Tag: neurology

The Neurology of Bharatanatyam

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Prahlad K Sethi1, Nitin K Sethi 2

Departments of Neurology Sir Ganga Ram Hospital, New Delhi, India 1

New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, U.S.A 2

Nataraja: the cosmic dancer

Address correspondence to:

Nitin K Sethi, MD, MBBS, FAAN

Email: sethinitinmd@hotmail.com

It all began with my friend Nagi inviting me to be chief guest at his daughter’s Arangetram. Arangetram, the debut on-stage performance of a Bharatanatyam student after successful completion of years of arduous training under her guru is certainly a matter of immense pride and joy not only for the student but also family and friends. Ekanta had worked hard for many years to achieve this milestone and finally was about to graduate. Touched by Nagi’s affection, I readily accepted to preside over the function.  

But being the chief guest meant that I would have to give a short speech to the assembled august gathering. As a neurologist I knew precious little about Bharatanatyam, the oldest classical dance tradition in India. Well maybe you can talk about the neurology of Bharatanatyam advised my son Nitin, himself a neurologist. While I had seen Bharatanatyam performances a few times, I had never studied the art form from a neurologist’s viewpoint. I opened Bradley’s Neurology in Clinical Practice and to my dismay found nothing about the neurology of dancing let alone the neurology of Bharatanatyam. After a PubMed search was unhelpful, an Internet search via Google yielded two interesting articles, one from Scientific American magazine and the other in the Journal of Aesthetic Education.

Bharatanatyam is a classical dance form from South India dating back to 1000 B.C.  It is based on ‘Adavu’ (steps) and ‘Hasthamudra’ (hand gestures). The dancer expresses herself via ‘bhavabhinaya’ (facial expression) and ‘hasthamudra’. The dancer is dressed bright colors and adorned with a garland in her hair and foot trinklets. The music is Carnatic classical music yielded by instruments such as violin, flute, mridangam (South Indian drum) and veena (string plucked instrument). The nattuvanar is the most important member of the Bharatanatyam orchestra and plays a set of cymbals known as talam and sings ‘Vaaythari’ (chanting). In a Bharatnatyam performance the dancer attempts to become the character she portrays be it Rama, Krishna or his beloved Radha and mimics all actions of the Supreme as best as she can.  During the duration of the program all participants, the artist and the audience alike are elevated to a spiritual dimension which the Upanishads call ‘Raso vai sah Rasam hyevayam labdhvanandi bhavati’ (he the highest self is bliss in itself). Every recital starts by invoking the blessing of Ganesha and Nataraja (the cosmic dancer) and it ends by seeking their blessings again.

The complexity of the central nervous system is evident even in the simplest of hand movements such as movement of the right index finger. Neurons in the contralateral motor strip are activated as are neurons innervating the corresponding antagonist muscles which need to relax so that movement can take place. Neural impulses travel down from the cortex via the internal capsule, mid brain, brain stem, pyramidal track, cervical spinal cord, peripheral nerve finally reaching their target muscles. The accompanying facial expressions add yet another dimension and convey a story to the spectator. 

Let us take the example of ‘Shabdam’ bharatanatyam performance – a scene from the epic Mahabharata where Draupadi is in great peril. The Pandavas have just lost her to the Kauravas in a game of dice and Draupadi is forcibly brought to the court being dragged by her hair. The evil Duryodhana attempts to disrobe her by pulling her sari.  The bharatanatyam artist performs this scene with just her facial expressions. A look of contempt towards her five husbands who wagered her in a game of dice and the next instant pleading with her eyes to Lord Krishna to help protect her modesty which he does so by extending the length of her sari repeatedly. At the same time the artist covers her bosom with her hands to save her modesty, eyes turned down exhibiting shame. Thus, a story involving many characters is conveyed by a single artist all with the use of hand and face gestures as well as eye movements. The artist during this complex performance is keeping time and synchronizing her actions to the vocalist who is singing and narrating the complex story. She also needs to keep pace with the music with her feet to the beat of mirdamgam.

It is indeed fascinating how the artist’s brain is able to accomplish all these complex actions simultaneously, eyes moving in different directions at times independent of each other with  facial expressions changing depending on the scene as narrated by the vocalist.

Behind every bharatanatyam recital there is intense ‘tapasya’ (practice) of several hundreds of hours and repetitive rehearsals starting from a very tender age under the watchful eyes of the guru. This extra ordinary coordination of movements of the hands, eyes and facial expressions synchronized to music is indeed a testament to the wonder of the human brain and incorporates several neuronal pathways.

To hop on one foot patting your head at the same time requires calculations relating to spatial awareness, balance, intention and timing, among other things, in the brain’s sensorimotor system. A region called the posterior parietal cortex (toward the back of the brain) translates visual information into motor commands, sending signals forward to motion-planning areas in the premotor cortex and supplementary motor area. Several neuronal networks are involved. The cortical center (s) and networks perceive the sound of vocalist, sound of mridangam and taalam, coordinate and then perform appropriate hand movements, eye movements and facial expressions. Simultaneously the brain coordinates the act of dancing keep rhythm with vocalist and other musical instruments. The whole performance requires multiple neuronal circuits of brain to plan and execute. How much role do the frontal cortex, hippocampus and cerebellum part we do not know.

At present we don’t have knowledge of the whole neuronal network involvement involved to perform this complex dance form. Unlike singing where functional MRI imaging has added to our knowledge, there are no functioning MRI imaging studies for dancing. One thing which is definite is that this art can be learnt when one is young because there is lot of plasticity of brain. Dance is indeed the essence of life. Now the role of dance as a form of therapy in diseases such as Parkinson’s disease is also well established.

The Nobel laureate Eccles in his famous book “THE UNDERSTANDING OF THE BRAIN” wrote “how can a brain understand a brain”. The human brain still remains the LAST FRONTIER to conquer.

Privacy concerns

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To the readers of my blog.  I had started this blog to disseminate information about neurological and neurosurgical conditions. Information which was written in a simple easy to understand language (aka free of medical jargon). Over the past 2 years, the readers of my blog started writing in to me with specific questions regarding their own health or that of a loved one.

While I attempt to answer these requests responsibly (please remember the Internet is no place to diagnose your condition and nothing quite replaces a face to face visit with your physician), what concerns me is that some of you are writing in and putting your MRI reports and medical record information in the email. Privacy concerns are paramount and hence I request you to refrain from doing this.  Also in your email, please remove any information which might identify you.

Things on the Internet stay for ever and can be misused. So a humble request, protect your private information!!!

Disclaimer

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Please do read my disclaimer. The purpose of my blog is purely educational and to disseminate information about neurological and neurosurgical diseases and condition. It is not meant to diagnose yourself over the Internet.

The information provided in this blog should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 if you have a medical emergency.

Links to other sites are provided for information only — they do not constitute my endorsements of those  sites.

 Any duplication or distribution of the information contained herein is strictly prohibited.

 

 

Nitin Sethi, MD

The neurology of aging

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Is aging normal or abnormal/pathological? No one quite knows the answer to that question. What we do know is that as we age, neurological disorders become increasingly common. These may range from well defined neurodegenerative diseases like Alzheimers dementia, Parkinson disease and amyotophic lateral sclerosis to other less well defined conditions like gait disorders, “balance problems”, “forgetfulness and senior moments” and increased propensity to falls. Strokes become more common in the aged brain vessels.

As life expectancy increases and more and more people live past the eight decade, neurological conditions become common and account for substantial morbidity and mortality in the oldest old (above 85). Earlier when the life expectancy was in the 60s, we did not see so much Alzheimers dementia, Parkinson’s disease or brain tumors. People died of other “natural” and “unnatural”  causes before the brain showed clinical manifestations of neurodegeneration.

Is it the norm that as we age, a substantial majority of us are destined to develop dementia?  Clinical studies have clearly shown that Alzhemier disease pathology increases with age and the incidence of the disease becomes increasingly common as one goes past 85 (the oldest old). Other studies suggest that though not all the oldest old show clinical dementia, a substantial majority have cognitive difficulties if carefully tested for at the bedside.

Why do neurological conditions become more “common” as we age and can we do anything to alter this? Many theories have been propounded. Increased amyloid deposition in the brain has causal association with Alzheimers dementia, in the same vein deposition of iron in the basal ganglia has been postulated to cause various basal ganglia pathology. There is increased oxidative stress in the “aged” brain which leads to free radical formation and damage to the cellular DNA. Genes get switched off or on triggering the disease process. A lot still needs to be learned about the neurology of aging.

While the mechanisms are still been elucidated, is there anything which we can do to change our “risks”. In the absence of good studies most of the data is open to interpretation. Aspirin prophylaxis, modification of microvascular and macrovascular risk factors like hypertension, diabetes mellitis and dyslipidemia (high “bad” cholesterol) all seem to be reasonable interventions. Obesity and sedentary life styles are bad for the brain too. Regular physical as well as brain exercises (neurobics) keeps the brain healthy and increases neuronal reserve. The role of anti-oxidants like coenzyme Q10 and alpha lipoic acid is still been defined. As they are relatively innocuous and free from side-effects, I would recommend them on a case by case basis. Episodes of major depression “hurt” the brain and aggressive treatment with anti-depressants should be initiated early rather than late.

The neurology of aging remains an uncharted territory but there is hope yet.

Nitin Sethi, MD

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

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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 http://braindiseases.info 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.)

Email: sethinitinmd@hotmail.com

 

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.