'Roshan - Keep smiling !' - Dystonia : Surgeon plays guitar undergoing skull surgery

‘Rohaan – keep smiling’ ~  Sushma Swaraj meets Pakistani infant who underwent surgery at Noida hospital.  A much appreciable feat .. .. .. Post surgery, Rohaan's father told the Indian Express, “The heart of my child beats today for Madam Sushma Swaraj”.  Rohaan and his parents were granted visas to travel to India after his father, Kamal Siddiqui, tweeted out to Swaraj and Sartaj Aziz, foreign affairs advisor to Pakistan Prime Minister Nawaz Sharif. He complained that his child was ‘suffering’ due to the delay in medical treatment over tensions between the two countries.  Sushma always active, took measures for grant of medical visa, the child and parents landed in India and Rohaan was successfully treated at a Noida hospital.

Miles away, moments before his surgery, an elderly man in Savona refused to be operated on when he discovered the anesthetist on shift was a woman. The 70-year-old was to undergo surgery at the San Paolo hospital in Liguria last week to repair an inguinal hernia. Medical staff had performed the required pre-surgery x-rays, blood tests and electrocardiograms, but as he was being prepped in the operating room the patient suddenly refused to let surgery to his groin area proceed unless the anesthesia was administered by a man.  

There have always been research on the power of mind ~ you might have  heard the occasional story where a person defies the ordinary and uses his or her mind to overcome what we think of as physical limitations.  The mind can block physical (and emotional) pain.  It can give someone “super-human strength”.  It can regulate core body processes like temperature control.  Long back on a New Year Eve, in World this Week special saw a man undergoing surgery without being under the influence of anesthesia ~ he was able to grin and bear the pain, even as the surgeon’s knives made the cuts !!

அரிது அரிது, மானிடராய் பிறத்தல் அரிது; மானிடராய் பிறந்த காலையின்                              கூன் குருடு செவிடு நீங்கி பிறத்தல் அரிது

~ the immortal words of Tamil Poetess Avvaiyar.  It means it is difficult (rare) to be born as a human being; having been born – it is rare to be a birth devoid of physical challenges like dumb, deaf, blind …. the significance is that one should use appropriately such good birth and do good to the Society.  One can easily add that is rarer still to live a healthy life, not visiting hospital or getting admitted into hospital for treatment.  Well, do most of us realize and feel happy in leading an ordinary life ?  - the moment of truth strikes for those who unfortunately have to undergo pain and suffering in seeing the treatment of self or near and dear.

Dystonia is a neurological movement disorder. It is caused by the brain sending incorrect information to the muscles and is characterised by involuntary, prolonged muscle contractions, which cause affected parts of the body to be twisted into abnormal postures. It can affect a range of parts of the body including the neck, eyes, voice and hand. Dystonia has a variety of causes – but dystonias affecting the hand are often caused by performing repeated hand movements. They can affect any profession which requires repeated movements but are more common among musicians than any other professional group. Hand dystonia affecting musicians is often called musician’s dystonia or musician’s cramp.

Men are more commonly affected by musician’s dystonia than women with estimates of the ratio ranging from 2:1 to 6:1.  Almost all media has reported the story of a  37-year-old musician who played guitar while a nerve disorder in his brain was stimulated at a private hospital in Bengaluru recently.  "We conducted a live brain circuit surgery on Abhishek Prasad to stimulate his left hand fingers even as he strummed his guitar in the operation theatre on July 11," Bhagawan Mahaveer Jain Hospital neurosurgeon Sharan Srinivasan told reporters.

Post-operation, a beaming Prasad, who hails from Bihar, but settled in the  tech hub Bangalore, displayed proficiency by playing guitar at ease nine days after his skull was drilled and operated upon to set right the disorder in his four fingers. Touted to be the first such brain circuit surgery in the country, the delicate operation involved passing an electrode 8-9cm through a 14mm hole into the brain and stimulating a specific nerve to confirm the right location and prevent any side-effect or complications to other circuits.

"After reconfirming the target location, a radio frequency lesion was made using a RF ablation machine. As the surgery was on, Prasad was conscious and played guitar, as the disorder used to manifest when he tried to play the instrument. The live feedback was important for us to ascertain the exact location to be lesioned," noted Srinivasan. Ahead of the surgery, Prasad underwent a MRI (magnetic resonance imagery) guided ablation, which enabled him to have relief from his symptoms on the operation table.

"It is a rare disorder that occurs to one per cent of professional musicians. Surgery is the only option to cure it when medicines can't do," asserted neurologist C.C. Sanjiv after Prasad removed stitches on his head and celebrated the occasion in the hospital.  Prasad is the eighth musician the world over and first in India to undergo such a complex surgery to cure the symptom called dystonia. Prasad's love for music and passion to play guitar made him quit a regular job five years ago in 2012 and trained to become a professional musician for a living.

"As fate would have it, the disorder in the nerve connected to the left hand fingers made the little finger stiff with no movement and the symptom spread to other three fingers," Prasad recalled. That really sounds exemplary !~  "By the sixth burn, my fingers opened up. I was normal on the operating table itself," Mr Prasad said after doctors removed the stitches on his head on Thursday, a week after his operation in the southern Indian city of Bangalore. The musician said he vividly remembered every detail of the procedure.

The details describe that Doctors made  a 14mm hole and inserted a specialised electrode into the skull and the "target areas were 8 to 9cms deep inside the brain" ~ and man on whom it was performed was  fully awake all through, and the result was available on the operating table because his fingers had started moving normally on the guitar !! 

What a medical miracle !!

With regards – S. Sampathkumar

23^rd July 2017.