needs in the various countries of AOS with respect to service, training, and research in Movement Disorders. There was an urgent need to communicate with the neurological/Movement Disorders societies of many countries and promote and help the young members of MDS. I actively worked towards formation of new Affiliate Societies of MDS-AOS and organized online networking events. In addition, myself and my co-course Director Dr. Pattamon Panyakaew started, for the first time, MDS-AOS online video case discussions. These were every 2 months and involved presentations of interesting video cases from different countries. This program provides a platform for junior members of MDS to have interactive case discussions and is now regarded as one of the most viewed and popular regional educational programs of MDS-AOS.
My direct involvement with central MDS began in 2019 when I became a member of the Education Committee of MDS, and currently I am the Chair of this important committee. I enjoy working in this committee and am fortunate to provide leadership in several programs including Train the Trainer for allied health professionals, career development, and Center to Center, which have helped many members of the Society to enhance their skills in Movement Disorders. We have also started new initiatives, which include Train the Trainer Program for General Physicians, translation of selected educational materials to other languages (an initiative by the Web-Based Learning Committee), and most recently a Genetics Subcommittee to impart learning and training in genetics in movement disorders.
One of my main interests is secondary Movement Disorders, more specifically those associated with infections. In 2021, I started the Infection-Related Study Group of MDS, which I co-chair with Dr. Susanne Schneider. It is a very active group, with bimonthly video case discussions. I am also actively involved in the Rare Movement Disorders Study Group, Neurophysiology Study Group, Movement Disorders in Asia Study Group, Ataxia Study Group, Rating Scales Education and Training Program Committee, and Tic Disorders Task Force.
Finally, I believe that clinical skills for recognizing the phenomenology of movement disorders and various syndromes are still very important. At the same time, regular updates of our knowledge and skills is mandatory, not forgetting that sometimes patients are our great teachers. All effort should be made for follow-up of patients, meticulous clinical examination, video documentation, and creation of teaching database. Keeping up to date with recent developments in therapeutics and diagnostics of movement disorders, genetics and the emerging role of artificial intelligence is warranted. In the early career, careful selection of a mentor is required. Establishing a Movement Disorder speciality/program requires dedicated time, commitment, and leadership. You need to select your team comprising an appropriate blend of mentees, peers, junior and senior movement disorder specialists, basic scientists and allied health professionals, depending on which area or areas you want to establish — patient service, manpower development, and research. Regular group discussions, exchange of ideas, networking, recognition, complementing of achievements of others, and analysis of strength and weakness of team members are essential for building a successful and sustainable team. In resource-constrained countries like India, there will always be a shortage of funds for research. It is advisable to have small beginnings with resources in hand, rather than to wait for large research grants.