Mumbai: Pamela Mehra had been diagnosed with autism at age three, and later also with epilepsy. She also showed signs of Obsessive Compulsive Disorder (OCD), aggression, and was virtually mute, communicating only through sign language. Ms. Mehra, who is now 42, comes from a family of doctors, and she has received extensive medical treatment from some of the top specialists in several countries including Germany, Australia and the USA.
Autism Spectrum Disorders typically appear before the age of three. They do not manifest in any way in the patient’s looks, and are not an indicator of mental development; Ms. Mehra, for instance, has an above-average IQ. The condition may also run in families: Pamela’s brother, for instance, lives with autism, but his condition is mild and he lives a normal life, practising as a neurologist.
Ms. Mehra, however, lives with a more severe form of the disorder, something that occurs in 30% of autism patients. Recently, her mother, Usha Mehra, a gynaecologist, decided to come back to Mumbai, the city she grew up in. She had been referred to Dr. Paresh Doshi, director of neurosurgery at Jaslok Hospital, by a number of specialists in the USA. Dr. Mehra says that Dr. Doshi is one among a handful of doctors who specialises in psychotic disorder surgeries across the world. “Her case is unique because she was suffering from both epilepsy and autism,” Dr. Doshi said.
A new procedure
On March 7, Dr. Doshi says, a deep brain surgery of nucleus accumbens has been performed on Ms. Mehra. “Nucleus accumbens is the area responsible for behavioural moods and phenomena of rewards. For example, when she gestures that she's hungry, she expects food in return. So, we wanted to improve that by stimulating it.” He said that electrodes were inserted in her brain during the surgery to stimulate the nucleus accumbens. The surgery took place after a number of consultations with specialists because of her complex condition.
Ms. Mehra has shown visible improvement after the surgery, Amit Desai, consulting psychiatrist at Jaslok, said. He recalled that when he first met Ms. Mehra, “She was sitting in Dr. Doshi's office and arranging the stationery on her table meticulously, a sign of OCD. But now, after the surgery, I met her to say hi. She said hi back. That's some great progress. She wasn't able to do that back then. Now when you offer her a handshake, she can return it.”
“Earlier, Pamela used to run to places with no aim,” her sister, Amita Mehra said. “But now she goes to places for a reason. Before the surgery, she did not communicate with us much, but now she willingly communicates with us.”
Ms. Mehra continues to display tremors, Dr. Doshi says, which are “caused by side-effects of anti-psychotic drugs that she had taken during her previous treatments.” He said that recovery would be progressive and the complete result of the surgery may not be seen immediately.
The surgery that Dr. Doshi performed is still a new procedure. “On Pubmed, a popular medical journal, I found only one research paper by a team of Korean doctors about nucleus accumbens,” he said. “That helped me during the treatment. After we write a paper about Pamela's case, it will give hope to many other autistic people across the world.” The cost of the surgery was around ₹12 lakh, he said.
Pamela Mehra and her family will return to the USA once her recovery has progressed.
