Adults Buddhi Stories Epilepsy & Seizures Featured Memory Problems Patient Stories

Joseph – His Unedited Life


Equipped with a Masters in Political Science, a supportive wife and 2 young children and a video-editing job in a reputed TV channel, which he carried out with a natural flair, Joseph had his stars to thank for a comfortable and fulfilling life. He had always been hardworking, an amiable companion at work, a good husband and a loving father. It was not just the sudden onset of seizures that disrupted his life flow, but the inability to work, the prominent cluster of neurobehavioural symptoms, the agitation, the paranoia, which mounted within a few weeks of the seizure onset. Back at work after recovery from the subacute phase, he could not perform. To make matters worse, the software of the editing platform had been updated with a newer version, during the period of his absence!

When Joseph presented to us over three years back with a cluster of seizure episodes, delirium and subsequent neurobehavioral symptoms, one needed to step back and view the sequence of events that led to this acute/subacute symptom complex that altered the course of his life so dramatically. The hospital which had received Joseph as an emergency had done well to manage the acute phase of the illness. The patient was diabetic and on oral medication with moderate control of blood sugar levels. Other laboratory parameters were within the normal range. The MRI showed bilateral hippocampal atrophy and the EEG recorded bilateral epileptiform dysfunction. A course of IV methylprednisolone brought about some control of the acute phase of the illness.

Exploring the Condition

However, Joseph continued to have seizures, poor recent memory, mood swings, irritability and aggression. He was unable to return to work both due to cognitive deficits which acted as impairment to his job performance and also due to poor social tolerance, to interact with team members. This came to the notice of the TV channel in which he was Senior Video Editor and the managerial staff of the channel took it upon themselves to support and take an active role in the neurorehabilitation  process of the patient. It was then that they stumbled upon Neurokrish – The Neuropsychiatry Center where they met Dr. Ennapadam S Krishnamoorthy. After a detailed interdisciplinary evaluation of his clinical profile, a discussion was held with the family and employer’s Chief Medical Officer on Joseph’s protracted cognitive and neurobehavioural sequelae and its impact – personal, familial and occupational. Concerned that their key employee should continue to work with them, the employer readily offered to support his care in all possible ways. The family too was committed to helping him get back on his feet.

Most importantly, the doctor was the purveyor of good news – that recovery from the ravages of a significant brain inflammation was possible, with medication, prolonged therapy and  psychosocial support. “Patience and gentle persuasion are the key” he said, in a convincing voice, persuading and encouraging patient, family and employers, through the long dreary days and months of targeted therapy.

Understanding Joseph

The enormity of the challenge of comprehensive neurorehabilitation for Joseph descended on us, fully, only when the clinical psychologist along with some other TriMed-Neurokrish team members, tried to unravel from basic literature, the complex demands on the video editor of a TV channel. With this background knowledge the cognitive retraining and cognitive behaviour therapy interventions could be individualized more effectively. A brief account of the video editor’s role would not be out of place here.

Video Editing

Although video editing may be considered a creative act, it requires working through a well-established, predictable set of steps. The first step is the importing and ingesting phase, followed by rough edits to the footage, dragging clips into the timeline, synchronizing the audio track and then fine-tuning the clips. Once the structure is set at this level, some additional post-production steps are required, namely, adding transitions between clips and various kinds of video filters, which change the visual quality of one or more clips to impact on the tone and texture of a piece. Titles are added and finally the color grading is done. In short, TV video editing calls for thematic conceptualization and sequencing in a timeline as executive function, with clarity of online working memory, pattern recognition and creative abilities, visual and auditory sensitivity, coupled with addressing the emotional element of a broadcast, team work and alert, timely delivery of the end product. This end product must capture the main features of the program, have a flow and continuity and appeal to the viewer expectations to create an overall impact!

Our Healing Approach

We came to the diagnosis that his symptoms were provoked by an underlying antibody syndrome – Autoimmune Limbic Encephalitis (LE). Detailed assessment for a possible malignancy was carried out, to rule out Paraneoplastic Limbic Encephalitis A second course of IV methyl prednisolone (the first having been given during admission in the acute phase), intensive cognitive rehabilitation and stress management was the doctor’s well considered management schedule, along with the other integrative therapies .Other medication included Levetiracetam for seizures, Donepezil for memory, Clobazam (for seizures and anxiety), Piracetam and Gingko Biloba (cognitive enhancers). He was under regular antidiabetic medication with his Diabetologist who also saw him through an unexplained acute skin reaction together with a dermatologist.

Cognitive Retraining (CRT) sessions were focused on improvement of sustained attention and memory enhancement. Tasks followed were the cancelling of digits for attention and verbal games, reading and visual memory games. He was able to recall from a small paragraph initially, to quarter of a page at mid therapy and half a page of details by the end of ten sessions of CRT.

Cognitive Behaviour Therapy (CBT) was given for his neurobehavioural symptoms. Family counseling, worksite review, and introduction of Joseph’s family members as his treatment monitors were other focused methods to enhance patient motivation and to see him progressively attain his premorbid state at home, in the community and at his workplace 

Our Ayurveda Consultant prescribed Shirodhara, the calming effect of which has been elaborated in the ancient texts. We have observed remarkable improvement in some of our patients with neurobehavioural problems who have undergone this procedure and we saw it succeed once again in Joseph.

Within a three month period of therapy, with the overall feeling of well being and improvement in his cognitive ability, that glimpse of hope of recovery sparked off definite positive trend in his attitude, with less agitation and irritation, a more focused goal to help himself and to take maximum advantage of the therapies and counseling offered to him by the TriMed-Neurokrish team. From this point the improvement in his condition was by leaps and bounds and there was no looking back.

Our Integrative Medical Therapy

  • Shirodhara is a classical and well-established procedure, as described in the ancient Ayurvedic treatises, of slowly and steadily dripping medicated oil or other liquids onto the forehead. Shira – head, is the ‘Seat of the Mind’ and Dhara signifies flow – a constant flow of the medicated, warm liquid – oil, milk,  buttermilk or coconut water onto the forehead of the subject, lying supine on the Ayurvedic massage table in the yogic Shavasana posture of complete relaxation of body and mind.
  • The liquid is gently poured, in a constant stream, ‘the size of the little finger’ from a height of 8-10cms from a special vessel, (protecting the eyes), onto the centre of the  forehead for a minimum duration of 30 minutes and a maximum of 60 minutes. The liquid is allowed to flow down the scalp and is collected from the table, warmed and reused during the procedure. Shirodhara may be repeated 2-3 times with an interval of 7, 14 or 21 days, depending on the severity of the disease/disorder.
  • The constant flow of fluid stimulating the Sthapani Marma (this ‘vital spot’ being one of the 37 vital spots of the head, the whole body consisting of 107 such spots) indirectly stimulates the pituitary gland, at which brain level (Sthapani), the liquid flow occurs. The Ayurvedic texts mention the master gland and other endocrine glands and their function and clearly outline the calming neurobehavioural benefits of the procedure. The centre of the forehead, which was evolution-wise related to the third eye, is also connected atavistically to the pineal gland. This spot is known as Agnya Chakra, one of the vital energy centres in the yogic tradition. Focusing on Agnya Chakra with closed eyes during meditation leads to psychosomatic harmony.
  • As the oil drips on the Agnya Chakra, the authors propose, that the meditation-like effect is a consequence of stillness of mind leading to adaptive response to the basal stress. Shirodhara is popularized today by the modern health spas as a sure way to ‘rejuvenation and stress relief’! However, the ancient texts lay emphasis on its role in neurological and psychological disorders, headache and insomnia, and mention other indications and contraindications.


  1. Vaghbatta. Shirodhara Ashtanga Hridaya, Sutra Sasthana, Chapter 22
  2. GS Lavekar, TV Menon,  Bharthi, A Practical Handbook of  Panchakarma Procedures (2009)  Central Council for Research in Ayurveda and Siddha, Dept. of AYUSH, Ministry of Health and Family Welfare GoI, New Delhi
  3. Ajanal Manjunath, Chougale Arun Action of Shirodhara– A Hypothetical Review J Res. Med. Plants & Indigen. Med. Sept. 2012 1;  9 : 457–463
  4. Kalpana D. Dhuri, Prashant V. Bodhe,  Ashok  B. Vaidya . Shirodhara: A Psycho-physiological Profile in Healthy Volunteers J Ayurveda Integr Med. 2013 Jan-Mar; 4(1): 40–44.

Our Neuropsychiatry Focus

Autoimmune Limbic Encephalitis is a rare disorder, characterised by the subacute onset of seizures, short-term memory loss, and psychiatric and behavioural symptoms. This type of limbic encephalitis is associated with Voltage-Gated Potassium Channel (VGKC) or N-methyl-D-aspartate receptor (NMDAR) antibodies.

  • The emphasis in the management of autoimmune LE is on its timely recognition, in order to rule out malignancy and to initiate treatment early. This potentially life-threatening disease responds well to immunomodulatory therapy.
  • The diagnosis of Paraneoplastic Limbic Encephalitis (PLE) is difficult because clinical markers are often absent and the LE symptoms usually precede the diagnosis of cancer or may mimic other complications. The clinical diagnosis of PLE requires :
    • a compatible clinical picture;
    • an interval of <4 years between the development of neurological symptoms and tumour diagnosis;
    • exclusion of other neuro-oncological complications.


  1. M.J. Thieben, ; Lennon, V.A.  Boeve B.F.  Aksamit A.J.,Keegan M,  Vernino S. Potentially reversible autoimmune limbic encephalitis with neuronal potassium  antibody Neurology April 2004;62:1177–1182
  2. Guetekin SH, Rosenfeld MR, Voltz R, Eichen J, Posner JB, Dalmau J Paraneoplastic limbic encephalitis: neurological symptoms, immunological findings and tumour association in 50 patients. Brain. 2000 Jul;123 ( Pt 7):1481-94

Looking Ahead

At work a change in the software platform used, resulted in Joseph’s problems being magnified. No longer could he work on the auto-pilot, with skills learnt over two decades suddenly becoming obsolete. Supported by the three legged stool, his family, his employer and our therapeutic team, all working in tandem, he has managed to overcome these many hurdles. Apart from therapy and rehabilitation, he has benefitted too from a second course of intravenous steroids. Titrating his drug prescription, avoiding drugs that have unacceptable side effects and responding to his changing situation have all been necessary.

Two years on, the transformation of Joseph is remarkable. He is seizure free, composed, communicates clearly and well, manages well at work having learnt to use the new software platform, and enjoys a close trusting relationship with his family. He still has some residual memory and cognitive dysfunction and attends our centre for periodic cognitive retraining sessions. This father of two, the sole breadwinner of a young family, has managed to retain his job, thanks to the therapeutic alliance between his family, employer and our treating team. Indeed, his employer’s corporate social responsibility in walking the distance with Joseph deserves special commendation. This editor’s life continues unedited, thanks to the science of modern medicine, the wisdom in our ancient medical systems and the goodness that continues to exist in our society.

Buddhi Stories Dementia Elders Featured Patient Stories

Bharadwaj – The Resurrection


Bharadwaj at 74 years was alert, active, enjoyed life as a whole and the company of his son, daughter, their spouses and their children. Born into an illustrious industrial house of Madras, he pursued his engineering studies abroad and came back to join, along with his 3 brothers, the industry founded by his father. In contrast to Jayaraman our other patient with dementia, here was Bharadwaj, with a huge extended family, all living close by, with him and his wife living with the son’s family, with a doting daughter and family next door. Socializing within this inner group, with true camaraderie and meeting over a meal on the multiple Indian festive occasions with exchange of gifts, and taking turns in singing south Indian classical music compositions solo or in groups was the traditional practice, a form of partial community living which could curb individuality, but did have its benefits for extended families that kept in close touch. There was  support through thick and thin from extended family, close family ties among large extended families being common till 3-4 decades ago. The advantages of such mutual support is slowly being eroded as families scatter and few of the younger generation, who migrate to greener pastures in the quest of employment and upward mobility, are left behind.

Exploring the Condition

Bharadwaj’s loss of cognitive ability was subtle and demonstrated itself as changes in mood and behavior. His family noticed several changes in him over time; he became progressively withdrawn socially, spoke very little, stopped watching TV or reading the newspaper. In stages, fatigued, depressed and lacking motivation, he confined himself to bed, and with less physical activity, he became a near recluse in the midst of the over-reaching social interaction around him. More worryingly, for the family, the gregarious family man became paranoid and prone to spells of aggression, a change that was both frightening and distressing. No amount of coaxing and cajoling from his son, daughter and other close family members could shake his resolve to slowly fade away. It is in this mood that he was brought to TriMed-Neurokrish, stubborn as a mule and refusing to co-operate for the comprehensive assessment and showing resistance to undergo therapy.

Bharadwaj was not diabetic or hypertensive. His lab reports were unremarkable. He had followed the middle path in his lifestyle, well-disciplined, with no excesses, and no smoking or drinking. He was, however, addicted to south Indian classical music, and would venture into complex pre-composed music, and sing along with his daughter in a state of joy and sheer abandon as the melody flowed in an unfettered cascade. Where had that music gone?

It was the gentle persuasion of the daughter and daughter-in-law on the one hand, and the professional prowess of the TriMed-Neurokrish team on the other, that saw the thawing of Bharadwaj‘s adamant early phase, and he entered the phase of acceptance of the assessment and integrated therapy, though rather grudgingly to start with. A diagnosis of Dementia, stage 2 was made, knocking threateningly at the doors of stage 3 if not intensively managed. His behavioural manifestations were those of apathy, irritability and aggression on the Neuropsychiatric Inventory (NPI).

Our Healing Approach

Bharadwaj was already on Admenta (memantine) and Cognix (piracetam) along with a mood elevator prescribed by a Neurology Consultant, who had seen him in early 2015. We added a small dose of an antipsychotic, Olanzapine. With strengthening of the lower limbs and gait training, Bharadwaj became less dependent as he walked with minimal support, and his low back pain, and body pain, which he had brought upon himself with poor physical activity, was under control. Abhyanga (Ayurvedic whole-body warm, herbal oil massage), Shirodhara (Ayurvedic therapy that involves gentle pouring of liquids over the forehead) and Acupressure ran parallel, as part of the intensive therapy. Reflexology was also introduced. It was a slow and tedious process that shook off the negative apathetic behaviour and veered Bharadwaj toward a more positive behaviour.


Reflexology is an ancient traditional massage form, involving particular areas of feet, hands and ears which are believed to represent specific human internal organs and body systems. These areas have been mapped elaborately especially to guide foot reflexology. The skilled massage can achieve positive changes in the function of these organs and systems and is also effective in neck, upper back, lower back, painful disorders of the spine, and knee pain. In the book “Relieving Pain At Home” authored by William H. Fitzgerald (1917), an ENT specialist, he observes “Humanity is awakening to the fact that sickness, in a large percentage of cases, is an error of body and mind”, echoing the modern concept of body-mind link in many chronic medical conditions. Reflexology as a discipline shares the common belief of the ancient therapies, in that of opening of any block in the energy channels of the body.

Our Focus

Cognitive retraining is a therapeutic strategy that seeks to improve or restore a specific person’s skills in the areas of paying attention, remembering, organizing, reasoning and understanding, problem-solving, decision making, and higher level cognitive abilities. The primary aim of this therapy is to train the patient to overcome the cognitive difficulties that interfere with day to day activity, towards gaining independence in activity.

Retraining usually begins with simpler cognitive skills like attention, short term memory and information processing and then proceeds to more complex skills like problem solving, and executive function. Each identified lost skill is retrained using graded practice of activities. Cognitive retraining involves repetitive practice that focuses on the skills of interest. Repetition is essential for the newly retrained skills to become automatic. Cognitive retraining requires a quiet room without distractions and the patient must be able to relax to receive optimum benefit from the retraining.


Alex Bahar-Fuchs A, Clare L, Wood  B Cognitive Training and Cognitive Rehabilitation for persons with mild to moderate dementia of the Alzheimer’s or vascular type: a review Alzheimers Res Ther. (2013) 5 (4): 35

Malhotra S,. Bhatia MS, Rajender G, Sharma V, Singh TB Current Update on Cognitive retraining in Neuropsychiatric disorders Review Article Delhi Psychiatry Journal (Oct. 2009) 12 ( 2 ): 213-218.

Looking Ahead

At the 6 month follow up, Bharadwaj is well overall, except for the occasional disturbances at night.

  • Aricep (donepezil) 10mg – 1-0-0
  • Admenta (memantine) 10mg – 0-0-2
  • Cognix Plus (piracetam + gingko biloba) 1-0-1
  • A to Z  1-0-0
  • Supracal A (calcium + D3) 1-0-0
  • Epitril 0.5 mg (clonazepam) was prescribed SOS at bedtime

He continues his therapies once a week. Bharadwaj walks with a little support within the house, is more independent in his self care, but needs help with soaping himself, and toweling after a bath. He socializes with immediate family members and language is more fluent and the content shows improvement. The lyrics of familiar songs are well recalled and musically expressed, as they go with the melody and the beat. Being able to sing puts him in a mood of elation. Perhaps most striking, he has islands of great clarity in thought and expression now. Recently, while watching a cricket match (another of his erstwhile passions) on the television, he regaled his family to their delight with comparisons, about the innings being played and another famous one from cricketing history. The family is pleased to see Bharadwaj enjoy some quality of life and never miss the once a week therapies.

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