Lifestyle Modification – a forgotten key to tackle Neurological disorders

By Dr. Manish Mahajan

Neurological disorders are common and refer to the diseases involving the brain, spinal cord, cranial and peripheral nerves, and muscles. Headache, stroke, epilepsy, Parkinson’s disease, dementia, peripheral neuropathy, and brain infections constitute the major proportion of these conditions and are a common source of mortality and/or morbidity. According to the World Health Organization (WHO), stroke alone claims over 6 million lives annually and over 50 million people suffer from epilepsy with a substantial treatment gap, primarily due to ignorance. The role of lifestyle in the causation and the part lifestyle modifications can play in bridging this treatment gap is further ignored.

Migraine, the commonest type of headache seen in a neurology outpatient department, has a huge correlation with sleep, dietary habits and obesity. Sleep is considered a natural medicine for migraine. Many diets, especially those rich in cheese and monosodium glutamate can act as a frequent trigger for migraine attacks. Similarly, skipping or delaying a meal as well as lack of sleep routine can be detrimental to the control of migraine. Weight loss, as little as 5%, achieved through dietary modifications and regular exercise is helpful in reducing the frequency, duration and severity of the attacks of migraine. Obesity is also a risk factor for Idiopathic Intracranial Hypertension (IIH), another cause of headache that closely mimics migraine.

Stroke is a leading cause of death and disability worldwide. But one would be surprised to know that it is preventable. A diet that is low on salt, simple carbohydrates, saturated fats and contains more of roughage such as fresh fruit servings and salads (the Mediterranean diet) help lower the blood pressure, control the blood lipids and sugar levels thus controlling the major modifiable risk factors for cerebrovascular diseases. Smoking and alcohol consumption cessation further lower the risk of acute or recurrent stroke. Obesity contributes to obstructive sleep apnea that increases the risk of stroke. Engaging in regular exercise, for example brisk walking for 45 minutes per day for at least 5 days, help lose weight. Very recently during this COVID-19 pandemic, the increased sedentary lifestyle, because of a rise in the ‘screen time’, has been identified as an important risk factor across ages for the metabolic syndrome.

Epilepsy is characterized by a tendency to have recurrent seizures. Sleep deprivation is a common precipitant for breakthrough seizures. Alcohol consumption not only triggers but also interfere with the anti-seizure drug’s metabolism. Indirectly by increasing the chances of road traffic accident, alcohol contributes to increased incidence of preventable epilepsy due to head injury. The dose of anti-seizure medications is also as per the body weight thus affecting the side-effect profile. Ketogenic diet is a great add-on for refractory epilepsy.

Dementia, especially of the Alzheimer’s type, is characterized by forgetfulness that affects activities of daily living. It poses a significant health burden in the elderly population and is also a major social and economic challenge for the caregivers. Social engagements and learning a new skill that involves stimulating different faculties of the cognition have been found in several scientific studies to either prevent or slow down the process of degenerative dementias. Weight loss and muscle-strengthening trainings help elderly to prevent falls, especially the people with Parkinson’s disease. Diabetes mellitus (DM) is a leading cause of painful neuropathy or foot gangrene and a good control of blood sugar levels reduces the risk or delay the onset of these complications of DM. High risk behaviors such as unprotected sexual practices, illicit intravenous drug abuse or inadvertent steroid use for endurance enhancement increases the risk of HIV, brain infections due to immunodeficiency states and other muscle weakness due to electrolyte imbalances.

A multi-pronged approach consisting of interventions targeting the major risk factors, as highlighted above, for the common neurological disorders can help either prevent many or alter the natural course of the illness. A holistic wellness approach, consisting of a balanced diet, regular exercise, good treatment compliance, and cessation of cigarette smoking and alcohol consumption beside monitoring BP, blood sugar and cholesterol levels, underscores this year’s slogan from the Indian Academy of Neurology (IAN) – “My Health, My Responsibility”.

(The author is Senior Consultant Neurology & Head of Neuroimmunology, Artemis Agrim Institute of Neurosciences, Artemis Hospital Gurgaon. The article is for information purpose only, consult a medical professional/doctor before starting any medication/therapy. Views expressed are personal.)