Mind-body interventions: applications in neurology

A comprehensive review  on mind-body interventions and its application in various neurological disorders was recently published in Neurology. The authors Wahbeh, Elas and Oken searched Medline and PsychoInfo databases to identify clinical trials, reviews and published evidence on mind-body therapies and neurological diseases.

Meditation, relaxation, breathing exercises, yoga, tai-chi, qigong, hypnosis and biofeedback are some of the mind-body interventions that have been used in various neurological conditions like general pain, back and neck pain, carpel tunnel syndrome, headaches (migraine and tension), fibromyalgia, multiple sclerosis, epilepsy, neuromuscular diseases, stroke, falls with aging, Parkinson disease, stroke and attention deficit hyperactivity disorder (ADHD).

The authors do a good job in shifting through all the data to try to identify the effectiveness of mind-body interventions. As they point out in their discussion , many patients as many as 62% use complementary and alternative medicine therapies (CAM). Some with and many without the knowledge of their physicians. One of the reason why CAM therapies are popular is that they are relatively easy to implement, cheap (though many patients have to pay out of their pocket. Some insurance companies shall reimburse if you have a letter from your doctor) and more importantly as the authors point out it makes the patients feel empowered. They feel that they are in control of some of the decision making in their disease process and treatment. Moreover it gives a sense of general well being.

The authors righly point out that is difficult to scientifically judge whether these interventions are all effective. The reason for this is that many of the studies included small number of subjects and some of them did not have a control group. Moreover it is hard to blind these studies so as to avoid a placebo effect. Like suppose I want to study whether acupuncture is effective for lower back pain. One group I give acupuncture. Ideally I should have a control, a group which receives sham acupuncture so as to null the placebo effect. Now this is difficult to implement.

Th authors in their review conclude that there are several neurological conditions where the evidence in favor of mind-body therapies is quite strong such as migraine headaches. In other conditions the evidence is limited due to small clincial trials and inadequate control group.

It is reasonable to conclude that CAM therapies like yoga, tai-chi and qigong improve balance in the elderly and decrease the incidence of falls. Moreover they give a sense of well being and happiness. Meditation exercises whether it is mindfulness meditation, transcendental meditation or concentration meditation with the repetition of a word like Om or a mantra

“Hare Krishna Hare Krishna

Krishna Krishna Hare Hare 

Hare Rama Hare Rama

Rama Rama Hare Hare”

all help in relaxation and reducing stress. This may decrease blood pressure and reduce the incidence of strokes and heart attacks. Brain changes have been observes during meditation in EEG and imaging studies and there is evidence that these exercises have wide spread effects on the endocrine and immune systems as well neurotransmitters. Hatha yoga may help in improving mobility and balance and thus decreasing fall risk. As the authors point out righly Bikram yoga  which is carried out in very hot temperatures is likely not good for patients with MS, as it may worsen their weakness. This is called Uhthoff phenomena.

There is also some evidence to suggest benefits of these interventions in patients who have chronic lower back and neck pain, those with fibromyalgia, osteoarthritis as well as carpel tunnel syndrome (some studies suggest benefit while others do not).

My advise to patients who want to try out CAM therapies for various neurological conditions is to take their doctors into confidence. It is likely that some of these therapies when used along with allopathic medicines shall give added benefits and likely make you feel better. Like with any other therapy one must find a knowledgeable practitioner who knows what he or she is doing.

Then one can truly reap the benefits of these ancient therapies.

Personal Regards,

Nitin Sethi, MD

Stroke and nirvana: what is the connection

Stroke and nirvana: what is the connection


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

Email: sethinitinmd@hotmail.com

I just read this article in the New York times today titled ” A superhighway to Bliss” by Leslie Kaufman which talks about Dr. Jill Taylor a neuroscientist working at Harvard’s brain research center who experiences nirvana while she is suffering a stroke. She suffers a left parietal bleed and at the time when she is hemorrhaging into the brain, she experiences this amazing peace. The constant chatter that normally fills her brain stops, her perceptions change and she feels disconnected.

What would you ask all this has to do with nirvana. Nirvana by the way is the state where you attain the supreme bliss. In Hindu mythology we talk about nirvana and mosha. Mosha as in when you are free from the troubles of this world and one with God.  Well basically as the article goes on to mention that the right and left hemispheres of the brain have different functions. The dominant left hemisphere (in people who are right handed) houses ego, context and time logic. The right hemisphere on the other hand gives creativity and empathy. So in a way when your left hemisphere is shut down (as in Dr. Taylor’s) case by a hemorrhagic stroke, she experiences this peace and calmness because her ego is gone. The article later goes on to mention, that she has written a book about the same and now lives a more peaceful and spirtual life because she has learnt how to sidestep her left brain.

Hmmmmm I am not sure what to make of this and where I stand on this topic. Sensory disintregation may occur at the time of a stroke and patients have reported some very vivid experiences during the time of the stroke such as out of body experiences. Did Dr. Taylor suffer something like that during the time of the stroke. The fact she is a neuroscientist may have given the ability to better recognize her stroke as it was occuring.

In any case, parietal strokes especially when large can be devastating and not everyone has such a nice outcome as Dr. Taylor. The two hemispheres in the brain are closely interconnected and it is not possible to voluntary shut down one part of the brain. We can do it in the lab, by injecting a drug which shuts down one side of the brain such as amobarbital. This test is called WADA test and it would be interesting to note if anyone else has described reaching nirvana at the time of WADA testing.

The human brain is indeed like the wind and difficult to control. Thoughts are always racing through the brain some useful and others at time meaningless. Why you may ask are we always having thoughts in our head? Is there a way to make the brain empty of thoughts maybe for just a short time so that we can be totally in peace. Can the practice of yoga and meditation do that.

This brings me to the question I asked in my post on yoga and meditation: Does a meditative mind lead to a meditative brain?  Can by intense meditation, yoga or spirituality we slow down and stop these thoughts in our head?

I would appreciated all my readers thoughts about this.

Your brain on yoga

Yoga and the brain

Your brain on yoga: its myths and healing powers



Nitin K. Sethi, MD







Address for Correspondence:


Nitin K. Sethi, MD

Department of Neurology

NYP-Weill Cornell Medical Center

525 East, 68th Street

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

Email: sethinitinmd@hotmail.com





What is yoga? Yoga literally means union. Union of the self with the inner consciousness is yoga. When one gets skilled in yoga then one can meditate. It is difficult when one tries to meditate for the first time. You close your eyes and the mind is bombarded with thoughts. What happened at work, who said what, things I have to do when I get done with meditation here. Mundane thoughts like these start racing through the mind. In the Bhagavad Gita an ancient Indian text Lord Krishna rightly tells Arjuna “your mind is your best friend but also your worst enemy”. It is indeed very difficult to control the mind, to slow it down and make it calm. In the recent years yoga has gained immense popularity in the west. What is about yoga that is different from traditional exercises like jogging and weight training? Why have so many people incorporated yoga into their hectic schedules? Yoga has been postulated to have dual benefits for the body (exercise) as well as the mind (meditation). What are these benefits of yoga? What is the neuroscience behind meditation? I shall discuss these and other issues briefly in this article.


Different types of Yoga


            Before we begin let us briefly talk about different types of yoga. I am in no way an authority on yoga and various yogic postures so I shall keep this short. If you seek further information, there are many books which go over the practice of yoga in great detail. In the Bhagavad Gita, Lord Krishna talks about three kinds of yoga namely karma yoga, bhakti yoga and gyana yoga.

Karma yoga as stated in the Bhagavad Gita means that one should do ones prescribed duties without worrying about the fruits. What does that mean and does that have any relevance to the health of our mind? A lot of stress in our daily lives is due to the attachment to results. We all seek something and strive hard to achieve it. This is especially true in a city like New York where I reside. It is hardly 6 am and the city is on the go. People rushing to work and to appointments, constantly on the move. I personally am of the philosophy that hard work never killed anyone. One should do ones prescribed duties. Like for instance I am a doctor and my duty is to my patients. I need to be there for them and take care of them. Karma yoga teaches us the same, do your prescribed duties, as one cannot remain stagnant. Stagnation or boredom is a big killer. When people get depressed they have what has been referred to as anhedonia. The term means the loss of interest in anything pleasurable. Work can and should be a pleasure. It gives us a reason to get out of our homes, meet new and interesting people, meet up with friends and share a coffee during the lunch break. All this keeps our minds healthy. Man is a social animal and the human brain seeks interaction and I feel thrives on it. What does hurt the mind and through the mind-body connection the health of our bodies in turn, is the desire for results. If I am working hard as a doctor because I want to get rich and famous then I am constantly worrying for the fruits of my endeavors. This attachment to the results leads to stress. Stress which may lead to a nervous breakdown, depression and which has been linked to cardiovascular diseases like heart attacks and cerebrovascular diseases like stroke. The philosophy behind Karma yoga is thus intensely appealing. It does not ask us to renounce life. If you love to party, so party (if indeed that is your prescribed work) but do it without getting attached to the results (I hope I meet someone famous there, someone that will help me in climbing up the social ladder).

Bhakti Yoga the word “bhakti” literally means faith. So what does bhakti yoga mean and is there a relevance to the state of our mental and physical wellness? The way bhakti yoga is described in Indian texts like the Bhagavad Gita is having faith in god. The human brain needs to believe in something. If you are religious you would believe in god (does not matter what your religion is or who is the god you believe in). If you are not religious you may believe in yourself or a close friend. Again bhakti helps the mind in turning inwards. They say faith can move mountains. People have faith and have been able to overcome physical hurdles or go through an intensely draining experience like been diagnosed with cancer.

            Gyana Yoga also called Jnana yoga or Dhyana yoga: refers to the yoga of knowledge. In the Gita this yoga refers to seeking the ultimate knowledge and in a way introspection, trying to make a union with the inner self. It also refers to leading a disciplined life in which one remains detached from extraneous sensory objects. In today’s world we are constantly wired. How many times in the space of a day do we check our emails or are talking on the cellphones. The mind just like any other organ of the body needs rest. Needs time to reflect, time to organize its thoughts. Many writers prefer to work in solitude, away from cellphones, televisions sets blaring out the same news and even the Internet.


Neuroscience of meditation


In a thought-provoking article, Deshmukh talks about the neuroscience behind meditation 1. Deshmukh likens meditation to an art, the art of being serene and alert in the present moment instead of a constant struggle to adapt and change to various external stimuli. As per Deshmukh, when one is meditating there is more efficient management of attentional energy, one may be totally engaged or totally disengaged. During meditation there is a simultaneous, participatory consciousness rather than a dualistic, sequential attentiveness. Thus meditation helps in changing the response of our mind to external stimuli. One can be a part of the external world yet at the same time be detached from its influence. This as Deshmukh points out leads to a natural sense of well-being and spontaneous joy.

Does a meditative mind function better? Does a meditative mind lead to a meditative brain? Meaning do the benefits of meditation on the mind translate into benefits for the brain too. Does regular practice of mediation lead to physiological and neurochemical changes in the brain? Hopefully science shall yield answers to the above questions soon.



Mind-body connection


Thus there is some evidence though not all scientific suggesting the benefits of yoga for the mind and the brain. That the mind is connected to the body has been emphasized recently. So changes in the milieu of the mind (and brain) affect the body and the reverse is also true. This mind-body connection works both in health and disease. A healthy brain and mind live in a healthy body and vice versa. Is it possible to use this mind-brain connection to promote healing? Can you use the power of the mind to fight cancer of the breast or to overcome a stroke that has left you weak on one side of the body? There is some evidence to suggest in the affirmative. I strongly feel that patients do well when you treat them as a whole, not just the body system that is giving them trouble. 



Benefits of yoga for the body


The concept of yoga benefiting the body is far easier to comprehend. The physical aspect of yoga involves various asana (postures or poses). These help in toning the muscles and improving balance and station (posture). Yoga may benefit people suffering from chronic back pain by strengthening the muscles of the back. Patients with Parkinson’s disease or those with mild to moderate Alzheimer’s dementia would likely benefit from some yoga exercise done under proper supervision. This would improve their stiffness as well as balance. I stress the “under proper supervision” part here as some of the advanced postures have the risk of causing injury 2.






            Yoga may have the unique capacity to benefit both the mind and the body. Further studies exploring the neuroscience behind yoga shall reveal the secrets behind this ancient science.





  1. Deshmukh VD. Neuroscience of meditation. Scientific World Journal 2006 Nov 16; 6:2239-53.
  2. PK Sethi, A. Batra, NK Sethi, J Torgovnick, E. Tortolani. Compressive cervical myelopathy due to sirsasana, a yoga posture: a case report. The Internet Journal of Neurology.2007.Volume 6 Number 1.


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Nourishing and nurturing your brain: from the things we eat to the things we do

Nourishing and nurturing your brain: from the things we eat to the things we do



Nitin K. Sethi, MD































Address for Correspondence:


Nitin K. Sethi, MD

Department of Neurology

NYP-Weill Cornell Medical Center

525 East, 68th Street

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

Email: sethinitinmd@hotmail.com

            The human brain is indeed complex made of millions of small cells called neurons working in close harmony with each other. Its capacity far exceeds that of any supercomputer designed as of yet by man. This fist full of about 1500 grams of tissue is the seat of our emotions, our memory, our senses and serves as the motherboard for all other body systems. This delicate supercomputer of ours is enclosed in a resilient bony skull able to withstand significant trauma. Our brain like our body needs to be nurtured and nourished.


Nourishing the brain: brain foods and more


            What we eat does to an extent determine the health of our brain. Recently the concept of brain foods has come into vogue. This refers to foods that have been postulated to boost brain power, improve memory and functioning of the brain. So what are these foods that have been postulated to help keep the brain young?


Omega 3- fatty acids: belong to the family of unsaturated fatty acids. The important ones among them include alpha linolenic acid, eicosapentaenoic acid and docosahexaenoic acid. Fatty acids form an important constituent of cell membranes. They thus perform important roles in various cell functions including cell to cell transmission and help maintain stability of cell membranes. A growing body of work has shown the beneficial effects of omega 3-fatty acids in prevention of atherosclerosis. The data showing a beneficial effect of fish oils is more robust for the cardiovascular system while no consisting relationship between fish consumption and stroke reduction has been documented. So while the data may not be robust, it probably makes sense to increase the omega 3-fatty acid content in your diet. I would advise replacing some of the saturated fats with polyunsaturated fatty acids rich in omega -3s like canola oil, walnut and olive oil.


Numerous other foods have been touted to promote brain heath. Some of these include avocado, various legumes (rich source of protein for vegetarians), oatmeal, peas, soybeans (again a good source of protein for vegetarians), wheat germ, fish like tuna, yogurt, brown rice, brussels sprouts and eggs among others. The brain just like any other organ of the human body needs a balanced nutritious diet consisting of the right mix of carbohydrates, proteins, fats, vitamins and minerals.


Role of Ginkgo biloba in enhancing memory: the extract of the Ginkgo leaves has been used for medicinal purposes for years. It contains flavonoid glycosides and terpenoids and is thought to enhance memory and concentration. Studies though have yielded conflicting results. While some studies on patients with Alzheimer’s dementia showed a benefit, others did not and benefits were attributed to a placebo effect. Ginkgo biloba affects the coagulation of blood and can interfere with other anticoagulants like warfarin and aspirin. It might be reasonable for people who have dementia or an early stage of dementia called mild cognitive impairment (MCI) to take Ginkgo biloba. Its use in healthy young adults as a memory enhancer is probably ill advised.


Role of vitamins and minerals in promoting brain health: Vitamins and minerals are also referred to as micronutrients. The body needs them albeit in small amounts for its well being. Vitamins and minerals are involved in diverse cellular functions. Deficiency of certain vitamins has been implicated in causing neurological diseases. Vitamin B1 also called thiamine is a water soluble vitamin. Deficiency of vitamin B1 causes a disease caller Beriberi. It presents clinically as a peripheral neuropathy (the peripheral nerves get involved). Deficiency is commonly seen in alcoholics and those with marginal diets like the elderly. Thiamine deficiency in heavy alcoholics may cause other neuro-psychiatric problems. Wernicke’s encephalopathy and Korsakoff psychosis occur in alcoholics and present clinically with confusion, gait, balance and memory problems. Foods that are rich in vitamin B1 include whole-grain cereals, bread, red meat, legumes, green leafy vegetables and brown rice. I would recommend vitamin B1 supplementation in the elderly and those who drink heavily. Ideally all people who drink a moderate amount on a regular basis should take one multi-vitamin a day.

Vitamin B12 deficiency can occur in people who have pernicious anemia or inflammatory bowel diseases like Crohn’s. Deficiency of B12 also called cyanocobalamine may present with neuropsychiatric manifestations (referred to as megaloblastic madness). It may also cause loss of vision (amblyopia) and weakness of the legs due to involvement of the spinal cord (the spinal cord involvement is referred to as sub-acute combined degeneration of the spinal cord). Meat and meat products like liver, beef, mutton, fish and egg are rich sources of B12. Hence vitamin B12 deficiency occurs mostly in pure vegetarians. In these groups, yes, vitamin B12 indeed does nourish the brain and in fact is vital for it to function normally.

Vitamin E is much in vogue today and has been aggressively touted as an anti-oxidant important for everything from aging gracefully to preventing cancer. Again there is yet no scientific evidence that it indeed does help in all this. Vitamin E deficiency causes ataxia and balance problems (ataxia of vitamin E deficiency). Deficiency occurs in people who for some reason cannot absorb the vitamin from the gut. Wheat germ, vegetable oils, whole grains and nuts are good sources of this vitamin. No one knows what the ideal dose of this vitamin should be. Even giving supratherapeutic doses (mega doses of 1000 IU and above) of vitamin E to patients who had neurodegenerative conditions like Alzheimer’s dementia did not result in any observable benefit.

This is a good time to talk about the role of various anti-oxidants in promoting and maintaining brain health. A variety of anti-oxidants are nowadays been marketed as a visit to any of the health stores shall reveal. These have been touted for their anti-cancerous properties as well as their cardiovascular and cerebrovascular benefits. Among them coenzyme Q10 and alpha lipoic acid are popular. There has been no proven benefit of coenzyme Q 10 when controlled trials have been done in patients with Parkinson’s disease or even in ALS. My personal view is that if someone has a strong family history of Alzheimer’s dementia, Parkinson’s disease or ALS, it may be reasonable to advice supplementation as these preparations are relatively safe with no major side-effects. Studies have shown that when you give them to patient’s who already have an advanced neurodegenerative condition like Parkinson’s disease they seem to be ineffective, no one though knows that if you take these supplements from a young age (before the onset of the disease), would they lessen the chances of developing Parkinson’s disease or dementia in the later life. Meaning do they actually promote brain health? I usually do recommend alpha lipoic acid supplementation in my diabetic patients with neuropathy. In health men and women, I would recommend taking them in moderation as there is no proven benefit.



Role of exercise in promoting brain health: “ The brain too needs to jog everyday” exercise is a natural aphrodisiac for the brain. It promotes the release of endorphins and other feel good neurotransmitters. The benefits of regular exercise in promoting brain heath have been documented repeatedly. Even people who have neurodegenerative conditions like Alzheimer’s dementia and Parkinson’s disease seem to do well if they exercise as compared to those that don’t. These patients are less prone to fall and have improved assessments on care-giver rating scales. My personal belief is that exercise promotes brain healing and improves synaptic transmission. Recently cognitive exercises have come into vogue. Brushing with your left hand (if you right handed), playing mind-games like crossword puzzles and scrabble have been documented in some studies to slow down the progression of dementia and improve memory and concentration. People who are high functioning and use their brain regularly like lawyers and teachers have a lower incidence of developing later life cognitive problems as compared to a construction worker whose job is more manual and does not involve the use of these higher mental functions. “ Use it or lose it!!!”



 “ Do not just exercise your body, exercise your brain too”



The mind-brain connection: How to keep your mind healthy


One should not only have a healthy brain but a healthy mind too. Inner peace, calmness, introspection, tranquility are essential qualities that nurture the mind and help to maintain its internal equilibrium. Meditation, been spiritual and doing yoga are ways by which that elusive inner peace can be obtained ensuring a healthy mind as well as brain. One should never forget the healing powers of the mind. Some cancer patients and patients who have had a devastating stroke have been able to overcome their illness and disability due to the healing power of their minds. One should harness this power in a positive direction because the mind can be your best friend as well as your worst enemy. Protect your mind against depression as attacks of major depression make one prone to later life dementia. Have healthy relationships that nurture and nourish your mind.


Someone once rightly said and I quote “ Your mind is your best friend, do not hurt him for whomsoever or whatsoever”.