Sunil Pradhan

Last updated

Sunil Pradhan
Born (1957-06-25) 25 June 1957 (age 66)
OccupationIndian neurologist
Awards Padma Shri
Shanti Swarup Bhatnagar Prize
Dr. B. C. Roy Award
Uttar Pradesh Vigyan Ratna
Dr. H. B. Dingley Memorial Award
Shakuntala Amirchand Memorial Award
Rajib Goyal Award
Amrut Modi Unichem Award
Maj Gen. Amir Chand Award
Dr. S. T. Achar Award
Best Poster Paper Award
Best Paper Award
Vocational Excellence Prize
WebsiteOfficial web site

Sunil Pradhan (born 25 June 1957) is an Indian neurologist, medical researcher and writer, known for the invention of two electrophysiological techniques. He has also described five medical signs, of which one related to Duchenne muscular dystrophy is known as Pradhan Sign, [1] [2] and the others associated with facioscapulohumeral muscular dystrophy (FSHD) and similar neuro diseases. [3] The Government of India awarded him the Padma Shri, the fourth highest civilian award, in 2014 for his contributions to the field of neuroscience. [4]

Contents

Biography

Dr. Pradhan's extensive clinical research in the area of muscular dystrophy has led to the discovery of five new clinical signs, each indicative of a specific type of the disease. Sanjay Gandhi Post Graduate Institute of Medical Sciences circular. [1]

Pradhan was born in the hill station of Najibabad, Bijnaur District, in the Indian state of Uttar Pradesh, on 25 June 1957. [1] [5] He did schooling at many local schools in Jhansi, Aligarh, Banda, Allahabad and Lucknow [1] and, choosing medical profession, he graduated in medicine, MBBS, from the King George's Medical University, Lucknow, in 1979 and did his post graduate studies in Internal Medicine (MD) there, which he completed in 1983. He did further specialization in neurology and secured the degree of DM. [1]

Pradhan started his career at Jaslok Hospital, Mumbai and later, shifted to the National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore. After a further move to the Nizam's Institute of Medical Sciences, Hyderabad, in 1989, he joined the faculty of the Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, [1] [5] and worked there till 2007, in various capacities. The next move was to the Institute of Human Behaviour and Allied Sciences (IHBAS) as the Head of the Department of Neurology and works there now as the Medical Superintendent since 2008.

Pradhan brought about many changes at the IHBAS. He was instrumental in updating and elaborating the signage, displays and boards and constructing patient shelters. The electrophysiology Lab was started where he arranged for the setting up of modern equipment like 32 Channels Polysomnography, Nicolet 32 Channels digital Portable Electroencephalography and Electromyography.

Pradhan lives in Lucknow, along the Rae Bareilly Road, in Uttar Pradesh. [5]

Legacy

The legacy of Pradhan centres primarily around the five medical signs he has discovered, the two electrophysiological techniques he has invented and his research findings on the neuro diseases of Japanese Encephalitis, Hirayama type monomelic amyotrophy and epilepsy. [1]

Medical signs

Pradhan sign or Valley sign: The first of the signs he discovered is related to Duchenne muscular dystrophy (DMD). [6] He discovered that the DMD patients tend to suffer visible enlargement of the infraspinatus and deltoid muscles, which when contracted shows partial wastage. Pradhan clarified that this revealed a valley between the two mounts, visible behind the outstretched shoulders and called it valley sign. [7] The sign was evident in patients with little calf muscle enlargement and visibly positive in DMD cases with 90% sensitivity. The sign was later renamed as Pradhan Sign, on recommendation from the American Academy of Pediatrics. [1] [6]

Poly hill sign: Poly Hill Sign, [8] the second of the signs Pradhan discovered related to facioscapulohumeral muscular dystrophy(FSHD). [6] Pradhan noticed that the shoulder abduction of a patient with external rotation resulted in the formation of six bulges on the back of the shoulders and arms and named it poly hill due to the bulges. [1] He has also reported of an extra hill in one of the cases he attended to. [9]

Shank sign: The third sign, Shank Sign, [10] is related to myotonic dystrophy type 1 (DM-1). When patients suffering from the disease abduct their arms to 90 degrees, a tapering of the upper arm musculature is observed when examined from behind, due to wasting of the biceps, triceps and forearm muscles. This gives a visual resemblance of the shanks of an animal. This sign had an occurrence on 78% of the patients examined by Dr. Pradhan. [6] [10]

Calf-head sign: miyoshi myopathy patients, when they raise their arms with shoulders abducted and elbows flexed to 90 degrees, returned a visual similar to a calf head trophy, on magnetic resonance imaging. [11] The test returned positive on 10 of the 15 patients examined by Dr. Pradhan. [6] [11]

Diamond on quadriceps sign: The sign is related to dysferlinopathy. [6] A clinical study of 31 patients revealed that the patients with the disease developed a diamond shaped bulge on the upper half of the anterolateral aspect of thighs when they stand with knees slightly bent, thereby putting pressure on the quadriceps muscles. The bulge did not appear when the patients were sitting or standing. MRI images confirmed focal bulging out of muscles. [12] The occurrence is observed on 66% of the patients.

Electrophysiological techniques

Pradhan is credited with two new techniques related to electrophysiology. [1]

The first technique is related to the non-invasive study of intercostal nerves. [13] The technique is reported to have been included in a text book published from the US, calling it as Pradhan Method. [1] The technique advises surface stimulation of the intercostal skin while using specific sites of the rectus abdominis muscle for surface recording. This helps in early detection of the symptoms in patients with Guillain–Barré syndrome. It is also used in the diagnosis of diabetic thoraco abdominal neuropathy. [1]

The second technique involves stimulating the intercostal nerves to study the somatosensory evoked potentials, for localizing the non compressive spinal cord lesions. [14]

Pradhan was successful in elucidating the mechanisms of neurophysiological F‑response generation in healthy and diseased bodies and discovered a phenomenon, F-response multiplicity, a symptom of the lower motor neuron disorder. Pradhan asserted, by way of his findings, loss of early components and scattering of late components are responsible for the different F-response parameters in the lower neuron disorders. [1] He has also demonstrated standardized variables of contraction enhanced H‑reflex called R‑1 response and its utility in nerve root lesions where H-reflex is not electable. This was ratified by many researchers. [1]

Research on Japanese Encephalitis

Pradhan found out that the Japanese‑B encephalitis (JE) sometimes produced selective lesions on the substrata nigra and this observation has assisted in eliciting a clue in explaining the early onset of Parkinson's disease. [15] This was ratified by Japanese scientists with the help of an animal model of the disease using rats. [1] His findings led to a new clinical entity called Parainfectious conus myelitis, thus drawing an explanation for the unexplained urinary symptoms in young patients. He is credited with the discovery of the role of immunoglobins in acute disseminated encephalomyelitis, a finding confirmed by many other researchers. [1]

Research on Epilepsy

Pradhan has done extensive research on epilepsy. [16] His studies revealed that patients are likely to suffer from chronic epileptogenesis with poor seizure outcome if gliosis is present around their lesions. He averred that the patients with neurocysticercosis are prone to developing perilesional gliosis, may develop drug resistance during anti‑epileptic drug (AED) therapy and may suffer seizures if the drug is stopped. He has also explained tickling seizures [17] and micturition induced reflex epilepsy, [18] both reported to be first time findings. [1]

Research on Hirayama type Monomelic Amyotrophy

Pradhan has done research on Hirayama type monomelic amyotrophy, [19] a disease described by Dr. Hirayama in 1959. [20] In 1977, he published a report explaining the features of diagnostic magnetic resonance imaging. [1] The diagnosis of the disease remaining purely clinical, it is reported that his findings are the only objective diagnostic method. Dr. Hirayama, in 2003, published a paper confirming Dr. Pradhan's findings. [1]

Other studies

Pradhan is also credited with other findings such as:

Awards and recognitions

The Government of India, in 2014, honoured Dr. Sunil Pradhan, by awarding him the civilian honour of Padma Shri. [4] He has received many other awards such as:

Sunil pardhan_007


Pradhan has published several research papers in peer reviewed journals, both national and international in circulation. [28] A random selection of his articles features:

The National Center for Biotechnology Information of the United States National Library of Medicine has published the abstracts of over 750 papers published by Dr. Pradhan. [28] Nanojamians, a blog providing information on technological advancement in neuro sciences, has also listed many of his papers.

Controversy

It was around 12 noon on Monday when the judge came to the OPD and asked to be seen by me. As is the normal procedure, I requested that the case should first go to a resident doctor for preparation of a medical case sheet. But he insisted to be seen by me only. He carried no medical file with him. Also, no doctor had referred him to me. Anyway, I called him in. As I was busy seeing a patient, I could only offer a chair to the lady accompanying the judge. I did not have more chairs to offer to the judge. He, however, left, Dr. Pradhan said about the incident. [2]

On 9 October 2006, Dr. Pradhan received a court summons from the Lucknow bench of the Allahabad High Court, on charges of contempt of court for allegedly ignoring a sitting judge of Allahabad High Court, to present himself before the judge the next day. Dr. Pradhan appeared before the judge at his chamber, along with the Advocate General and the Additional Advocate General of Uttar Pradesh and was asked to tender a written apology, which included an assurance to not to repeat the mistake in future. He duly did so and was released without a sentence. Reports about the incident appeared in the media, and drew comments from the public and the law circles. The comments of the judge, however, was not reported. [2]

Later, acting on the news report, the Governor of Uttar Pradesh, T. V. Rajeswar, ordered an enquiry into the incident. The Principal Secretary to the Governor contacted Sanjay Gandhi Post Graduate Institute of Medical Sciences and asked for a report from the management of the institute. Dr. Pradhan's statement was recorded and a report was submitted to the Governor. The details about the action taken are not known. [29]

Related Research Articles

Kocher–Debré–Semelaigne syndrome(KDSS) is hypothyroidism in infancy or childhood characterised by lower extremity or generalized muscular hypertrophy (Herculean appearance), myxoedema, short stature, and cognitive impairment.

<span class="mw-page-title-main">Muscular dystrophy</span> Genetic disorder

Muscular dystrophies (MD) are a genetically and clinically heterogeneous group of rare neuromuscular diseases that cause progressive weakness and breakdown of skeletal muscles over time. The disorders differ as to which muscles are primarily affected, the degree of weakness, how fast they worsen, and when symptoms begin. Some types are also associated with problems in other organs.

<span class="mw-page-title-main">Limb–girdle muscular dystrophy</span> Medical condition

Limb–girdle muscular dystrophy (LGMD) is a genetically heterogeneous group of rare muscular dystrophies that share a set of clinical characteristics. It is characterised by progressive muscle wasting which affects predominantly hip and shoulder muscles. LGMD usually has an autosomal pattern of inheritance. It currently has no known cure or treatment.

<span class="mw-page-title-main">Guillaume Duchenne de Boulogne</span> French neurologist (1806–1875)

Guillaume-Benjamin-Amand Duchenne was a French neurologist who revived Galvani's research and greatly advanced the science of electrophysiology. The era of modern neurology developed from Duchenne's understanding of neural pathways and his diagnostic innovations including deep tissue biopsy, nerve conduction tests (NCS), and clinical photography. This extraordinary range of activities was achieved against the background of a troubled personal life and a generally indifferent medical and scientific establishment.

Muscular Dystrophy Association (MDA) is an American nonprofit organization dedicated to supporting people living with muscular dystrophy, ALS, and related neuromuscular diseases. Founded in 1950 by Paul Cohen, who lived with muscular dystrophy, MDA accelerates research, advances care, and works to empower families to live longer and more independent lives. Renowned for The MDA Labor Day Telethon, the annual telecast aired live from 1966 to 2010 and was hosted by Jerry Lewis, who also served as MDA's national chairman.

<span class="mw-page-title-main">Dystrophin</span> Rod-shaped cytoplasmic protein

Dystrophin is a rod-shaped cytoplasmic protein, and a vital part of a protein complex that connects the cytoskeleton of a muscle fiber to the surrounding extracellular matrix through the cell membrane. This complex is variously known as the costamere or the dystrophin-associated protein complex (DAPC). Many muscle proteins, such as α-dystrobrevin, syncoilin, synemin, sarcoglycan, dystroglycan, and sarcospan, colocalize with dystrophin at the costamere. It has a molecular weight of 427 kDa

<span class="mw-page-title-main">Duchenne muscular dystrophy</span> Type of muscular dystrophy

Duchenne muscular dystrophy (DMD) is a severe type of muscular dystrophy predominantly affecting boys. The onset of muscle weakness typically begins around age four, with rapid progression. Initially, muscle loss occurs in the thighs and pelvis, extending to the arms, which can lead to difficulties in standing up. By the age of 12, most individuals with Duchenne muscular dystrophy are unable to walk. Affected muscles may appear larger due to an increase in fat content, and scoliosis is common. Some individuals may experience intellectual disability, and females carrying a single copy of the mutated gene may show mild symptoms.

<span class="mw-page-title-main">Becker muscular dystrophy</span> Genetic muscle disorder

Becker muscular dystrophy (BMD) is an X-linked recessive inherited disorder characterized by slowly progressing muscle weakness of the legs and pelvis. It is a type of dystrophinopathy. The cause is mutations and deletions in any of the 79 exons encoding the large dystrophin protein, essential for maintaining the muscle fiber's cell membrane integrity. Becker muscular dystrophy is related to Duchenne muscular dystrophy in that both result from a mutation in the dystrophin gene, however the hallmark of Becker is milder in-frame deletions. and hence has a milder course, with patients maintaining ambulation till 50–60 years if detected early.

<span class="mw-page-title-main">Facioscapulohumeral muscular dystrophy</span> Medical condition

Facioscapulohumeral muscular dystrophy (FSHD) is a type of muscular dystrophy, a group of heritable diseases that cause degeneration of muscle and progressive weakness. Per the name, FSHD tends to sequentially weaken the muscles of the face, those that position the scapula, and those overlying the humerus bone of the upper arm. These areas can be spared, and muscles of other areas usually are affected, especially those of the chest, abdomen, spine, and shin. Almost any skeletal muscle can be affected in advanced disease. Abnormally positioned, termed 'winged', scapulas are common, as is the inability to lift the foot, known as foot drop. The two sides of the body are often affected unequally. Weakness typically manifests at ages 15 – 30 years. FSHD can also cause hearing loss and blood vessel abnormalities at the back of the eye.

Beevor's sign is medical sign in which the navel moves towards the head upon flexing the neck, indicating selective weakness of the lower abdominal muscles. Causes include spinal cord injury, amyotrophic lateral sclerosis (ALS), and facioscapulohumeral muscular dystrophy (FSHD).

<span class="mw-page-title-main">Progressive muscular atrophy</span> Medical condition

Progressive muscular atrophy (PMA), also called Duchenne–Aran disease and Duchenne–Aran muscular atrophy, is a disorder characterised by the degeneration of lower motor neurons, resulting in generalised, progressive loss of muscle function.

The dystrophin-associated protein complex, also known as the dystrophin-associated glycoprotein complex is a multiprotein complex that includes dystrophin and the dystrophin-associated proteins. It is one of the two protein complexes that make up the costamere in striated muscle cells. The other complex is the integrin-vinculin-talin complex.

<span class="mw-page-title-main">Winged scapula</span> Skeletal muscle condition around the shoulder blade

A winged scapula is a skeletal medical condition in which the shoulder blade protrudes from a person's back in an abnormal position.

Stamulumab (MYO-029) is an experimental myostatin inhibiting drug developed by Wyeth Pharmaceuticals for the treatment of muscular dystrophy (MD). Stamulumab was formulated and tested by Wyeth in Collegeville, Pennsylvania. Myostatin is a protein that inhibits the growth of muscle tissue, stamulumab is a recombinant human antibody designed to bind to and inhibit the activity of myostatin.

<span class="mw-page-title-main">Monomelic amyotrophy</span> Medical condition

Monomelic amyotrophy (MMA) is a rare motor neuron disease first described in 1959 in Japan. Its symptoms usually appear about two years after adolescent growth spurt and is significantly more common in males, with an average age of onset between 15 and 25 years. MMA is reported most frequently in Asia but has a global distribution. It is typically marked by insidious onset of muscle atrophy of an upper limb, which plateaus after two to five years from which it neither improves nor worsens. There is no pain or sensory loss associated with MMA. MMA is not believed to be hereditary.

<span class="mw-page-title-main">Muscle–eye–brain disease</span> Medical condition

Muscle–eye–brain (MEB) disease, also known as muscular dystrophy-dystroglycanopathy congenital with brain and eye anomalies A3 (MDDGA3), is a kind of rare congenital muscular dystrophy (CMD), largely characterized by hypotonia at birth. Patients have muscular dystrophy, central nervous system abnormalities and ocular abnormalities. The condition is degenerative.

<span class="mw-page-title-main">David Gardner-Medwin</span> British neurologist who worked in Newcastle upon Tyne

David Gardner-Medwin was a British physician who worked as a paediatric neurologist in Newcastle upon Tyne, serving as the only neurologist for children for a population of 3.5 million. He is credited with introducing multidisciplinary care to the management of boys with Duchenne muscular dystrophy (DMD). When he retired at the age of 60, four consultants were appointed to replace him.

Toshifumi (Toshi) Yokota is a medical scientist and professor of medical genetics at the University of Alberta, where he also holds the titles of the Friends of Garrett Cumming Research & Muscular Dystrophy Canada Endowed Research Chair and the Henri M. Toupin Chair in Neurological Science. He is best known for his pioneering research in antisense therapy for muscular dystrophy that led to the development of an FDA-approved drug viltolarsen. His research interests include precision medicine for muscular dystrophy and genetic diseases. He has co-edited three books published in the Methods in Molecular Biology series from Humana Press, Springer-Nature, and has published more than 100 refereed papers and patents. He is a fellow of the Canadian Academy of Health Sciences, a member of the editorial boards for the International Journal of Molecular Sciences, Genes, Frontiers in Genome Editing, Frontiers in Physiology, and Nucleic Acid Therapeutics, a member of the Medical and Scientific Advisory Committee of Muscular Dystrophy Canada, and a co-founder of the Canadian Neuromuscular Network (CAN-NMD).

Reachable workspace is an outcome measure used in medicine to track disease progression in neuromuscular disorders that affect the upper extremities. It is defined as the space, relative to the torso, that an individual can reach by moving their upper extremities. It has been used in patients with duchenne muscular dystrophy (DMD) and facioscapulohumeral muscular dystrophy (FSHD).

Elizabeth Quarrier Banker was a neurologist known for her work in pediatric neuropathology. In 1983, she became the first woman to win the Hower Award of the Child Neurology Society.

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