BOSTON—Dr. Nagagopal Venna, MD, last year was appointed as the Chief of the Division of Neuro-Immunology and Neuro-Infectious Diseases in the Department of Neurology at Boston’s prestigious Massachusetts General Hospital, known as MGH.
This newly created division at MGH underscores the recent advances and discoveries in the field of wide range of brain and spinal cord and nerve diseases caused by one’s own dys-regulated immune system (Autoimmune disorders). Many unusual neurological illnesses, whose causes were previously of unknown, are now being recognized as due to autoimmunity. Moreover, these conditions are treatable and with early recognition and immunological treatments, neurological functions can be restored.
In an interview with INDIA New England News, Dr. Venna talks about his role, his interest in neurology and recent breakthroughs and challenges. (The text has been edited for clarity.)
INDIA New England News: What is your primary role and responsibilities as the head of this this newly-created division at MGH?
Nagagopal Venna: The major focus for me as chief of this division is to diagnose and treat patients with these unusual disorders and create Center of Excellence for the optimal care of patients affected by these serious autoimmune and infection related neurological conditions.
An important part of my role is to create and foster a team of expert physicians and researchers including neurologists, rheumatologists and infectious diseases specialists to provide comprehensive and long-term and safe care and rehabilitation for the patients.
Another critical focus is to foster research into the basic science of the disorders by developing clinical research into the long term outcome of treated patients. I and my faculty are developing Autoimmune Neurology outreach programs for the community of patients and families for education and raising awareness and also fund raising to support research and patient services.
INE: How did you get interested in neurology?
NV: My fascination with neurology stems from my Medical School days in Guntur Medical College in AP, India. There I was blessed with teachers who were giants of clinical medicine and laid foundations of Medicine. However, at that time confronting patients with illness affecting the brain and spinal cord was filled with dread and uncertainty for the physicians, not to mention medical students like me.
It was then I decided to eventually specialize in this complex field of Medicine. Interestingly, it is the widespread fear of Neurology (neurophobia) among doctors that drove me to this field. I began training in Neurology at the Neurological Unit of Boston City Hospital and Boston University Medical School , known as the “Cradle of American Neurology.”
The outbreak of AIDS in early 1980s with many patients inundating Boston City Hospital led me to specialize in the numerous and new neurological complications of HIV infections. This work and interest have continued at MGH with the creation of Neuro-Infectious Diseases Clinic at MGH in 1998 and active to the present.
INE: What is new in the field of autoimmune neurology today?
NV: Several diseases affecting the nervous system have long been recognized as due to injury caused by body’s own immune system attacking specific populations of nerve cells or their networks.
A classic example is myasthenia gravis causing fatigable weakness of the muscles, typically starting with weakness of eyelid and eye movements but can spread to cause severe weakness of head and neck and limbs and event to respiratory failure in severe cases. It is found to be caused by antibodies that circulate in the blood and attack the key receptors at the muscle-nerve junctions.
Immunological treatment (e.g., corticosteroids such as prednisone) curtail the production of these harmful auto-antibodies and is effective in relieving the weakness. Another long-known disorders in this category are the variety of afflictions of brain, spinal cord and peripheral nerves, often in combination curiously mediated at a distance from the cancer by autoimmunity triggered by underlying cancers , the para-neoplastic neurological conditions.
Over the past 15 years or so, a whole range of diseases of the brain, spinal cord and nerves and muscles of unknown causes and seemed untreatable are being found to be related autoimmunity directed at the nerve tissues and found to be reversible by appropriate treatments, ushering another major chapter in the Autoimmune Neurology.
A striking example of this is condition occurring in young women with sudden onset of bizarre behavior and psychosis, confusion , memory disturbance, and progressing rapidly to seizures, involuntary movements and respiratory failure and unstable blood pressure and even death if not recognized and treated. Only recently was this found to be mediated by auto-antibodies against certain nerve cell membrane receptors called NMDA receptors and that most of these patients have benign tumor of the ovary called teratoma.
A host of other neurological conditions are increasingly recognized with similar mechanisms including some previously thought to be variants of multiple sclerosis (MS) and responding to specific immunological treatments, an example of which is NMO-neuromyelitis optica. This field is rapidly expanding specialty in Neurology and is indeed the inspiration for creating of this Division at MGH
INE: How has MGH enriched your personal and professional life?
NV: MGH has been an institution of inspiration and strong support across many aspects of my professional life. This flagship hospital for Harvard Medical School is a bastion for over 250 years of the best of Medicine in the USA.
It has great depth and breadth of specialists in almost all areas of medicine, affiliated with Harvard University and Harvard Medical School, who are eager to share their experience and wisdom freely and with enthusiasm to advance patient care excellence and provide strong and deep resources for research to advance the science of medicine.
MGH attracts some of the best young physicians to train in Neurology and later in advanced Neurology Fellowship.
The resources and encouragement of MGH and Harvard Medical School have allowed me over the past 20 years to reach out to physicians across the world through distant learning forums, CME courses, and visiting Professor roles and via publications in journals and books. This is a major source of my professional satisfaction.
My position at MGH allowed me to have many students from high schools and colleges as well as visiting physicians from other countries to work with me providing me opportunities to teach and inspire them to future careers in Neurology.
INE: What are main causes of neurological diseases and what we can do to help us protect from them?
NV: Burden of neurological illness in the community and globally is indeed heavy.
Stroke affecting the brain is a leading cause of death and disability worldwide. Over the past 25 years major advances have been made is early treatment of stroke that are increasingly successful in minimizing the disabling consequences of mental and physical function.
Much needs to be done yet in promoting recovery of function in the long term after stroke. Early detection and long term treatment of stroke risk factors is proven to protect from devastation of stroke. These are treatment of high blood pressure, control of high blood lipids such as LDL cholesterol , use of low dose aspirin in selected cases, prevention and treatment of diabetes, avoiding and ceasing tobacco smoking in all its forms, detection and use of anticoagulation in case of atrial fibrillation of the heart and regular moderate physical exercise are potent ways to guard against stroke.
Epilepsy is another major neurological illness encompassing a wide variety of causes of seizure disorders spanning infancy to old age and across the globe. Significant advances have been made in understanding genetic and autoimmune basis for some subsets of epilepsy. Immunosuppression is beginning to find a fundamental and potentially curative role in this subgroup of patients with epilepsy.
Effective control of seizures with medications, brain surgery in selected patients and new biomedical devices that control medication-resistant seizures are making major difference for the quality of life of patients and families. Early recognition and treatment minimizes the disabilities from epilepsy. When medications are not enough surgical treatment options should be sought in specialized centers without waiting too long.
Alzheimer disease and related dementias that rob persons of their most precious mind abilities are a large and looming public health issue in USA and Europe and increasingly acknowledged in India and worldwide as life spans are extended. There is definitely need for breakthroughs in the fundamental causes of these dementing illnesses and crying need for effective treatments to prevent and treat them. Encouragingly there is enormous research effort on this front and likely to generate treatments in the next decade.
Physical exercise, mental engagement, treating vascular risk factors for stroke and looking for associated treatable causes of cognitive difficulties such B12 vitamin and thyroid deficiency are helpful.
INE: What about Parkinson and similar disease?
NV: Parkinson disease is common and seemingly increasing in incidence. At present there are no proven preventive treatment or measures. Current medications definitely provide good quality of life for the first 8 to 10 years. Brain surgery with deep brain stimulation (a kind of brain pacemaker) improves life quality in many patients who stop responding to medications and large experience in refining these procedures has accumulated over the past 3 to 4 decades and worth considering this as the disease progresses.
Multiple sclerosis (MS) is prevalent in New England; though rare in India, but it still affects some of Indian roots. Effective treatments are steadily being discovered and employed in mitigating the ravages of this group of brain and spinal cord disorders. Currently available treatments are increasingly shown to prevent expected progression to severe disabilities.
Neuropathies of wide variety caused by diabetes is common in daily medical experience and advances in the treatment of diabetes has been decreasing but nor eliminating this often painful ailment.
Meningitis, encephalitis and neuritis caused by infections including Lyme disease in New England, are other neurological conditions we encounter commonly in neurology practice. Vaccinations for shingles and pneumococcal vaccine have proven preventive effect as well
INE: Is HIV still dangerous?
NV: HIV related neurological disorders are wide ranging and are still prevalent in the USA and across the world and especially sub-Saharan Africa. HIV does affect the brain and spinal cord and nerves in many different ways and in the different stages of the disease but the deadly neurological complications have become rare thanks to the dramatic advances in treatment of the infection.
Early detection by universal testing for HIV is the best way to treat and prevent the many complications of AIDS including life-threatening brain infections.
INE: Who are some of the people who have inspired you?
NV: My wife Usharani has been the bedrock of support for me over many decades of work in the academic Medicine and has been source of sustained support and inspiration with her frequent refrain of “maanava seva is madhava seva”
I and my medical school mates were blessed to be taught fundamentals of medicine by stalwart physician- professors at Guntur Medical College in India.
My Guru is Dr Thomas Sabin, a doyen of Neurology in the US, from whom I learned all the key aspects of neurology and who gave me the tools of knowledge and reasoning and sense of love of the field to go forth into the wider world.