“திடீர்னு எல்லாத்துலயும் Interest குறையுதா?😨” Depression கூட இந்த நோயின் அறிகுறியா? SHOCKING பேட்டி

Added: 2026-05-12

[00:00:00]depression.

[00:00:04]Okay. So, I'm not depressed.

[00:00:17][music] sense of smell anosmia and often people don't realize that these are symptoms of heart.

[00:00:38]Okay, that is a change that you should be observed.

[00:00:42]Screaming in sleep, shouting in sleep [music] behavior disorder part and parcel of Parkinson. [music] It's a network disorder.

[00:01:04]Connections are disregulated. [music] regulation gets affected.

[00:01:09]Your brain has the capacity to learn. So capacity and the capacity to learn, relearn and readapt, we are going to use that.

[00:01:21]That's why even as prevention if you see Parkinson's disease symptoms and treatment the founder of welcome doctor when it comes to Parkinson why I asked this is because doctor where people are saying that I knew something was Very important question. So Parkinson tremor, stiffness, slowness, slowness symptoms, people go to the doctor. But many things can proceed. Research depression.

[00:02:19]Depression.

[00:02:24]Okay. And depression, lack of interest. Okay. So, I'm not depressed.

[00:02:42]So, lack of interest. So apathy, smelling coffee, not being able to smell, losing sense of smell, anosmia, base of the brain. And again, one of the oldest things, smallest mammal, say take a rat or a mouse.

[00:03:12]commonality smell gives us memory. Smell is connected with memory. So aspect losing the sense of smell aspect then memory itself can sometimes be affected. Executive functionarket so that they don't carry those things.

[00:03:49]Now this is planning and organization.

[00:03:51]So that capacity comes down. So we lose in Parkinson's and often people don't realize that these are symptoms of Parkinson.

[00:04:07]slow down. One very interesting type of slowing down that you can railway station right now.

[00:04:35]you're slowing down. Okay. So, people should be alert and aware about okay that is a change that you should be observing. So these are indications that movement but movement for somebody in a family problems. Some are very devastating like for example personality changes or compulsive behavior like gambling but people are not talking about it enough. So how do you bring this up with the parents and father he had some disturbances so screaming in sleep shouting in sleep behavior disorder part and parcel of Parkinson mental health problem treatments.

[00:06:03]What we have to understand is Parkinson.

[00:06:06]Yes. Dopamine that is true.

[00:06:12]What we increasingly it's a network disorder connections are disregulated regulation gets affected symptoms freezing for example especially chasing center of gravity that is forward butward impulse control disorders. Impulse control disorders Parkinson.

[00:06:54]So gambling is an impulse control disorder, right? It's an impulse control disorder.

[00:07:00]Impulse control disorders for example, right? that's uh an impulse control disorder, right? Or behaving inappropriately towards somebody, that's also an impulse control disorder. Or anger management issues issues, impulse control. So treat okay.

[00:07:34]So that is a challenge actually especially when we meet a patient who's already on treatment and complaints as you saying the person is usually an older person in the family has to be approached and sometimes we need to speak to the spouse alone to understand what is happening sometimes they will ask can I talk to the doctor alone you know they want to tell her sexuality can sometimes be a problem hypersexuality that is over demanding the need to have sex I've had patients whose spouses will complain why doctor symptoms of Parkinson's but they can also be affected treat soies major fear concerning memory problems.

[00:08:41]These are all real concerns. So how does the cognitive side of Parkinson's differ from Alzheimer's and family?

[00:08:54]It's just not a part of aging. When do they take that call? So usually and sometimes the problem 40s and 50s when it is presenting they are in the peak years of their career. So for example implications are many it goes beyond family also. So It is not enough that a doctor sees you.

[00:09:31]Neurodeenerative conditions, Parkinson, stroke, Alzheimer's disease. Multi-disciplinary assessment is what is important. In fact, this is something we insist upon in Buddhi clinic that a whole team will see you. The team is a physiootherapist, a psychologist, a doctor memory. For example, suppose I'm well presented memory problem.

[00:10:01]Okay. Now, somebody has to confirm whether I really had fourlies or not. I may be just bluffing. Okay. And not wantingly my brain teaches me how to do this.

[00:10:12]Parkinson disability.

[00:10:19]So that's where a multi-disiplinary assessment unified Parkinson's disease rating scale memory scores mood scores behavioral scores relevant and conditions it is not enough we talk to the patient we have to talk to the family to understand how they are seeing this person because patient may say I am fine I'm managing quite well family will tell you they will inform Holistic view of the patient it is required until now if a family has not seen a person have that kind of assessment few minutes prescri at some stage they should ask for it is it is like a master health check and just to see how is this person doing symptoms. These tests of memory, tests of movement, scoring systems they are very very important and it is all available. It can be done. You have to ask for it. So that it has to be looked for.

[00:11:33]Example, someone in the peak of their career or who is a very important figure in the family main bread winner prognostication.

[00:11:50]I'll give you an example of medicine.

[00:11:57]It stimulates the dopamine that's already inside you.

[00:12:03]type of medicine. It is a synthetic analog.

[00:12:11]What people tend to do first of all after some time they start overusing the medicine. Okay. Now the medicine gives you an effect maybe for 2 hours, 3 hours, 4 hours. So on the gap times I start overusing. Now that is not ideal >> in the medication that you're saying responsive medication. If there's something happening you should take this medication periodically suggested >> it is to be taken periodically as per doctor's prescription. Okay. It cannot be used like that. Ideally you should not use it to your liking. Now but what happens I'm an active person. Okay. I'll give you an example. One person with Parkinson's we look after is a chairman of a big company. Okay. So I need to use take an extra. Now what happens is after some medicine unnecessary movements called regulating the medicine very important modifying lifestyle very important. So now very often patid morning why don't you rest for 2 hours right you can become active again at 3:00 or 4:00 in the afternoon that people don't realize that I need to take a break so the taking breaks tendency that we wait for things to go bad and then only we get into rehab So in the particular field there are a lot of technologies like functional electrical stimulation through devices like excite system which basically retrain your muscles during everyday tasks and we have smart gloves like the gallento rehab revive which turn your hand exercises into games. So in the rehab start and what are the programs that are available? What does a good rehab program look like doctor?

[00:14:21]The conventional thinking rehabilitation is considered to be something you do when you are disabled. That is I need rehabilitation.

[00:14:33]Rehabilitation is something you should ideally be doing right from early on.

[00:14:38]Okay. Now I'll give you an example. I'm early Parkinson's doing quite well in this stage. Some physiootherapist guided activity and exercises are more than enough for me. Right? But is not wise. Having some guidance and doing some guided activity periodically every day say twice a week it is very important but as the problem advances definitely you are going to lose for example fine motor function. So for example, right or I'm not able to pull up my trousers or the fingers are not going correctly into the chapel. So I'm finding it difficult to wear my chapel.

[00:15:23]I'm finding it hard to shave. I'm women start finding it difficult to wear a sari. Right? All this means your hand coordination and function is becoming weak. You will definitely be benefited by good rehabilitation. Good rehabilitation is not just many people think rehabilitation in the rocky you carry a rock you pull something very heavy and run. No rehabilitation today is precision rehabilitation in the robotic technologies what we call functional electrical stimulation using devices like RT300 bike like excite like the Galanto glove these are all functional electrical stimulation devices not only do they aid your rehabilitation including fine motor not just gross motor see gross motor is my picking up some say that uh waste that is there that is gross Cross motor fine motor is putting on a button. Fine motor writing most people find their writing changes with Parkinson right my checks are now being refused by the bank that is a very good indication of Parkinson.

[00:16:31]So you need fine motor and technology apart from being an exercise technology gives you feedback and aids. So robotic technology advantage it has that capacity to not only aid what you are doing make you do it better make it fun and give you feedback and this is extremely important uh we can take advantage of this in rehabilitation because it really helps people be better. The other thing is I was telling you about this being a network problem.

[00:17:03]So being a network problem network it is actually not just a slowing down of the network. there are some hyperconnection of the network with some parts of the brain as well. Freezing for example is all is part of that. So brain stimulation is also a technology that is very very useful for these patients. Previously brain stimulation was you know the there are two types of brain stimulation. Invasive brain stimulation, deep brain stimulation is what everybody is familiar Parkinson's the neurosurgeon does an operation and implants a stimulator inside the brain.

[00:17:40]Then you have a method of adjusting it from the outside and so on. This is a a procedure that's helped a lot of people.

[00:17:47]But with technology improving, the non-invasive type what's called transranial magnetic stimulation has slowly become more and more relevant in Parkinson's. And one of the reasons we understand now how it helps is because it is working on the network uh the social cognitive action network. It is working on that network itself and that is why it is so effective. Now the new research is telling us this and of course we have other technologies like TDCS transcranial direct stimulation less well studied but very very useful and now emerging technology is vagus nerve stimulation that also seems to be helpful so I'm sure you'll get a lot more information about all this from Vive but as a clinician I see a lot of prospect for technology being used in rehabilitation so freezing where people when they're walking they get glued and collapse electrical stimulation but because the brain signal gets stuck.

[00:18:51]Do you think this aids them in walking?

[00:18:53]>> So the most important concept that's why we say treatment should start early is neuroplasticity. Okay. Your brain has the capacity to learn. So capacity and the capacity to learn, relearn and readdapt. We are going to use that.

[00:19:11]That's why even as prevention if you see if you do the same thing every day you walk the same pathway you walk the in the same way you are not helping yourself. Okay. If you do different trails more difficult ones where a lot of climbing up and down is involved or navigating through obstacles is involved it's better for your brain. So and the plasticity unlock technology becomes very very crucial and helpful and your even if you're so we have patients we are able to get them off the wheelchair and make them work. It's not magic. It is basically one is of course stimulating their brain and stimulating their nervous system to work better.

[00:19:53]Okay. and using the power of technology but the other also is using this whole concept of neuroplasticity brain capacity to learn when we do that they find other ways of doing things and especially when it comes to everyday hand functions learning it becomes very very important to be able to use neuroplasticity to bring about after a stroke for example weaker say I'm a right-handed person my right side is weak okay my left hand can learn okay what I could not do well with the left hand before because my right hand that is uh one very as important aspect of rehab that we need to unlock non-invasive brain stimulation methods TMS TDCS vag nerve stimulation so some target movement some motion some pain and some even digestion problems so for families that are looking for alternates for Parkinson's treatment beyond medication and surgery and in India today what are the biggest what are the best options that they have doctor what what should they choose and some are experimental also >> so the first thing to also keep in mind and it is very much there anient medical systems the understanding which is the body is one interconnected system right Parkinson constipation there is a part of your nervous system called autonomic nervous system that is the part of the nervous system that controls all your organs. So I'll give you an example.

[00:21:36]Sitting outside and talking.

[00:21:39]We came in, we sat down, we talking actions after breakfast.

[00:21:50]Somewhere your body tells you you're hungry, eat, we are not controlling, right? We may feel it's too hot or too cold, but we can't control it. So either the part of the nervous system that controls your internal organs autonomic nervous system either it gets affected in Parkinson's disease and physical symptoms. So one of the symptoms that people have uh in Parkinson's panic attacks for a few years before Parkinson start nothing but this system being overactive autonomic arousal constipation same system not working well is what is causing constipation. So the system excitatory and inhibitory and the balance is what is getting disturbed. So how is the system controlled?

[00:22:40]One of the most important parts is the Vegas nerve. Vegas nerve.

[00:22:47]The only one that leaves the brain and comes out in the nerve.

[00:23:02]Previously the last few years the technology has come where many of these symptoms start to get better. So gut health will improve.

[00:23:20]Unnecessary cardiac symptoms like palpitations will come down. Sweating that's a very classic symptom. So influence okay so one way of thinking is that every type of intervention we do it is using a different access point into the brain right so I was at a conference in Mumbai where we were discing discussing and debating with a professor who is created a technique called neurological music therapy thought from Canada.

[00:24:08]Every time on the glass door he freezes.

[00:24:10]So just by in the background showing a rhythmic sound it makes him walk. No instruction to the person just a rhythmic sound helps the person go through the door. So music therapy uses these principles like entertainment. So access points music can be an access point. Mirror therapy where we train you know paralyzed we use a mirror inside a box and move the good hand but it looks like the bad hand moving. So access points.

[00:24:50]Dr. I'm so glad we're having these conversations because every session I'm gaining more knowledge. So thank you for sharing all this information with us doctor.

[00:24:57]>> My pleasure. Thank you. Parkinson's disease Mr. Vive Mishra senior consultant neuromodation welcome.

[00:25:08]>> Tell us about this super network you know because a lot of studies recently have been talking about it and they also found out that uh Parkinson's isn't about one brain uh chemical gone wrong it's a brain network called scan. Can can you explain this in detail to us?

[00:25:24]See uh though yes the recently in the nature journal which is one of the premier journal the uh the paper got published but see the theoretical understanding coming from a very long period of time that our brain is just not like a multiple drawers it's all interconnected so when we look for Parkinson's disease the scan network which is the sumato cognitive action network that our information being processed in in a brain not just from the one particular area it is a cumulative effect. So for example, am I walking straight? Now that comes from the multiple uh brain networks that yes, my balance is good. I'm able to walk.

[00:26:09]Then my another brain network process that information that which direction I am going, where I have to stop. So it's all part of a system rather than just one block. So usually when we Google and research about Parkinson's and we say you know substantia one place which is dark substance substantial there is a degeneration it's not producing the dopamine and then it's causing the tremor but that's not the case because if that is the case we see different types of Parkinson for example some people don't have tremors they just have rigidity stiffness in their body some have tremor and then they can't walk they feel like they have glued to to the ground they're unable to take the step. So the networks which some networks are stronger they are built they are communicating they are building stronger networks they are overdominating and that is what this network is about that some parts of the network are stronger some are weaker and this miscommunication between the network produces the symptoms like what we are seeing in the Parkinson's disease >> Dr. Now the same study has also revealed something you know phenomenal like for example all the techniques for treating Parkinson's like whether it's medication or uh brain stimulation technique or magnetic stimulation all of these work by first calming down this one particular set of overactive network. So what they're also saying is that in the magnetic uh stimulation when targeted at this particular network it the people they get they improve everything twice as fast uh you know there's one talk as well can you tell us more about that >> exactly when we are targeting the different networks so we have to see that how we are targeting the different networks there are what we say is the minimally invasive as we discussed us about the deep brain stimulation. Yes, it is targeting the networks very precise electrodes you know just goes to that particular area but it have its own surgical uh advantages and the disadvantages so advantages yes it's penetrating deeper really on the target disadvantage not everyone is suitable for the DBS I have we know that there are many people who have cognitive impairment now those people are not a right candidate for DBS so then what you will do so the techniques like uh TMS we and able to stimulate the motor cortex which is essentially the movement in our body. Some people have freezing of gate.

[00:28:46]We can target area which is called supplementary motor cortex. So it is different. So now if we are targeting the supplementary motor cortex it have a very clear indication for the freezing of gate. Ultimately in these networks precisely choosing for each patient is the key. So when we are talking about the networks and we are trying to modulate the network what we are doing it is the 3P it is personalized it is precise and most probably it is more powerful because it is chosen for that particular patient not just like all Parkinson's patient are going to get that no and it have to be mapped so are we are using uh machine like you know learning like from EG we are looking for their physical gate symptoms in fact when we use that do Do I need the supplementary motor cortex stimulation or the motor cortex? So we use this AI based gate analysis shoe and you know one of the good part is it is also a make in India for global consumption. So this is a startup from Tjawar uh incubator and we like you know the when the founder came to me and say you know why not and over the period of time we are able to see 12 different gate parameters while just 3 minute of walking. So we exactly know what this person is lagging. Is it slowness? Is it stiffness or it is the freezing of gate?

[00:30:10]So it gives us that many parameter. Now based on that we plan our precise uh tools like be it TMS in some of the condition we are using TDCS which is a transcranial direct current stimulation very mild electrical stimulus given to the relevant brain areas. So that is the advantage of using the network model rather than you have PD this is your treatment. Well that's not it won't work for all the patients.

[00:30:37]>> So recently there's been a lot of buzz about uh this clip on your system that stimulates your vagus nerve right. Can you tell us more about that? Is it a real possibility in today's scenario?

[00:30:46]>> Interesting fact about that during the course of Parkinson's. So if I say that an average age is 55 and so on roughly 70 to 80% of the people get what is called disonomia which is our autonomic function in the brain like you know we uh never think about sweating heart rate palpitation all those thing we never think but it happens automatically that is a autonomic nervous system now roughly 70 to 80% of the people with Parkinson's have these symptoms over their course of life. Okay. If we do comprehensive autonomic testing, some studies report up to 90% of the people have it. Now what are these symptoms?

[00:31:28]What usually people feel? Constipation, giddiness and uh what we say the hypertension which is also called as orthostatic hypertension pots syndrome.

[00:31:39]Now you see the 70 and 80% people are having the ANS dysfunction. How we are going to treat it? Now we know that the vagus nerve is the messenger nerve control these symptoms while stimulating the vagus nerve from the left ear. So we don't put it on right because right controls the heart side of the vagus nerve. So we have to control put a very small headphone like clip on the left ear and we can able to stimulate a branch of vagus nerve called orurricular branch of vagus nerve. So if I have to give very simple answer, there is a flow of information and you are putting a pump in the middle and it relays the signal better and faster. So that relaying the signal improves these functions of autonomic uh system in our body giving the quality of life better.

[00:32:24]See nobody with a constipation, urinary incontinence or even when we are looking for the hypotension so they get up and they just fall the BP drops, the pulse drop. So that while standardizing it it have a very positive impact. In fact there are uh new clinical trials which also suggests that can we in a longer term how we can optimize the parameters.

[00:32:48]So there is a very active research in VNS in terms of the Parkinson's. So yeah it it is good.

[00:32:54]>> So uh one of the researchers from the study has some said something really bold. What he's saying is that basically in the particular network scan target you will be able to slow down the progress of Parkinson's and in many cases even reverse its effects. This is a huge statement right. So do you think this is true and what do you think is the future?

[00:33:17]>> When we look at the research we have to look that how they are making the claims for. So theoretical understanding is yes that we are able to modify the networks and we are making them efficient and better but the fact all remains that it is a progressive neurodeenerative disorder. Unless we stop or control the degeneration, we are not able to make any progress or reverse the progress.

[00:33:43]Now we it's very you know uh we understand that it is we are not able to reverse but what is there is to stop the further deterioration by making our brain networks efficient. We are bringing efficiency to stop the deterioration. So what really happens?

[00:33:59]So you know we have lots of examples in our uh clinic that we do an intensive phase of treatment and which last for about 5 to 6 weeks and then what I tell them is right now you are doing very good you know on the UPDRS scores they improve like you know up to 50% in this 5 weeks which is they are more functional they are able to walk more smoothly the tremors are under control but that's not going to last forever so then what happens is every 2 months or 6 to 8 weeks I said you don't have to do that treatment again come get stimulated ated the TMS and the therapy for 3 days in a week. So what really happens is our brain re get that feedback. Oh, you know this is how I have to fire. Now it is like relearning. Then you know you learn something. The brain get the signal it again you stimulate after 2 months. So again it get the signal that okay this is how I have to keep on firing. Well that is the best case scenario as of today. There are other modalities right?

[00:34:52]uh like you know people uh come and ask about the other forms of brain stimulation like the MRG first many people you know they just Google and come but there the candidacy is what matters am I a right person to do the first and second once you have done it and if it backfires there is nothing what you can do because it's just like a lesion or a hole in a brain now do I want to change it well you can't change it DBS we can moni like you know change the parameters Here we have ability there is a wash out period of the non-invasive brain stimulation and we can always optimize it. So first looking at the non-invasive methods and then moving on to the other methods make total sense. We have seen people whose like you know the MRG f which is the focus ultrasound have gone like terrible within 1 and a half years the symptom all came back and even worsen it now they can't do any more things because there is already a lesion. So what defines the candidacy and that's where precise targeting using the non-invasive methods like TMS helps we are able to pick up the target stimulate it there are new targets like cerebulum which is like called a smaller brain so not on the top but on the behind targeting there brings the smoothness controlling our fine motor actions so you see how those network works you stimulate the brain networks which are responsible for fine motor and then use the technologies like the fest which is the functional electrical stimulation and the galanto rehab which even control our smaller joints. So it's not just the bigger joint controlling this it is smaller joints. So when you are able to stimulate we can able to train a person to hold a pen. So what really happens is there are electro plays and now you are doing it. Now you are when you are doing you are training and the reverse feedback goes from the hand to the brain and previously we have stimulated the brain network from brain to the hand.

[00:36:50]>> It makes those networks stronger >> leading to a better outcome.

[00:36:54]>> Thank you so much for sharing all this information with us. It was uh truly very insightful. Thank you.

[00:37:00]>> Thanks.