The healthy brain


As a neurologist, I see the diseased brain everyday. Patients suffering from acute and chronic debilitating neurological conditions like strokes, uncontrolled seizures, brain tumors, Parkinson disease and ALS. The devastating toll of neurodegenerative conditions like Alzhemiers dementia is enormous. They affect not just the immediate patient but also family and friends.

It seems to me that as doctors we talk a lot about the brain in disease (the diseased brain) but precious little about the brain in health (the healthy brain). Why this fascination with the brain in disease? Why do we not invest more in keeping the brain healthy.

There is so much literature out there about how to keep the heart healthy. Take a low cholesterol diet, exercise regularly, keep your blood pressure under control, eat fish and keep your stress low to keep your heart healthy. What about the brain’s health?  Can we extrapolate data obtained from studies done on the heart and apply it to the brain? Are the heart and brain alike? Is their physiology the same? What is good for the heart, is it also good for the brain?

At the expense of making cardiologists really angry I would like to point out here what was once told to me by my friend. The only function of the heart is to keep the brain alive!!! To pump blood to the brain so that the supercomputer, the masterboard of the human body can work smoothly. The heart and brain are not alike and what is good for the heart need not be good for the brain. The blood vessels of the heart and brain do not work in the same way. The human brain is far more intricate and complex and there is still precious little we know about it.

The decade of the brain came and went. True there has been an explosion of knowledge in the field of neurosciences but we still have miles and miles to go. I think we have reached the stage when we pretty much know everything about the heart, we can open blocked blood vessels, bypass coronary vessels and hey even transplant the heart. A few nicks here and there and out pops the old heart and in goes a new one. But what about the brain? Can we even dream of transplanting a human brain? One can imagine a neurosurgeon trying to connect billions of synaptic connections, so that the new brain works just like th old one. It is the brain which defines us, makes us what we are, the seat of our emotions, memory and intelligence. How would we make sure that the new brain still houses all the old information?

As you can see there are more questions than answers at least with our current degree of understanding of the human brain. So till we learn more, we should as doctors and patient advocates talk more about the brain in health. How do we keep this supercomputer healthy? For every one lecture a neurologist gives about treatment of stroke, he should give ten about stroke prevention. We need good quality research to figure out what foods does our supercomputer like (what are these brain foods, how much is good and how much is bad). How much sleep and down time this supercomputer needs? Does it like complementary therapies like yoga, meditation and tai-chi? Does neurobics help in keeping it hale and hearty.


Emotions that define us as human beings such as love come from the brain. The rush one feels as he sees his beloved, the longing, the pain all come from the brain. Hmm I even propose that instead of having a arrow through the heart to display cupid, we should have an arrow through the brain, after all that is where the love center is.

So lets take a pledge to keep our brains healthy. There is no better gift we can give ourselves than a healthy brain and mind.


Nitin Sethi, MD

Successful aging and living with adversity

                             Successful aging and living with adversity

Nitin K Sethi, MD


        Comprehensive Epilepsy Center, Department of Neurology, NYP-Weill Cornell Medical Center, New York, NY (U.S.A.)

Address for Correspondence:

NK Sethi, MD

Comprehensive Epilepsy Center

Department of Neurology

NYP-Weill Cornell Medical Center

525 East 68th Street, York Avenue

New York, NY 10021

Fax: 212-746-8984


I read a very fascinating article recently in the Journal of Neurology Neurosurgery and Psychiatry about successful aging in adversity. We all want to age successfully . Successful aging though is just not about escaping illness as the authors (Livingston point out but also of having a positive attitude towards one’s life despite poor health. In their study they interviewed patients with dementia to find out how they view their aging. To my pleasant surprise they found that many people with dementia feel that they are aging successfully and rate their quality of life as good. This may be against what their caregivers feel. I should add these were people with mild to moderate and not severe dementia.

So how can we age successfully both in health and disease? Well if you are healthy, good then the odds are with you. Your quality of life is good, you have no physical or mental impairments due to disease and if you maintain a positive attitude and avoid depression and anxiety successful aging can be readily achieved. Exercise regulary, keep your mind occupied (read books, watch television, read the newspaper), maintain good and healthy social interactions (surround yourself with family and friends, date if you are single) and hey you are on your way to aging successfully.

But what if you are sick?  Is successful aging possible in adversity. YES as the study points out. It is very much so. What is needed is good mental health and social relationships. Have a positive frame of mind. The study points out that an individual’s underlying resilience plays a big role in successful aging and even though the disease may progress as time goes by, the individual shall still continue to feel he is aging well. Again the importance of mental health is stressed. Avoiding depression and anxiety is the key to successful aging in the face of adversity. The importance of social relationships and support of family and friends cannot be stressed more.

Well there you have it, maybe a small piece to the puzzle of successful aging and at least to some of us in the face of adversity.


When and how to seek a second opinion: a patient’s perspective

I originally wanted to publish this in the New York Times as I wrote it primarily for patients and care-givers. They did not accept it. It seems they rather devote a page to which model makes how much money or who is dating who rather than publish something like this. I always wanted this to be freely accessible to patients and care-givers. That is the reason I started this blog and my website in the first place. It is my way of giving back to my patients. I owe a lot to them and they are my first and foremost teachers. The article is hopefully going to appear in the Internet Journal of Neurology soon. Here is a small piece of the article. I cannot publish the entire piece as then I would be in copyright violation.


When and how to seek a second opinion-a patient’s perspective


NK Sethi 1, PK Sethi 2


1 Department of Neurology, Comprehensive Epilepsy Center, NYP-Weill Cornell Medical Center, New York, NY (U.S.A.)

2 Department of Neurology, Sir Ganga Ram Hospital, New Delhi (India)








Address for Correspondence:

NK Sethi, MD

Department of Neurology

Comprehensive Epilepsy Center

NYP-Weill Cornell Medical Center

525 East, 68th Street

New York, NY 10021 (U.S.A.)



There are times when a second opinion is not only appropriate, its necessary. This is true both from the patient’s as well as the doctor’s perspective. Since the patient technically has more to lose, it is imperative that patient’s know when and how to seek a second opinion. This is more significant in clinical neurology especially when one is handed down a diagnosis of a neurodegenerative condition like young onset Parkinson’s or Huntington’s disease. Diagnosis of a disease like amyotrophic lateral sclerosis (ALS) is essentially like signing off on a death sentence. Patients and caregivers are distraught and may not know what to do. Some may trust their doctor and agree to his or her management plan. But what if he is wrong? Maybe there is something out there that may help me. Maybe my doctor does not know about it. Even if the diagnosis is correct some may not be comfortable with the line of care. It is at times like these that the question of seeking a second opinion crops up.


Brain Care Foundation

Please visit the Brain Care Foundation of India website at

We would appreciate your suggestions and comments as we strive in our endeavor to make neurological services accessible to the poorest of the poor and to care for the brain just not in disease but also in health.

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It is declared that the senses are superior but more than the senses the mind is superior but more than the mind the intelligence is superior and more than the intelligence that which is superior is the individual consciousness


Lord Krishna in the Bhagavad Gita