An Introduction

Hi Folks! This blog aims to attempt to sensitize the readers about research in neurosciences with a focus on PhD Clinical neurosciences program targeted at medical graduates. Though it is 8 years after the inception of this course, things remain hazy and the beginners are apprehensive to plunge into this opportunity in spite of clearing the required exam.

What is research? It is as simply defined as discovering something.  A discovery that will add to the fund of facts of science , arts , literature or any field in that case. Few discoveries change the pace of human progress , few just contribute to make lives of people better.


Science>>Biology>>Neurosciences.. What about it?
Research in science is one of the fantastic job on this planet. Science subjects span Physical sciences, chemistry, Biology etc. I see Mathematics is indeed a science similar to the other ones. As I am into biological sciences (neurosciences), this blog restricts itself to that. Charming thing about biological research is that it deals with life and the products of its research directly benefit the living beings on the earth. Coming to neurosciences, there could not be anything more fascinating than studying a brain,  its processes and diseases which distinguishes human beings in the taxonomic ladder. At this moment, the text I am composing and the ideas I am sharing and mechanically typing are all the resultant of dynamic brain processes. (including the communication it is making with your brains now reading this.

I believe that 21st century is an era of neurosciences. To the beginner's despair , it is true that we know very little about this amazing organ, nevertheless it is driving all the great brains to study what this greatness is about and how to understand it. Do you know that Einstein's brain was stolen by the pathologist on call at the cost of his job?. But all the findings were just not acceptable it is not just anatomy that dictates brain's functions and capacities and what dictates in real appears to be intangible (along with few tangible factors like anatomy and chemical processes) as of today to me!!.

From the molecules to the behavior, neuroscience offers tremendous scope for research.

Molecular(genes and the first products) >>subcellular>>cellular >>intercellular(synapses)>>tissue level>>circuitry level>>lobar level>>behavior.(cognition, consciousness etc)
 Studying neurotransmitters and the hormones responsible for behavior (not sure where I can fit into this hierarchical flow. But the communication within the cell parts and between the cells and between the different areas of the brain underlines the principles of deciphering the secrets.

Approaches span, molecular approaches, histopathology, electrophsyiology, imaging (functional , structural {gross or tract level and a combination of structural and functional), behavioral interventions.

Interestingly the invention of the computer served a sample and thrown insights into the organization of brain. Currently brain research and the the computer research converge at the point that both are reciprocally giving insights into each other (development of artifical intelligence etc). Computer is ofcourse the simplest version of the master organ of us.  Development of newer biomedical technical modalities is aiding the neuroresearch, hence it is not entirely independent.

Clinical Neurosciences

Clinical neurosciences is that branch which focuses at the diseases of the brain. The mechanisms that damage the brain and the mechanisms involving its repair, forecasting the outcomes and developing effective pharmacological and non pharmacological treatments and interventions. It is essentially a translational research.

Translational research is something that should be translated in to clinical application in diagnosis, prognosis or therapeutics. On the other side basic science research need not directly target a translatable purpose but may indirectly be useful or be translated at a later point of time. In my view I do not see a big difference as ultimately everything needs to be translated to human welfare. But at the start , both differ in terms of the approaches and the apparent primary objectives.

I think the whole focus in this decade is shifting towards translational research. Newer academic programs and industries focused on translational research are emerging up and funding agencies are tending to support projects more of direct translational potential. Because of which doctors have to play a key role in collaborating with basic scientists. Doctors are the best people to generate questions which are useful to the patient. As a consequence of this raised importance and market drift, every other branch of science is extending its wings for collaborations into medical fields say the engineers in supplying technology, the software applications in calibrating machines, development of algorithms to use device (say imaging), using tools like MATLAB to design artificial prosthesis for the handicapped people.

Key components and approaches in clinical neurosciences As I mentioned , brain can be studied at different levels starting from molecules to behavior and anything can be translated for brain welfare. Here Brain not only refers to just brain but its extensions (spinal cord and the nerves).

Studying clinical phenotypes, correlating with lab findings like genetic markers, blood bio markers, (bio markers can also be behavioral), imaging bio markers and outcomes with certain drugs or non pharmacological management (including rehabilitation- an effect of plasticity) is one straight huge area for a beginner, which is endless and can be done extensively. But this offers little scope for experimentation. We can not aggressively experiment with living brains or living beings.

To circumvent this we can use computational models to study brains, animal models to study everything that we can do to humans with a little limitation for behavioral study. We have animal models for many diseases like AD, PD, and what not? knock out mice for every monogenic brain disease can be well developed.

The latest discover of IPSC offers a huge potential to develop neuronal cell lineages from non neuronal cells like lymphocytes etc and subject them to different chemical , physical milieu, study their properties including their membrane characteristics, firing patterns and observe their morphology if the developed lines are containing a a known or suspected mutation of brain disease.

Besides all these, a clinical researcher by actively involving in clinical care, looking patients in depth wearing research spectacles that regular treating physicians do not wear (because of the work load an their primary objective of treating) and postulate the phenomenology of the lesions, like description of mirror agnosia, phantom limbs etc by Dr. V.S Ramachandran.


I found this article really interesting and methodical in presentation for fundamental ideas about neuroscience research. http://www.newyorker.com/magazine/2015/05/18/lighting-the-brain

Brain - A biologically special organ!

Brain actually is a lot different from many organs of the human body for various reasons obvious to a medical/biological graduate. It is designed such that it receives the maximum importance, and is always salvaged in the crisis sparing other organs. It could dominantly influence the other parts of the body and the converse is not possible (I strongly feel it).

Few notable things are..

1) Blood brain barrier

2) Immunological privilege

3) Cell fate of neurons- inability to divide. (neurogenesis) causing irreversibility of the damages.

4) Modulation of the structural and functional aspects of the brain through the behavior. This reciprocity between the brain and the behavior is the most fascinating thing I suppose.

5) Plasticity : The ability of the brain to modulate itself to functionally adapt /compensate structural defects or to meet the demanding needs.

PhD in clinical neurosciences at NIMHANS

This post specifically deals with an ICMR funded PhD program in clinical neurosciences for medical graduates at NIMHANS. It includes the course profile, active areas of research at NIMHANS, skills you can acquire and the career prospects. It should not only help you in making a right research choice but help the science to have the right and passionate researchers.

This currently not so popular course was initially popularized as an MD-PhD that should be in par with western MD PhD which actually did not fit into the system and is been converted to plain PhD. As it was a popular notion that doctors are not engaged in medical research in Indian unlike western world, this course has been initiated by the ICMR (Indian council of medical research). Naturally the charisma is lost because it is neither in par with western MD-PhD nor with a clinical masters degree, yet I personally feel this is a wonderful route to embark upon a rewarding medical(neuro) research career by taking the road not taken.

So here comes the typical Indian dilemma of joining the course with unknown prospects and relatively very new in the market. Every other person asks me " Can we practice in clinics or will I get a research job in any organization". I would quote the lines of Professor Sponder which our ace scientist of the generation quoted in his book "Wings of fire".

"One should never worry about one's future prospects  instead it is more important to lay sound foundations, to have sufficient enthusiasm and an accompanying passion for one's chosen field of study"

Yes, I may not sound practical, but it is a fact that relying on certificates and credentials is the resultant of insecurity that we have nurtured in us because of strength less skills and concepts we have. If you believe in the above quoted lines, then things should fall in place when you do what you love for the sake of your passion and compassion of saving humanity with whatever you can contribute. As an example it worked for APJ Abdul Kalam!

Having said all these, I can say it was a very tough journey for the first few batches after its inception in 2007. The course did not have proper structure and established areas to start working up on. The faculty were new to this as well. I think this is what any field or any course should face in the beginning. The intake was 1 in 2007, 3 in 2008, and 5 from 2009. 

Active areas of research By this I mean , I primarily mean the areas that current PhD clinical neurosciences are involved (did not consider all the basic science/non medic people involved in the translational research).
1. The epilepsy group
2. The movement disorder group
3. Neuromuscular disorder group (DMD, ALS)
4. Degenerative disorders which includes peripheral, central, age related, infective etc... e.g. M.S, A.D, mitochondrial disorders (can also be considered developmental disorder),
Among the degeneration , Dementia is taken up as a special area with special dementia clinic on Saturday. Apart from AD, FTD and CBGD are also gaining importance.
5.Tumors like glioblastoma
6. TBI traumatic brain injury
7. Addiction medicine (epigenetic basis of alcohol addiction)
8. Developmental disorders (Autism ).  Hopefully this will grow in the coming days. Genetic diseases with complex phenotypes like Autism+refractory epilepsy+mental retardation should be taken up in future for active research.

Techniques actively taken up are imaging (fMRI, PET, MEG, DTI, SPECT etc), molecular genetics (polymporphisms, linkage studies etc),  electrophysiology (EEG, ENMG), histopathology like muscle/nerve biopsies, immunological (flowcytometry), retinal scans (eye as a window to neurological illnesses), autonomic function tests.

Course Profile : For the first one year, as a PhD CNS student you are expected to work in clinics and wards to get sensitized about the diseases. By the end of one year you have to chose a guide and a topic and draft a protocol within 6 months after that. So the thesis actually begins after one year of rotations in various neuropsychiatirc departments.

Rotation details:
1. 3 months of neurology
2. 3 months of neurosurgery
3. 3 months of psychiatry
4. 1 month of child psychiatry
5. 1 month of neuroradiology
6. 1 month of neuroanesthesia


Critical things :  According to ICMR guidelines your primary guide should be a clinician. So to get a guide and matching it with your basic interests is the real hurdle before you start thesis. Protocol acceptance is the next hurdle. ethical clearance etc should also be well taken care of.


Dual PhD!! Currently (as of today) NIMHANS holds collaboration for dual PhDs for clinical neurosciences fellows with 2 universities. One is the university of Liverpool and the Maastricht university. If you meet the criteria then you would be ending up with a dual PhD!
Currently one student is already in Liverpool and few are heading towards Maastricht.

Prospects : It really depends on what kind of work you do in these 5 years and what skills you acquire. With the usual habit of measuring the prospects with alumni placements does not hold good in our context as this is a budding course. Only 2 batches (3 students finished till now) and 3 more on the way to their defense. Measuring with the credential of publications may not be also accurate at this juvenile stage of the course. Many of the current students are hopeful about a post doctoral fellowship in Europe and USA in their respective fields. Again the decision of switching to lab sciences or practicing or balancing the both is your choice.

Can we practice? depends on your skills as mentioned above. I do not think anyone have to worry about legitimacy as you know the kind of practice happens in India. 50% of Indian practitioners are totally unqualified (because they are the only one who has access to rural India). There are many grand old MBBS graduates who actually got specialized with their experience and practicing successfully. There is no law as far as I know that can prevent a MBBS grad with a 5 year old experience in clinical neurosciences (work involving patient care) from practicing primary neurology atleast. Ideal kind of practice is in academic or university settings, simultaneously contributing to the research, generating hypothesis and solving problems.

Many people plan a neuro residency abroad too by clearing USMLE, PLAB or MRCP which is worthwhile if you are more into clinical practice.