మన మెదడు ఆరోగ్యం: డాక్టర్ మానస్ పాణిగ్రాహితో || Our Brain Health: Dr. Manas Panigrahi ||

[00:00:00]Namaste friends neurosurgeon one of India's foremost and eminent neurosurgeons Dr. Manusrai Kim neuro a person who doesn't need any introduction so Dr. General [clears throat] neurological disorders.

[00:00:27]Brain first let us begin with common neurological disorders.

[00:00:51]But before we focus on brain neurological disorders commonly elderly people memory disturbances is common and followed by brain stroke and brain stroke brain tumors the third common in adults but in age children brain tumors is more common than stroke or memory problems.

[00:01:21]So let us begin with memory.

[00:01:40]for memory improvement from childhood practice.

[00:01:46]Children who studied Sanskrit, repeatation of words, they had a better memory retention power than people who did not read Sanskrit because in Sanskrit you repeat the same thing 50 times, 100 times. So that improves the neurons in the part of the brain. It's called hypocampus which is responsible for memory. Mhm.

[00:02:09]>> So uh uh that is why it it's if you want to have a good memory, you should start teaching children Sanskrit from childhood.

[00:02:35]So is it a lifestyle problem or really a medical problem? Medical problem. It's a lifestyle problem. Uh earlier like uh if you have to go from one place to other we used to remember the road.

[00:02:51]>> Exactly. And so the brain was had some exercise. So the brain development was good. Memory circuits were developed.

[00:03:01]>> But now if you want to go somewhere we use GPS.

[00:03:04]>> Exactly.

[00:03:05]>> GPS the brain if there is no activity it's like brain gets rusted. Cycle cycle if you don't cycle rest.

[00:03:13]>> Exactly.

[00:03:14]>> So same thing because we are dependent everything on phone for any earlier for reading for class law. So if you give homework the child had to read the book, memorize and write the answer.

[00:03:26]>> Yeah.

[00:03:27]>> So that improved the brain circuits but now they don't have to read book what is the question answer.

[00:03:37]So the brain exercise is not there.

[00:03:41]Hence they develop early memory problems. Then [clears throat] if what happened in 1950s and60s for it is true I really don't know [clears throat] is it true see for daytoday life you need only 10% of the brain to be active but if you want to excel in something the rest of the 90% of the brain brain has to be activated by doing different task. If you want memory, you have to do memory task. If you want to play, you do that task more. If you want to be a painter like the in the painter, the right side of the brain is more active.

[00:04:29]So if you want to be orator, the left side of the brain will be more active.

[00:04:33]So the 90% of the brain which is does is not required for daily life. But you can channelize by and activate more that part by doing uh specific task multiple times. It's like going to gym.

[00:04:48]>> If you go to gym, you can develop six packs. If you don't go, you cannot develop that.

[00:04:52]>> Which means you have to as you use the brain, it's ability your capacity increases practice for sure. Yeah.

[00:05:00]So brain stroke brain.

[00:05:16]What is brain stroke? How is it different from heart stroke?

[00:05:23]Brain stroke anything related to brain people brain stroke.

[00:05:28]uh but heart stroke blood supply heart stroke people will accept that like heart attack but in brain two types of stroke like heart suddenly blood flow then some part of the brain doesn't function it's called brain stroke but even some part of the brain if you have a tumor and suddenly it uh it has a bleeding in it and because of the tumor they can become suddenly only unconscious and again recover or they can have fits like uh so so brain stroke uh that also is is taken as brain stroke by the public.

[00:06:09]>> So brain stroke can be two types one because of less of blood flow.

[00:06:13]>> Mhm. [clears throat] And one because of tumors uh or it can be because of tumors with bleed also blood blood clot formation.

[00:06:30][clears throat] Brain stroke uh has to be uh if it's due to the blood vessel it has to be prevented >> uh like uh uh heart stroke prevention exercise lifestyle change your life food habits change uh so less of oil more of vegetables and do exercises same things will help in reducing the brain stroke which is due to blood flow changes.

[00:06:59]>> Mhm. But brain stroke which is due to tumor they are not related to the lifestyle and so it is more related to uh uh to other diseases because there are no specific reasons for brain tumors. We'll come back to the brain tumor doctor brain stroke any brain for that matter tumor brain health family members there may be some brain related problems I think human body it will present at a very early stage in a different form asytomatic symptomatic if the family cholesterol some families run family they have high cholesterol level.

[00:07:55]>> Mhm. And uh so they are more prone for brain stroke. And people who do not take care of their healthy food habit but they oil and pickle and uh acquire non-weit then they have more prone for brain stroke. And there is another disease of the blood vessel of the brain. It's called aneurysm.

[00:08:18]>> Aneurysm cholesterol blood.

[00:08:23]Then that part of the blood vessel becomes weak.

[00:08:27]>> Mhm.

[00:08:27]>> Then [clears throat] it can suddenly burst when it when it's weak. So that is called aneurism. And that happens in 1 to 10 people in one lakh.

[00:08:38]>> And [clears throat] uh so that that is something which can be prevented if if patient can be diagnosed early. These aneurysms can be detected by doing uh early CT angio or MR angio and diagnostible brain related problem.

[00:09:13]Uh no uh we cannot suspect but if in a family if there is brain stroke like if aneurysm is there in the family then there are chances that in he or she can have so that is an aneurysm but if it's just like a stroke lesser blood flow that cannot be predicted with any specific disease but only with investigation brain stroke Brain tumor both are the same or the different brain stroke and brain tumor.

[00:09:47]>> Brain uh no no stroke is because of less of blood flow and also can be because of tumor also.

[00:09:56]People in a colloial term people take that as brain tumor.

[00:10:01]>> Brain tumor suddenly then they consider as a stroke >> but it's not stroke.

[00:10:07]>> But technically it is not a stroke. It is because of unconsciousness because of the brain tumor.

[00:10:14]Brain tumor headache dizziness memory loss.

[00:10:32]Are they related to something to brain or should we suspect? Actually everybody at the end of the head day because of uh work many people have headache. Well all headaches should not be taken as that they suffer from brain tumors. But if the headache if everybody if a person has daily headache but then if there's a change in the nature of the headache.

[00:10:56]>> Okay.

[00:10:56]>> If it becomes after suppose after suffering from one low grade headache after one month it becomes severe headache every day.

[00:11:04]>> Mhm. [clears throat] Or if the headache is has associated with vomiting. Mhm.

[00:11:08]>> Or at the time of headache if he sees his vision has some blurring then you think that that headache is not normal one has to do some investigation.

[00:11:19]>> Plus if somebody has headache every day when he gets up in the morning.

[00:11:23]>> Okay. Yeah.

[00:11:25]>> Early morning headache he gets up and when he gets up then the headache comes down. He gets up because of headache.

[00:11:31]>> Okay.

[00:11:31]>> Early morning.

[00:11:32]>> That regularly. regularly and uh and during that headache he has vomiting then one has to suspect there is headache I mean there is a suspect a brain tumor >> or if some develops memory disturbances at say 30 40 years people should not have memory disturbance exactly >> at 6 70 years 80 years is expected >> so if somebody has a memory disturbance at young age then one has to suspect something is Not all tumors are cancers and benign tumors cancer tumors.

[00:12:15]Yeah. Brain like 40 to 50% are cancers >> and the other 50% are non-cancer.

[00:12:23]>> Mhm. So brain cancer like other parts of the body brain cancer four types stage one grade one grade two grade three grade four is there [clears throat] so grade three and four is considered cancer one and two is not considered cancer they told low grade one is non-cancerous two is in between [clears throat] tumor is there any signal or is there any symptoms other than the headache they can have like uh ma >> okay >> multiple times unconscious >> unconscious huh >> say a child with musher yoga may not be because of brain tumor but somebody who is more than 18 years and develops unconsciousness more than one time then one has to think there is a brain tumor and do an investigation or if or if he develops weakness or cannot hold a pen cannot button unbutton shirt because of weakness in the finger fingers.

[00:13:23]>> Mhm.

[00:13:23]>> Uh then you should think there is something wrong with the brain or somebody u has a young person develops cannot one side hearing loss.

[00:13:36]>> Okay.

[00:13:37]>> Slowly hearing then normally phone they normally we tend to use the phone on the left side. But uh a person if he uses on the right side >> they don't notice that they're slowly developing hearing loss on the left >> they ignore that.

[00:13:53]>> So if there's one side vision problem one side hearing problem then or one side even smell sensation >> then one should think that there is uh brain related uh problem it possible can be tumor then they have to get a consultation.

[00:14:11]>> Mhm.

[00:14:13]Brain tumor tumor surgery without surgery just medication conservative treatment all brain tumors don't need surgery uh earlier before the era of MRI uh brain tumors was diagnosed only with the CT scan with the CT scan it was difficult to uh mean a grade of tumor prediction difficult don't but with MR different technique of MR you can predict it is possible grade one or grade two or grade three and grade four so if you predict from the MR that it's grade 1 and grade two and if tumor size is small like 2.5 cm and less then one can treat without surgery >> okay that's called gamma knife surgery >> where the patient comes in the morning and goes in the evening there's no need of hospital admission.

[00:15:18]>> Mhm. But if in the MRI it the MRA picture is like conclusion like it's like grade three and grade four then one has to confirm by surgery what it is what kind of tumor it is and then do further treatment even I heard 10,000 brain really unbelievable congratulations on this occasion even fetus Yeah.

[00:15:59]With [snorts] detection of like earlier ultrasound machines was not so accurate but 4D ultrasound. Mhm. [clears throat] We can do MR of the mother with the fetus also. Fetal M.

[00:16:17]Yes.

[00:16:19]If there is brain tumor can detect and then you can treat them early like after birth you treated children at 1 month 3 months.

[00:16:32]How wonderful.

[00:16:42]Yeah, that is actually that's the myth.

[00:16:44]People think that children brain is not developed and then if you operate then they will not develop. It will not they'll become mentally lifelong.

[00:16:53]>> Uhhuh.

[00:16:54]>> Are they correct? Kadu it's the opposite.

[00:16:56]>> Uhhuh.

[00:16:57]>> Children fetus brain is more plasticity is more.

[00:17:03]>> Mhm.

[00:17:03]>> So it is more moldable.

[00:17:05]>> Okay. Ah, >> so even if you remove tumor the other parts of the brain will take over the function.

[00:17:12]>> Oh good. Ah >> and that ability can is there till 10 years of age in the brain.

[00:17:17]>> Mhm.

[00:17:18]>> So anything which is operated less than 8 to 10 years they have a better result of surgery because the other parts of the brain will take over the function.

[00:17:28]>> Uhhuh. So if if you detect early and treat early then actually doing you're not doing harm but rather they're helpful for the better even if it is inevitable.

[00:17:52]>> Yeah. If he if scan if you detect a tumor in children then it is better to get operated early.

[00:17:59]>> Oh great.

[00:18:00]>> Otherwise the what happens that because of presence of tumor much start >> okay fits much then if it don't take out the tumor that much it becomes uncontrolled with medicine. Initially with one medicine Then future patient becomes 10 20 30 years. In addition to removing the tumor, we also have to remove some other other parts of the brain.

[00:18:35]>> Mhm.

[00:18:36]>> Which is become abnormal because of multiple fits.

[00:18:42]recovery rate. The brain surgery is low quality of life.

[00:18:49]Next, how long they should be on medication complications?

[00:18:58]Complication depends on the where is the tumor. Brain law uh there are some parts of the brain which is very important like uh motor cortex which controls the hand and leg movement.

[00:19:12]>> Uh on the left side here in front of the ear there is area called brokas area that is responsible for speaking.

[00:19:19]>> Mhm.

[00:19:20]>> Then chinamed is responsible for balance for walking. Mhm.

[00:19:25]>> So um if if the tumor is in an important part of the brain like this then after surgery they probably can have some complications or deficits.

[00:19:37]>> Mhm.

[00:19:38]>> But [clears throat] if it's but 90% of the brain is not so important and more brain tumor happens in that area. So the the common that myth that brain tumor surgery 90 95% it is safe 90% of the places in tumor problem.

[00:20:08]Yes.

[00:20:13]90% not worry 5 to 10% sleeper.

[00:20:36]Now if you don't uh sleep well brain uh like needs time for recovery >> Mhm.

[00:20:44]>> of the brain function. So usually 6 to 8 hours of sleep required for the brain to recover the energy for to work on the next day. So if they do not sleep for 6 to 10 8 hours then [clears throat] there will be lot of stress on the brain and the the normal brain circuits because brain works like any circuit in a phone.

[00:21:07]>> Mhm.

[00:21:07]>> And [clears throat] then the circuit fails.

[00:21:09]>> Uhhuh. And uh so uh children who do not sleep well and who do who kept on keep on using phones and all those uh so first of all they don't sleep and then they don't use the brain >> so the brain uh exercise is gone and the time for uh recovering also is gone.

[00:21:32]>> Mhm. That is why in the young generation people have more stress, more memory problem, uh more psychiatric and psych behavioral disturbances is increasing.

[00:21:53]function means optimum that 6 to 8 hours 6 to 8 hours 6 to 8 hours more sleep more hours of sleep >> no more hours of sleep somebody is sleeping it can be a disease >> okay yeah so if somebody then have to be investigated [laughter] because some hormones then [clears throat] like cortisol hormone growth hormone then they'll not sleep they'll sleep more or if there is tumors in the sleeping area of the brain >> like hypothalamus then they'll sleep more so if somebody's sleeping more it's not normal >> they have to consult >> they have to consult the doctor yes mobile concern mobile brain effect. Is it true?

[00:22:54]>> That's again a myth. Everybody uh thinks mobile phone causes brain tumor.

[00:23:00]>> Uh it mobile phone does not cause brain tumor.

[00:23:03]>> Mobile.

[00:23:05]>> Mhm. But mobile phone the the radiation of the mobile phone if you're using then that can cause like memory problem concentration problem [clears throat] >> uh but not brain tumors people there's no activity they go on passively watching which have no nothing to they not exposed to any cerebral activity analytical things. So passive exposure to social media reduces the brain's ability to perform.

[00:23:55]Is it true or no? That's correct. even uh people have published that uh they they studied a group of children who used AI >> and a group of children who did not use AI.

[00:24:09]>> Mhm.

[00:24:09]>> Uh so the children who used AI over a period of time their IQ came down.

[00:24:15]>> So [laughter] each technology has it own good problem sir >> because they because because of AI they never used their brain.

[00:24:25]>> Exactly.

[00:24:25]>> So over a period their IQ came down. So it is better to use NI like natural intelligence than [laughter] artificial intelligence. Yeah.

[00:24:37]medical.

[00:24:45]So even in diagnosis and treatment artificial robots doctor is different and using AI for treatment is different. [clears throat] uh AI if if a doctor every times ask AI putting symptoms what is the disease then whatever AI gives it may not be correct because AI will give what is fed >> information if the information is wrong the results also will be wrong >> but AI makes our life easier the doctor's life easier >> like any other profession's life easiest >> easier normally for if you have some rare symptom then earlier we had to go to library sit for hours to read and find where is it available the old >> but if you have AI immediately you can within 5 minutes you know the information anywhere in the world that kind of disease is is uh means treated or not. So in that way finding information and and transferring it to your patient becomes faster.

[00:25:59]>> But [clears throat] for normal routine diagnosis if you use AI probably you might sometimes get wrong diabetes.

[00:26:14]They almost crack diabetics.

[00:26:27]Yeah. Because of blood pressure and diabetes there lot of cholesterol gets deposited in the blood vessels.

[00:26:34]>> So the it also means this deposition can happen for any organ. It can happen to blood vessel of the kidney to the liver to the brain.

[00:26:48]Cholesterol heart that is uh because from the beginning we gave importance from time immorial to heart only >> we forgot that heart is controlled by the brain. [laughter] The earlier if you see like when I was a student 30 40 years ago >> everybody wanted to be a cardiac surgeon.

[00:27:14]>> Every hospital of bypass surgery means they are like gods in the hospital.

[00:27:19][laughter] >> But now it is slowly changed because now people have realized that brain is more important than heart. So if you look at all hospitals they concentrate on brain neuroscience department more than the cardiac science.

[00:27:35]Not just BP even diabetes is it diabetes same mechanism because in diabetes also blood flow to like kidney to liver to eyes it gets reduced. Similarly brain hypo and then that will cause like stroke that will cause memory problem that will cause uh seaars all those any particular demographic group elements urban rich brain related problems more avocash brain problems.

[00:28:38]>> Yeah, actually in Asian countries which involves India and Southeast Asian >> uh compared to the western population >> Mhm. the blood vessels uh are more prone for affecting being affected by blood diabetes and hypertension and cholesterol.

[00:28:57]>> Mhm.

[00:28:58]>> So in our country the incidence of like heart attack or brain attack, brain stroke is more than uh you look at US or Europe. M >> so our Asian group in which includes India if somebody is there I mean they are more prone our incidence of heart attacks are in 40 50 years but in those countries it is 10 years later >> and uh males are more affected than the female >> and people later >> huh uh brain and heart both means whatever affects the heart can affect the brain >> okay >> it's not specific for the brain >> and uh people who smoke And men are more affected than women.

[00:29:42]>> Mhm.

[00:29:48]Anything brain related problems, genetic factors.

[00:29:57]Uh yes, some like aneurysm where it's a disease of the blood vessel where the blood blood vessels become weak and suddenly rupture.

[00:30:07]>> Mhm. They can run in families genetically oriented.

[00:30:11]>> Few of the brain tumors also can be genetically oriented like neurop fibromyitosis and van ripple lindo disease.

[00:30:20]>> So those are can be genetically oriented.

[00:30:24]uh but brain stroke as such uh if also can be genetically oriented. If the there is a high cholesterol level runs in the family or hypertension runs in the family.

[00:30:37]>> Mhm.

[00:30:38]>> Diabetes runs in the family then they develop early diabetes and hypertension younger age and that indirectly causes earlier brain problems.

[00:30:49]families 80 90 years a good sign but they suffer lot of a lot of problems means as longevity has increased uh tremors >> only essential tremor, Parkinson disease, Alzheimer's has increased even brain cancer also is more common in elderly.

[00:31:28]>> Mhm.

[00:31:29]>> Uh but then there are uh you can uh reduce the effect of your Parkinson's and Alzheimer's by doing regular uh physical exercises.

[00:31:42]>> People when they become old they try to be confined at home.

[00:31:46]>> Yeah. Yeah.

[00:31:47]>> Yeah. And so if they when they become confined then the problems actually gets aggravated.

[00:31:54]>> Especially it happens for government employees.

[00:31:58]>> They'll be very active till they are working.

[00:32:01]>> Exactly.

[00:32:01]>> And after retirement in one two years suddenly they become >> uh because they don't they don't continue to work and they then they have memory problems and all those. So whereas people who are in business or in profession like like same thing between private doctors who are in government and private doesn't [laughter] so same thing all the government officials who when they retire uh they should continue to work somewhere or continue to do some physical exercises same amount of physical they should do some voluntary job or uh some charity job or they have to do some hobby >> or take care of the grandchildren something they have to do.

[00:32:51]>> Yes.

[00:32:52]Minds mind mind is like a devil's workshop technology every profession medical profession not diagnosis treatment surgery neurological disagree few technologies which has significantly changed uh the uh complications in brain tumor surgery.

[00:33:30]>> Uh one is uh navigation and this robotic guided navigation.

[00:33:35]>> Okay. And you robot roboted surgery.

[00:33:38]>> Yes. So uh suppose a tumor is in the central part of the brain [clears throat] >> then to reach that part when you go through a brain then that can cause some damage to the brain.

[00:33:49]>> Okay. Uh but when we use navigation uh we can decide uh which part of the brain is uh safe causes less of problem and when you plan that trajectory robo can help us in going through that tract perfectly >> the precision.

[00:34:09]Yes.

[00:34:10]>> So so the complications will come down and because of that precision our size of opening on the skull also has come down. Oh good peda surgery >> earlier peda opening chie we were doing but now we have surgeries which is done with a 2 mm hole with a 10 mm hole and 5 cm or 6 cm also.

[00:34:32]>> So uh because of the uh robotic technology and navigation technology >> has uh reduced the size of the surgery.

[00:34:42]>> Mhm. And [clears throat] earlier we when we operated we did not means finding the tumor no and the brain many times the tumor and the brain was looking similar.

[00:34:53]>> Okay.

[00:34:54]>> When you open >> and uh so it was difficult to identify >> because then for that we use ultrasound during the surgery.

[00:35:09]>> Mhm. uh to find out where is the tumor and many times we give a coloring agent also in the injection we give a coloring agent which will go and only color the tumor.

[00:35:21]>> Oh my part. Okay.

[00:35:23]>> So that there is a fluorescent microscope where it will show only the brain as a yellow color. The normal brain will not be sewn. Ah the uh the new technology robotic assisted micros microscope which we have uh acquired now >> so that uh identification of the tumor with colors uh is far better.

[00:35:47]>> Mhm. [clears throat] >> Uh so when we operate we can remove the only the tumor and the normal cells of the brain can be saved. So hence the the complications comes down significantly.

[00:36:01]>> Gene therapy, stem cell therapy, even brain health.

[00:36:13]Yeah. Uh gene therapy is still uh not very popular, not very successful, >> but targeted therapy and imunotherapy is already there.

[00:36:24]>> Mhm. uh uh earlier when chemotherapy means all of us know >> that when you give chemotherapy a lot of side effects >> and uh unfortunately most of the chemotherapy drugs when we give they don't enter the brain >> because of a there is a barrier bloodb brain barrier >> so it never used to work >> the [clears throat] there was not there not very few one or two drugs which will enter the brain >> whereas imunotherapy uh uh is and targeted therapy they enter the brain because they are smaller in size.

[00:37:00]>> The advantage with targeted therapy and imunotherapy is they will only go and destroy the the cancer cells.

[00:37:08]>> Mhm.

[00:37:09]>> Not the normal cell. But when you give chemotherapy it will also damage >> it'll destroy the normal cells also. So that's why side effect is less. So now side side effect can be reduced by using imunotherapy and targeted therapy [clears throat] uh wherever it is possible. [snorts] Same thing when we give radiation earlier used to give cobalt radiation.

[00:37:33]>> Mhm.

[00:37:34]>> That is to cause damage to the normal cells also.

[00:37:37]>> Mhm. But when you use gamma knife radiation or or use photon proton radiation that only causes means destruction of the tumor cells and the normal brain is not affected. So the complications with radiation and chemotherapy can be reduced by using the new technology.

[00:38:03]uh that is the reason if you look at the uh outcome of patients like 20 30 years ago and now there is a lot of hell and heaven difference what is life [clears throat] what is human resilience 80 some some thought process. How do you feel as a doctor who has seen the brains who has worked with brains?

[00:38:43]>> Unlike other parts of the body, brain behaves differently.

[00:38:47]>> If a skin is damaged, skin can be replaced.

[00:38:51]>> Exactly.

[00:38:52]>> Uh liver is damaged, liver regenerates.

[00:38:55]>> Transplant can be done and it regenerates also. Muscle damage, muscle regenerates. But brain if it's damaged it does not regenerate.

[00:39:03]>> Mhm.

[00:39:04]>> Nor a brain transplant is available.

[00:39:06][laughter] >> Exactly.

[00:39:07]>> So anything related to brain one has to be very patient. Save every normal cell and only only take out abnormal cell because it doesn't regenerate. So each cell of the or each part of the brain is important and the uh so one has to have patience uh the doctor has to have patience to save every part of brain and brain also takes lot of time to recover.

[00:39:36]>> So patience is needed uh from from relatives also and patient also. So uh it's not like a uh fast food center in brain. is not like heart bypass done then you're fine or appendicctomy done you are fine in your brain both the doctor and patient should be partners in having patience [laughter] 45 minutes despite so busy practice.

[00:40:25]So really grateful to you. Thank you doctor. Thanks. Thank