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 Elders Epilepsy & Seizures Featured Patient Stories Stroke & Cardiovascular Diseases

Devi – The Iron Lady

It was the harvest festival of South India, Pongal – the day of Thanksgiving to the Sun God – the beginning of the new Tamil month, Thai, and as the popular saying goes, “Thai brings in its wake, new hope and cheer”. The house had to be decorated with flowers and the pot of rice with all its special ingredients had to be allowed to boil over, symbolic of plenty, peace and prosperity. Families would gather to celebrate the joyous occasion together. The festivities would continue over 4 days – cattle pampered with special food, decked with bells, cowrie shells and flower garlands and rejoicing covered every aspect of agricultural life. Urbanisation had not taken away from marking this day of festivity every year, when man, beast, the sun and rain gods and the earth, all came together to celebrate the yield of man’s toil, in the form of nature’s harvest bounty. It was a celebration of life and all living things in an environment of harmony, peace and goodwill to all.


January 14th, 2015, 6 am on Pongal day and the 80 year old lady Mrs. Devi was already up, bathed and dressed in the exquisite new Kanchipuram sari gifted to her by her family for the festive occasion. The gift was also to mark a warm home-coming, after three months of grappling with the acute phase and serious sequelae of a cerebrovascular event she had miraculously conquered. The spirit of Pongal which signifies the unity of all living things on the face of the earth and the five elements, seemed to echo the principles of Yoga, acupuncture, Ayurvedic massage and other forms of traditional Medicine of the East, which follow the tenet that the body heals itself. Mrs. Devi had undergone these alternative therapies in the subacute and rehabilitation phase of the stroke.

Was Devi slowly reclaiming her original, premorbid personality, which many could have envied?  She had been active and on her toes from dawn to dusk, warm in her relationship with the members of her family and friends alike, a good wife, a loving mother, a doting grandmother and  a charming and gracious host. As a homemaker, home and hearth were always her priority, but it was the joy of giving of her best that made her unique! The grandchildren swore that only grandma could make such exotic ‘meen kozhumbu’ (fish curry). The daughters’- in – law sharpened their culinary skills, with Devi overseeing the making of the new recipe, or produced the most intricate rangoli designs on the floor in their courtyard, with her active participation, or just tucked the children in bed before going out for a function with their respective husbands, with the assurance that Devi was there to keep a watchful eye on them, even through their deep slumber.

Exploring the Condition

Mrs Devi, a known hypertensive on regular antihypertensive medication for 6 years, (Tab Telma 40 mg. 1-0-0 and Tab. Tazloc 20mg.-0-0-1), had  an episode of seizure followed by difficulty in speaking and  weakness of the right upper and lower limbs in mid October 2014, when she was admitted to a leading hospital in Chennai.

Frisium (Clobazam) and Dicorate (Divalproex Sodium) tablets were added to her drug regimen as anticonvulsant therapy. A diagnosis of left middle cerebral artery (MCA) infarct was made, confirmed by CT scan and routine stroke management initiated. All seemed well till 3rd November, when she developed acute breathlessness and emergency tracheostomy was performed, following which she was on ventilator support for a period of ten days. On inpatient treatment, she recovered, was able to talk normally, walk, and attend to her activities of daily living with partial support.

A second episode of seizure and loss of consciousness occurred, The repeat MR imaging revealed bilateral subarachnoid haemorrhage, with oedema and mass effect. There was a 50-60% block of the right internal carotid artery and a small berry aneurysm of the left middle cerebral artery. After a stormy period in ICU, she slipped into deep coma. The hospital indicated to the family that continued intensive care while required, did not guarantee a good prognosis.

At this point, she was transferred at the family’s initiative to Trimed-Neurokrish care in our partner hospital. At the time of take over, Devi was barely conscious, had the tracheostomy tube, feeding tube and catheter in place, was severely paralysed on the left side, with not even a flicker of muscle contraction and had excessive throat secretions and severe chest congestion.

The Diagnosis

The first stroke was an infarct, due to lack of blood supply to a well – defined vascular territory of the brain, the first indicator of a cerebrovascular deficit.  The second stroke was the result of a bleed from the berry aneurysm into the subarachnoid space. Was there a minor re-bleed resulting in the first respiratory distress event, or was it caused purely by aspiration, and secondary chest congestion and infection? Initially, the tracheostomy tube was blocked requiring constant attention and had to be replaced by a metal tube, and this was electively removed after a few months of stabilization of the patient’s condition by the ENT surgeon.

Saccular Cerebral Aneurysms, also known as Berry Aneurysms, are intracranial aneurysms with a rounded appearance and account for the majority of intracranial aneurysms. They are also the most common cause of non-traumatic Subarachnoid Haemorrhage (SAH). SAH  accounts for 3% of all strokes, and 50% are fatal

Sudlow and Warlow, 19971

Of those who survive, “All in all, only a small minority of all patients with SAH have a truly good outcome.”

Johnston 19982

Aneurysmal Subarachnoid Haemorrhage (aSAH): The prevalence of intracranial aneurysms from various parts of India varies from 0.75 to 10.3%, with higher numbers of cases being diagnosed due to increasing age of the population and improvements in imaging techniques. Surgical clipping of aneurysm is not much resorted to in India

Koshy 20103

Un-ruptured aneurysms are asymptomatic making it difficult to identify the patients with un-ruptured aneurysms and prevent subarachnoid haemorrhage

Shingare 20114

There is familial predisposition to SAH, with 5-20% having a positive family history. Hypertension, excessive alcohol consumption and smoking are the other risk factors. Though a very severe headache of sudden onset is the typical history, as in the case of  Devi, seizure may mark the onset, with loss of consciousness initially and in an obtunded state over several days. The risk of rebleeding gradually decrease between 1-6 months. MRA is a feasible tool for detecting aneurysms.

1 Sudlow CL, Warlow CP. Comparable studies of the incidence of stroke and its pathological types: results from an international collaboration. Stroke 1997; 28: 491–9.

Our Healing Approach

After the TriMed-Neurokrish comprehensive assessment, overseen by our neurologist and rehabilitation physician, supported by our chest and ENT physician, we optimised all Devi’s medication including broad spectrum antibiotics, bronchodilators and nebulisation, and the patient’s condition stabilized. We introduced moderate dose intravenous steroids to kick start brain function. We also started to deliver to her, on the bedside, an integrative therapy program. She was discharged after an ENT opinion was obtained on the tracheostomy status and the cardiologist opinion. She continued therapy at home.

The patient was readmitted 3 weeks later into the ICU with acute symptoms following a probable aspiration. Endotracheal secretion culture and sensitivity was positive for Klebsiella pneumoniae and Pseudomonas aeroginosa, and treated with the antibiotic of choice.  Suction of the lung secretions and chest physiotherapy was part of the intensive treatment of this second episode of acute respiratory distress. This was followed by stepping up the alternative therapies and the patient’s recovery has been on a remarkable upward curve.

Our Focus:

Devi had undergone Yoga, Ayurvedic massage, acupuncture, acupressure, reflexology and other forms of traditional Medicine of the East over the subacute and rehabilitation phase of the stroke. All these forms of what is globally termed Complementary and Alternative Medicine (CAM) sets its strong belief in the body healing itself, empowered by the energy centres in the body and the flow of this energy through specific channels. Any block in the energy flow causes ill health. Traditional knowledge-based interventions released these blocks, to pave the way to recovery. The TriMed-Neurokrish technique is to encourage the CAM procedures of the trained team, to complement the astute Allopathic diagnosis and management, cognitive therapies and counseling. It allows patient participation in his/her own healthcare, along with family members, who witness the palpable improvement in the patient’s health condition.

A little detail of the yoga breathing patterns and exercises that benefitted Devi and its rationale in yogic terms, will not be out of place in its elaboration here.

Yoga asanas involve movements (bending, stretching, rotating), that stimulate ‘injured’ parts of the body by increasing the blood supply, followed by phases of total relaxation, Savasana, between movement phases. In the case of Devi, our Naturopathy & Yoga doctor believed that the group of asanas that stretch and strengthen the thoracic cage muscles, to encourage full excursion of the chest wall in efficacious breathing would benefit her most as therapy and eliminate her acute respiratory episodes. Considering her age and health state, the therapist chose to put her on a simple but an intensive asana regimen which he stepped up in a graded manner. Padahasthasana involves a set of asanas with stretching and touching toes standing and in a seated position, with outstretched lower limbs. Thadasana is standing upright ‘like a mountain’, stretching backward and bending forward to touch toes on the same side. Trikonasana: standing and bending diagonally to touch toes on the opposite side; repeating stretches in the seated position – Paschimottanasanas – seated and bending forward to touch toes; also bending diagonally to touch toes on opposite feet, alternately. Rhythmic abdominal breathing accompanies these movements, with the  inhalation phase accompanying the stretch and exhalation phase, the bending.

Breath is the essence of Prana – the ‘life force’. Pranayama, alternative nostril breathing in Padmasana meditative seated posture, seeks to harness this prana. By focusing the mind totally on the rhythmic breathing, the body channels are opened, allowing energy to flow freely and connect with the life force. In modern scientific terms, the role of the autonomic nervous system in this breathing pattern has been recognized, with increase in sympathetic inputs. As a result, concentration and clarity of thought develops. Prana provides the strength, power and vitality required to carry out higher level activity. Attentive awareness of the breath can gently lead the aspirant to the art of meditation.

Chinmudra is hand gesture with opposition of the thumb and index finger bilaterally and the other fingers are outstretched and facing upwards. Chinmudra in yogic meditative posture enhances Ekagrhachittam – one-pointed concentration of the mind during meditation. When the finger touches the thumb a circuit is established, which allows the energy that would normally dissipate into the environment, to travel back into the body. When the fingers and hands are placed on the knees, in the meditative seated posture, the knees are sensitized, creating another pranic circuit that maintains and redirects prana within the body. As the palms face upwards in Chinmudra, the chest and heart area are opened up as well.

Why this thumb and index finger alignment in yoga gesture, towards deep concentration? It makes us look for a link with theories regarding the evolution and attributes of thumb opposition in the early homo sapien, employment of toys which encourage a pincer grip for toddlers in the Montessori system of child education, the Neuroscience concept in modern Medicine of the homunculus, where the cortical motor (and sensory) representation of the thumb is enormous, with the index finger next in line, the maximum use of the index finger for serious Braille reading.

“It is specifically the opposition between the thumb and index finger that has made it possible to execute the extremely refined movements that have produced the whole of human culture — from architecture to writing, from music to painting, and all the technology that enriches our lives.”

Looking Ahead

With the last admission for the aspiration pneumonia, Devi had left behind the roller coaster ride through various catastrophic health events. She was alert and poised to instruct her daughters-in-law on making the rice dish to perfection and all the other delicacies for lunch, when the whole family would feast together. Till the previous year, she had led the women of her household by nonchalantly tossing in hand-measured quantities of ingredients with the flourish of the seasoned cook that she was. This year she had to be content with gesturing the instructions with her hands, with the occasional word thrown in. She knew that the cashew-nut jar was on the topmost shelf, out of reach of the children, the jaggery in the jar could not be adequate and more had to be purchased from the corner store. All these minor details of the kitchen front, her culinary skills her motivation and leadership quality returned and she was to participate in yet another family Pongal festivity.

The family members felt that the level of recovery was well beyond all expectations and recollected their shocked state and hopelessness when they saw their dear one being wheeled into the hospital in an obtunded state for the second time in a month. The TriMed-Neurokrish team gave of their best, with total co-operation from the family. But it was the Iron Lady, the patient herself, with her ekagrhachittam or single –pointed intent, focus and willpower that saw her in this recovered state, with some residual visual deficit, a more subdued, rasping voice due to left laryngeal nerve palsy, mild gait disability, but with a mind to overcome even these residual problems or accept the  discomfort they posed, with cheer, to lead from the front once again, as was her nature.

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