A Journey of Neurotrauma in India: Looking Back 27 Years

Introduction

Head injury is a great public health problem, with everincreasing vehicular traffic and modernization. In India, it has increased to an extent that more than 400 people die every day due to head injuries. In the 1980s and 1990s, world of neurosurgery was moving rapidly toward development of subspecialization of neurosurgery. Among them, neurotrauma was the most important one. In India, the Neurological Society of India (NSI) was the parent body of neuroscientists. In 1989, a significant change came in the field of neurosciences, as the World Federation of Neurosurgeon, the World Federation of Neurology, and the International Society of Pediatric Neurosurgery (ISPN) had their meeting in India, which provided rapid subspecialization in the 1990s. In the process of development of neurosciences in India, over the years, the Neurotrauma Society of India (NTSI) has played an important role in management of trauma patients.

Conceptualization

Ever though in many centers in India neurosurgeons were treating head injury, it was believed, by and large, that with a limited number of neurosurgeons (< 400) in the 1970s and 1980s, it was not possible that all head injuries get managed by neurosurgeons. Hence in a large number of hospitals, institutions, and medical colleges, neurotrauma was being managed by general surgeons. It is not difficult to understand why patients with head injury were neglected. In 1991, it was decided in the NSI that to propagate, encourage, and improve the management of head and spinal cord injury, a subcommittee of the NSI must be made so that we can do justice to a large number of patients in neurosurgery.

To my mind, neurotrauma cases constitute 25 to 30% of all admissions in a neurosurgery unit. However, it needs infrastructure, intensive care unit (ICU), and workforce. Hence in many medical colleges and hospitals, these patients got managed by the general surgeons in the past. The creation of neurotrauma subcommittee was a landmark in the history of NSI.

Neurotrauma subcommittee was headed by Prof. Sambasivam as chairman, and Prof. Ramani was the secretary with few other members, including Prof. Kalyan Raman, Prof. A. k. Banarji, Prof. Kak, Prof. Dinakar, Prof. Ramesh Chandra, Prof. Mohanty, Prof. B. S Das, and Prof. Mahapatra. It was also decided that the neurotrauma meeting will be held once a year in the month of August, for a period of 2½ days, including CME, symposium, free papers, and poster session. First meeting was held at Hyderabad in 1992. In 1993, the conference was at Madurai. In 1994, it was held at Mumbai; in 1995, it was at Cochin; in 1996, it was at Chandigarh; and in 1997, it was held at Banaras Hindu University (BHU), Varanasi. Over a period of 2 years, it got a tremendous response. The number of people attending the annual meeting increased from 30 to 40 in 1992 to 100 to 150 by 1996–1997, and 5 years had passed in the process of consolidation. In 1997, it was conceptualized that the NTSI must be formed, which has to be independent of the NSI with its constitution, rules, and regulations. In this process, Dr. A. D Sehagal with Prof. Sambasivan, Prof. Kalyantam, Prof. P. S. Ramani, Prof. A. K Banarji, Prof. Ramesh Chandra, Prof. Mohanty, Prof. Mahapatra, and Dr. V. S Madan formed the constitution for the NTSI.

Neurotrauma Society of India

The NTSI was formed in 1997, which was registered in Delhi. Dr. A. D. Sehgal became the president, Dr. Ramani was the secretary, and Dr. Rajria was the treasurer. There was a working constitution, which was not printed. In 1998, the conference was held at Indore, and Prof. Kak was the NSI president. It was felt that NTSI newsletter must be started twice a year and circulated to all members. Thus a newsletter was started from 1998. Prof. Mohanty was the secretary during 1999–2002. I (A. K. M.) took over as secretary of the NTSI in 2002. In 2002, at the NTSI meeting at Agra, it was decided that we must have a journal and that an editor post must be created. In the 2001 meeting at Coimbatore, it was decided to have a committee to draft constitution. It was headed by Prof. A. K. Mahapatra and supported by Dr. V. S. Maidan and Prof. Kak. The constitution had provision for the editor. Therefore, constitution was released in 2002 and Dr. Bhatoe was nominated as editor of the journal, which was named as Indian Journal of Neurotrauma (IJNT). Thus two regular issues of IJNT started from 2004.[1] [2]

NTSI Academic Activity and Awards

Besides the annual meeting, other activities included publication of guidelines, orations, and best paper awards. In this regard, I must confess that all credit must go to Prof. P. S. Ramani. In 1993, at a stage when there was of neurotrauma subcommittee and Prof. Ramani was secretary, he managed to get funds for (1) Shetti Rengachey Oration and (2) P. S Ramani Oration, and the oration started from 1994. He could also manage JB Modi Gold Medal for best platform presentation and also 1st, 2nd, and 3rd prizes for poster presentation. In 1997, Dr. A. D. Sehgal Oration Fund was created, and from 1998, Dr A. D. Sehgal Oration started. In 2007, the NTSI met at Gwalior, and there was a proposal for Dr. Raghubansi Prize and Prof. A. K. Banarji Oration. In principle, both were approved by executive committee and Prof. A. K. Banarji Oration started in 2008, so also Dr. Raghubansi Prize.

Neurotrauma Guideline

Another significant history is the publication of neurotrauma guideline in 1996. In 1996, the executive body decided at Chandigarh that a guideline must be printed and circulated. Prof. P. S. Ramani and Prof. A. K. Mahapatra were given the responsibility. In 1996, a book was published by a pharmaceutical company, named as Basic Guideline for Management of Brain and Spinal Cord Injury, edited by Prof. Raman and Prof. A. K. Mahapatra.[3] It was a book of 55 pages but was concise and to the point. Second guideline was prepared by Dr. G. K. Prusty in 2006–2007, which could not get printed. The Textbook of Head Injury, 47th edition, was published in 2014, edited by Prof. A. K. Mahapatra and Dr. Rajkamal.[4] The third traumatic brain injury (TBI) guidelines was prepared by Prof. Jogi, and a CD and a booklet were published in 2015. Thus repeated guidelines have been made time to time to facilitate and legalize the rational treatment in India, as per available skill and facilities.

Neurotrauma in Past 20 Years

In the past two decades, there has been tremendous improvement in the management of neurotrauma patients in India irrespective of private or government hospital. The hard work of pioneers such as Prof. Sambasivam, Prof. Ramani, Prof. Kalyan Raman, Prof. A. K. Banarji, Prof. Kak, Prof. Dinakar, Prof. Ramesh Chandra, Prof. B. S Das, Prof. Sureswar Mohanty, Prof. A. K. Mahapatra, and Colonel Dr. H. S. Bhatoe, for the past 20 years, has resulted in proper trauma guidelines, neurotrauma society, neurotrauma journal, and last but not the least the research in the field of head and spinal cord injuries. Lastly, in another 10 years, trauma, particularly TBI, is going to be the third leading cause of death, so we have to put a lot of importance on prevention aspect strictly and sincerely, so that huge loss of young productive life and economic loss at large can be prevented for a better and healthy India.[5]

Conclusion

Neurotrauma contributes significantly to the neurosurgery patient population. Over the past three decades, the management of patients has improved very significantly. However, much is needed to be done to reach the world level. We all have a tremendous role in improving care of neurotrauma patients in India.

• References

• 1 Raju S, Guptra DK, Mehta VS, Mahapatra AK. Predictive outcome in acute SDH in severe head injury. A prospective study. Indian J Neurotrauma 2004; 1: 34-44
• 2 Singh M, Mahapatra AK. Traumatic pseudoaneurysm of cavernous internal carotid artery following trans-nasal endoscopic decompression of optic nerve. Indian J Neurotrauma 2004; 1: 59-61
• 3 Ramani PS, Mahapatra AK. eds. Basic Manual for Management of Head and Spinal Cord Injury. 1996
• 4 Mahapatra AK, Kamal R. eds. Textbook of Head Injury. 47th ed.. New Delhi, India: CBS Publisher and Distributors; 2014
• 5 Mahapatra AK. Neuro surgery in last two decades. In: Dhawan BN, Seth PK. eds. Neuro Sciences in India Lucknow. India: Indian Academy of Neuro Science and CSIR, Publication, Maruti Scanner; 2009: 375-415