First in India and second in world, brain surgery for autism gives new lease of life to a US woman

USA-based Pamela Mehra was diagnosed with autism at the age of 3. She was doing well, but eventually started reducing her social interaction with others. After failing to get her treated in the US and Germany, the Mehra’s flew down to India. Jaslok Hospital doctors revived hope of life for Mehra’s with this successful surgery

First in India and second in world, brain surgery for autism gives new lease of life to a 42-year-old US woman
(Standing from left to right) Dr Paresh Doshi, Director, Department of Neurosurgery and Dr Amit Desai, Consulting Psychiatrist. (Seated from left to right) Anita Mehra, Pamela’s sister, Pamela Mehra and Usha Mehra, her mother

In a first-of-its-kind surgery in India and second in the world, a 42-year-old underwent a deep brain surgery of nucleus accumbens (NAc) for autism and obsessive compulsive behaviour was successfully performed at Jaslok Hospital and Research Centre of Mumbai.

USA-based Pamela Mehra was diagnosed with autism at the age of 3. She was doing well, but eventually started reducing her social interaction with others. Her communication with her family members would be only through hand signs and actions.

Her mother, Usha Mehra, said in 2015 she started suffering from obsessive compulsive behaviour and aggression, besides autism and epilepsy. This aggressive nature was mostly towards herself and her relatives.

“She was obsessed about organising the position of objects or people in her surroundings. She liked to stay alone in her own space and would not like anyone entering her room. We were really worried for her,” said the mother.

Deep Brain Surgery of Nucleus Accumbens is a neurosurgical procedure in which a doctor implants a medical device i.e. a neurostimulator or brain pacemaker which sends electrical impulses through implanted electrodes to specific targets in the brain for treatment of movement and neuropsychiatric disorders.

“I have performed many psychiatric disorders surgeries, but never imagined of doing a brain surgery on an autistic person. This was very challenging for us as Pamela also had epilepsy and we had to be careful to ensure a safe surgery. First such kind of surgery was performed in Republic of Korea around two years back. This is the first of a kind Deep Brain Surgery of Nucleus Accumbens (NAc) for autism in India,” said Dr Paresh Doshi, Director of Neurosurgery at Jaslok Hospital and Research Centre.

It is estimated that in the US, 1 in 68 children suffer from autism, which includes 1 in 42 boys and 1 in 189 girls. However, in India about 18 million people suffer from autism, of which around one third of people with autism remain non-verbal and one-third of people with autism have an intellectual disability.

Mumbai’s Lokmanya Tilak Municipal General Hospital at Sion receives 80 to 90 cases of autistic children each year.

Dr Amit Desai, Psychiatrist at Jaslok Hospital, said, “When I met Pamela for the first time, she was not looking into my eyes and was reluctant to communicate with me. But, when I met her after the surgery, she greeted me with a hello without being told or taught by anyone.”

Autism is a complex development disability that typically appears during the first three years of life and is the result of a neurological disorder that affects the normal functioning of the brain, impacting development in the areas of social interaction and communication skills.

Remembering some of the stressful days, Usha said, “In America, things are impersonal and you just dial a number and you get facility, but there is no human touch. They would come and just change her diaper, change her clothes, bathe her and then she would be left in bed with a helmet to avoid banging her head.”

Mehra’s family consulted many doctors before getting the treatment in India.

“We consulted many doctors from different hospitals in the USA where a surgical option was suggested, but were unable to offer. We found hope with a doctor in Germany who agreed to treat her, but due to some unexplained reasons, the German doctor denied the surgery. Then we were recommended to Dr Doshi,” she explained.”

Pamela’s post examination results stated that her disease was severe and refractory to medical treatment.

“We performed the surgery on March 7 to control her obsession, aggression and autism in that order. Extensive literature review narrowed down the target of surgery to nucleus accumbens,” said Doshi.

Post surgery, Mehra’s condition started improving as the severity of her obsessive behaviour came under control and she became less aggressive. Her family observed lots of positive changes in her.

Sharing one happy incident Mehra’s sister, Anita, said, “When the waiter in the hotel greeted her with a namaste, Pamela responded back by with a namaste. This was the first social interaction that I have noted in her since age 3. It was the happiest moment of our life.”

Her sister added that Pamela now looks at them and says that she is happy with a hand gesture and also asks for food when hungry.

“Earlier, she did not communicate much, but now she willingly communicates with us,” said her sister.

With this drastic change in Mehra’s life, her mother and sister are hoping for positive results in near future.

“She has started expressing herself now. We are pretty impressed with her progress. This is just the beginning, we just hope things will get better with each passing day,” said Usha. Pamela Mehra was discharged from the hospital on March 17. She will be flying to US soon.