Dr. Fedor Panov, a functional and epilepsy neurosurgeon at Mount Sinai West, and Director of the Adult Epilepsy Surgery Program at the Mount Sinai Health System, describes the impact of meditation on the brain and his research into monitoring the brain during meditation to better understand its effects. All right. So with that, we'll move on to our last speaker of the day. Uh, Ted Pan of we all know is one of our faculty and the functional and epilepsy division here at Mount Sinai. Um, he completed his empty at Jefferson and his residency here at Mount Sinai before heading off to California for a fellowship in functional neurosurgery and epilepsy with Eddie Chang. Hey is widely published. He has an extremely academic approach to his work, which I have been fortunate enough to witness in our epilepsy conferences. A very thoughtful approach to taking care of his patients. And he'll be speaking to us today about functional neurosurgery, epilepsy. Mhm. Thank you, Peter, for that kind introduction. And, uh, just, uh, let me know if I'm able to share correctly. And that looks like the final slide, huh? You do see it. Hey. Alright, how about the first slide? How we're good. Got it. All right. Oh, guys, it's always such a pleasure to be able to discuss some of these research efforts with the greater amount sign in your surgical community. Um, the title today is impact of meditation on limbic circuit reactivity, and I must say, I believe my passion for this topic most certainly outweighs my knowledge, and our entire team is looking for feedback and possible collaboration as we get some of these research projects going. Quick outline of what we will cover today includes historical backgrounds into meditation, and it's eventual and hopeful collision with intracranial recordings. The current evaluations of chronic meditations of what is out there in the literature right now. The potential meditation paradigms that we can introduce in our comprehensive epilepsy center and future directions for us as a field. Aziz, we start embracing some of these traditions, So if we go back, the first mentions of meditations are pictorial. They're not written, and they go back between 5000 and 7000 before current era, and this would be wall art from the Indian subcontinent. This would be positions of individuals and clearly meditative poses with eyes closed or half open, justifying to the fact that this has been around for, you know, I'm saying 67 but at least 7000 potentially 8000 years. The first written documentations of this would be in the Indian subcontinent writings about 3500 before current era and those would be the vetters. And from that point on, we moved to the spread from just Hinduism to other religions, including Talisman Buddhism about 2500 years ago. Moving over into the Middle East with some paradigms in the Old Testament, now interpreted as meditative, practices the Roman Empire around the first century before current era and sliding into until its demise around the 4th and 5th century of the current era. One of the fascinating aspect of this is a lot of the early Christian thinkers attempted meditation and one of the famed one, ST Augustine actually gave up on meditation when he allegedly could not achieve Ecstasy. Pretty high bar, and I'm sorry that he gave up on it. The Middle Ages stretched us into cannibalistic meditation and the Judaism faith and some of the mysticism around the Sufi branches off Islam and on Lee, really the last 150 to 200 years that we're talking about it really entering Western mainstream to compare with what we're discussing here and what we'd like to fuse it to modern neurosurgery. Most likely, it's a spot right over here, not quite to scale, but just to give you a perspective of the tradition of what we would normally call alternative medicine, where in this case most likely is actually traditional medicine. Each religious spiritual discipline that we were able to look at includes meditation like practices. So a quick list, you know, in Hindus and we talk about Isha yoga and Himalayan yoga in Giant is, um, meditation is critical to that faith. Another interesting component of giant is, um, is you have to wear masks at all times, So we were thinking this would be a really good faith to adopt. Currently, uh, they cannot kill any other living being, and they would always wear a mask to prevent breathing in insects. Sometimes there's a person walking ahead of them, swiping the ground to assure that they do not step on any insects. Judaism. As we said, the Old Testament prophets would go out into the desert and meditate on. But in the Kabbalah, the divine name of God can be considered a mantra that is now more utilized in Western and transcendental meditation. Buddhism. The Paseana yoga is, ah, good off, branching from the previous Hinduism faiths and even stretching into Christianity, something like Catholic prayer beats again. Continuous recitation can be considered a mantra esque attempt of meditation. Then you have Islamist. We discussed before centralization and concentration this term of tomorrow cause and the move levy order, which we probably all know better as the whirling dervishes again entering into. And I apologize. This video is not working, but entering into a state of trance a Z, you continuously spin in a certain rotation. This is a bit of a jest, but Wicca Fallon, my new paganism occultism I will put neurosurgery here because I do truly believe that each one of us has their own early onset of meditation. Whatever it may be, I remember Dr Medicine stressing with us when you are washing your hands, those 5, 10 minutes really set everything else aside and, you know, focus on the case. Forget about the distractions. Think of the ways that you can potentially harm the patients and work your way through avoiding that. Uh, this could be swimming. This could be exercised. But a lot of us already do meditate, which is don't consider labels itself. Excuse me. So what do you perceive benefits of meditation? Well, this gentleman right here. Matthew Ricard is known as the happiest person in the world. Hard to confirm something like this, but a lot of good research has been done mostly in, uh, Wisconsin Madison. Under the guidance of Dr Davidson Stress relief, increased ability to focus performance and specifically stoic performance during difficult and dangerous tasks under significant pressures. It sounds like no surgery to me. Uh, intense serenity, bliss enhanced physical well being heightened self awareness. The perception of time dilates almost a mystic religious experience. And this is the first trick of the lecture. Um, this right here actually is not what is reported as you perceived benefit of meditation, but is the description of a type of epilepsy. Then I want to start making this connection and foreshadowing this early on. This is actually Dostoevsky describing ecstatic epilepsy which is thought to reside in the interior insulin. What should have been in that slide is increased happiness. And in the layperson's term, this is labeled as loving kindness, improved emotional regulation, amelioration of anxiety and depression and the boost of positive mood. I would like to pitch this book to everyone who has time, maybe for your next flight when we're able to travel a really good description of the career and the life path of this gentleman here who in his early twenties forsaken his PhD academic career in France and went thio Tibet and became a So what do we have peer review research wise regarding meditation? Well, there is research showing that there is going to be excessive activity on the left prefrontal cortex compared to the right now, obviously, due to patient confidentiality, we don't know that that research was specifically regarding Matthew Ricard, but he was part of that study and the studies published just without his name of normally large capacity for happiness and reduce propensity towards negativity. And this is all used quantitative and qualitative scales. Long term practitioners are categorized as people who have done more than 50,000 rounds of meditations. This is a lifetime commitment, but at the same time you can make a difference with short term investment. And that would be, you know, 20 minutes a day for three weeks, having you know, a retreat. Three days, seven days, 10 days of a silence retreat where you learn mantra meditation. So this is one of Dr Davidson's papers. Impact of short and long term mindfulness on specifically the reactivity of our Olympic circuit on the amygdala. And what they found is that people who have meditated for a long time are able to decrease reactivity to negative images, people who have moderately meditated. Let's say one of these eight week courses are able to decrease their activity to positive images, which surprisingly, is also very important. And it looks like there is reduced Magdala reactivity and increased connectivity to the venture Lateral prefrontal venture media. I'm sorry, prefrontal cortex, and this may decrease emotional liability off a person. Now, that study was done with FMR. I bowled signal. Uh, this next one here is increased gamma brain wave amplitude compared to control in three different meditation, um, traditions. So what they found is increased gamma activity. We usually call this high gamma around 6200 and 10. And all of these deposit on a Himalayan Yoga issues junior or Isha yoga allow for this kind of movement off your high frequency brain activity and a quick review between focused attention, meditation and open monitoring. Meditation. So the best way to describe this Himalayan yoga would be akin to Catholicism reciting 10 Mary's So it zits focused attention on mantra based, which means you will be reciting a phrase and at some point that should fade away from your attention. But it's still a focus based meditation on something that is external. The possibly is a little bit more towards the open. Monitoring. This would be focusing on somatic sensory awareness. Let's say we had a discussion yesterday focusing on the tip of your nose on the bridge of your nose and spending hours doing that, whereas issue yoga stands a little bit more open monitoring phase, and that is really trying to think of nothing. And there's a personal experience. There was nothing worse than a five year old when my dad told me to go stand in the corner and not think about the polar bear. On the moment I was able to achieve that, I could finish my punishment and leave the corner incredibly difficult to achieve. On most certainly does focus on internal stimulus interception and also allows potentially thoughts to just flow through your brain without getting stuck on any one of them, eventually achieving this open monitoring state. So research on chronic meditators here showed that the gamma power correlated with the reported depth of the meditation session, and you guys can see in this graph here as we head towards frequency above 60 you can see significant separation between the Purple Line of controls and the other three lines of meditation. The types of meditation will have to leave for a later talk. This is clearly a rabbit hole from which there is no escape because the definitions. Unfortunately, I still so fluid. You have Buddhist meditation, which is an and mindfulness. You have transcendental meditation, which can be completely a religious and hence more potentially approachable to the majority of our patients and faculty. This will be manager based. You have yoga meditations, which would be postures, positions, breathing and still mantra. And you have certain the last 200 years, building on the last 2030 years of technological advances where you have paced, breathing and device augmented meditation. So one of the devices will discuss today is the muse, and the other one is the new call. So device based meditation again is not FDA approved, really, for any reason. But it is FDA cleared as a low risk device and there will be against some asterisks to that. And I do wanna have a word of caution before we proceed. So new call utilizes acupuncture meridians for biofeedback. They will introduce things like Gabba tablets. During these sessions, they will actually put a gabigol on your neck to try to access the vagal nerve and use T extract. They will use neuro caustic software frequencies to allegedly slow the brain function. So again, all of those things from the basis of us as scientists are not quite to the level of far of peer review research. But most certainly this is allowing the the population of the United States and other first World countries to really embrace meditation and to give it a try and to get people interested in it. Eso this music this device here, the meuse is a little bit less labor intensive. Uh, this utilizes heart rate and e g from sensors across the frontal lobe here on the forehead, as well as a couple of sensors in the temporal lobe just behind your ear to monitor heart rate and e g for biofeedback. There is no medicinal augmentation, although that's up to the patient, of course, and acoustic software allows you buy a feedback, whereas you're guided to the alleged depth of your meditation during the session itself. Now I do want to caution everyone at the stock. Um, specifically because I've left to form. Potentials are similar to this chronic meditation state of high gamma. And you know, there's some questions about the loving kindness state of meditation that is achieved approaching some intellectual discharges that we see in our patients when we monitor them in and out of the epilepsy monitoring unit. Is there any connection between meditation and this ecstatic epilepsy that is reported in the anterior insulin? This is an incredibly charged topic in literature. Most seem to agree to say that meditation is protective and that the connection between meditation and epilepsy is more of a final common pathway. Meditation is really not something that will potentially promote or start epilepsy patients. But if you in the literature as you see here, do disagree, so let's quickly cover the ecstatic seizures that we spoke about initially is foreshadowing in this talk. So there's not a lot of cases reported in the literature, and we'll discuss the reason for that. Why as well, they are difficult to describe, but overwhelmingly their stated to be a positive experience. The most vivid descriptions, as we mentioned before, will be in the writings of Dostoyevsky. And it's argued whether he had temporal lobe epilepsy, which stayed away from being generalized long enough to actually trigger some of these limbic circuits and for him to experience this ecstatic epilepsy. And you guys have seen the descriptions of this before, right? Intense serenity, bliss enhanced well being hiding self awareness, changing the perception of time all together with unfortunately, ominous experience that they would describe because usually following this is a generalized seizure. So wireless, overwhelmingly positive experience goes on. The patient is aware that this potentially can go to a generalized convulsion and embarrass them or hurt them. The interesting part here is is documented to be potentially triggered by focus on specific memories or focusing on previous epilepsy events that you have had. And is there a connection off this focus, too similar to what we discussed when we discuss meditation, the likely origin of this is the anterior insula to just a quick review. Here, you see the frontal and temporal approach will pull back to reveal insula and the anterior cortex of it. There are case reports where stereo EEG electrodes that are stimulating the entire insulin cause similar effects to ecstatic seizures. There's rapid connectivity and spread to the basil lateral amygdala, which again happens to be one of the circuits in the limbic lobe that we almost always investigate in our stereo e G patients. And here's a quick map, and if you focus on the red in the lower right hand corner, you can see how densely connected the anterior insula is, from the emotional, social and cognitive perspective to the amygdala and to the hypothalamus and to the cortex. Most likely, these were not reported more often because it is such a small area of the entire insulin. If the epilepsy starts just next to it or in the temporal lobe or quickly connects to the middle of temporal lobe, then the seaney ology to perceive the fact of the seizures really does overtake this initial origin, and the patient is unable to separate those two experience to report them. So this interesting paper from 2013 talks about resting state functional structural connectivity within the insulin and amygdala and then connection to the ventral medial prefrontal cortex, which would potentially allow us to manage our anxiety. So all three of those mentioned our notes and the anxiety related processes. They are known to be hyperactive and anxiety disorders, and the possible modulation of the circuit seems to increase gamma power and the ventral medial prefrontal cortex. Is there a component of meditation that potentially builds up resilience and lack of fear? Uh, as meditators go through, this is their way to potentially manage this incredibly complex circuit on again to show you guys here. So B l. A is the base of lateral amygdala, and anterior insula is up above. You can see that there is a feedback mechanism with anxiety between those two, as well as other loops that include associate cor disease and post your insulin as well as the hypothalamus. For those of you who are stressed from this, uh, this diagram here, we will go ahead and modulate your anxiety circuit by introduction off. Happy stimulus, hopefully getting you back away from the anxiety. So what would be beneficial about dampening the Magdala response? Well, um, regarding potential downsides. This would probably make the Socratic method of neurosurgical education less active. Um, you know, I know George is never going to forget that That's the third cranial nerve. And the reason why is because his Magdala was triggered during the questioning by our chair. And he will forever remember that that's what the third cranial nerve looks like on a memory. If we are to dampen that. One of the downsides is the Socratic method of emotional education does not work as well. Same thing about the potential triggers that we have for emotional memories in our life. There's a reason why we remember the birth of our child and our wedding day more than we remember just a regular Tuesday, and that includes this Olympic circuit. Emotional memory. But a lot of the times this amygdala response is not beneficial. And since we have moved away from living in caves and on the plains and running away from tigers, it seems that potentially dampening the Magdala would be good for us. On it would allow us to function better, inherently stressful situations. So can we start considering that part of the limbic lobe, the appendix of the central nervous system. Can this kind of dampening be accomplished through meditation and can modulation of the circuit done extra cranial e or intracranial e augment meditation that allow us to reach those of Michaela dampening states sooner? Well, as an example of a person who is able to achieve this, uh, this is Alex on hold, and if you have not seen this movie free solo yet, I highly recommend it. Um, he is high functioning person who has minimal activation of his left the middle, which is proven by F memories. What it allows Alex to do is to climb El Capitan in Yosemite without the use of ropes. And he was able to do this and I believe, just under four hours. His ability to function under high pressure situation and continuously focusing on his task is the only way I think that anyone could possibly do something like this. So can we get closer to that state potentially through meditation, specifically for Alex? Most likely, genetics have a lot to do with this. His father, although not diagnosed, probably was borderline autistic. And most likely, Alex has inherited just enough genetics to allow his, um, make that look to be dampened in these stressful situations. This can potentially also benefit us. And multitasking and granted multitasking itself is probably an erroneous term. We never truly multitask. We just switch from one task to another, sometimes efficiently and sometimes not to give the semblance of an actual process of multitasking. So the ability to switch from one task to the next quickly without getting stuck on a task rumination something that obsessive compulsive disorder patients go through is incredibly important. And I think it's incredibly important in the neurosurgical community. The ability to be able to see a magic trick for what it is, uh, is the ability to perceive things as they are, and not as where the magician is guiding us. And potentially, if we truly are able to switch from task to task quickly, we can most certainly not be distracted by whatever is happening during a magic trick and can see where the card actually goes or when the rabbit gets placed into a hat. Another important component here is the ability to detach from an emotionally loaded situation when it is not useful in your next task, when something unfortunate horrific happens to a patient's and you're done with that patient conversation and you have to move on in your clinic or in your operative day or in your daily life. The ability to detach from what just happened, as long as it is in no way beneficial to your next task, is critical in the field of nurse surgery, and potentially meditation can help us achieve that. Dr. Benson described this on one of the previous grand rounds, talking about Dr Benton as equanimity as this columnist in the storm. And we now know that this trait, while most certainly inherited, can be developed and can be strengthened, and they are important. Component here is appropriate allocation off, Unfortunately, increments incredibly limited brain resource is that we all have. We're really only able to pay attention, toe one thing at a time. And how can we get better at that to allow our daily lives as neurosurgeons of neuroscientists and its positions to become more efficient? So this paper, again from Richard Davidson's group from Wisconsin in collaboration with a group from the Netherlands, shows that mental training effects your ability on the attention blink task in brief, what happens during that task is you are shown certain letters and you're asked to focus on a specific letter and be able to catch it when you are distracted by another letter. That is not the trigger. And then the letter that you're tasked with shows up a few milliseconds afterwards. We tend to miss it. We tend to spend too much of our limited brain resource on that previous letter. Chronic meditators are able to catch that second letter. They are able to switch from task to task quickly, and our label to appropriately allocate those limited brain resource is So what is happening currently in the field? Well, right now, the research is focusing mostly on extra cranial egg f memory and make studies. There's really no studies of stereo G on meditation. There's really have been no attempts of intracranial stimulation with the goal of reaching potentially meditative states. And there's really limited behavioral feedback and studies with stereo G used for that kind of information gathering and guidance of the patient. The only article that we were able to find is one report of a patient who was undergoing stereo G for her epilepsy evaluation in Europe, who was also an occasional meditator, and they asked her to proceed with meditation exercises. Azaz open to sort of the standard of it, which would just be letting your mind wander. And what they found in that article is when the two tasks were compared again, mind wondering and breath. Focus. My fullness, they so sorry. They first assessed the depth to which her meditation was able to get, and also the thought density thought Density is something that allows us to know how well the patient was able to focus. Decreased. Our density is meditation, whereas increased our density would be mine. Wondering the intellectual epileptic form discharges for this specific patient did increase in meditation compared to mind wondering. So this one patient leans us towards the idea that meditation is an incredibly expensive calorie. Utilizing way to get high gamma up potentially gets us closer to what we would call seizures. So this gets us to the summary slides. Well, what are seizures truly? Why have certain disorders like schizophrenia and epilepsy remained in the gene pool when there's perceiving Lee? No benefit to them, especially for the patients that we deal with whose life is in danger every day. Is there a benefit in this incredibly, you know, taxing state of high gamma hyper synchrony? Are we all on a spectrum from normal to Matthew Ricard and then over to a seizure patient? And can we find the optimum of human function on the spectrum to allow us to do the job that we need to do and do it well with potentially help from meditation? And also do we need to re evaluate what actually happens to the brain when we give somebody kept or Dilantin? How far down on that spectrum are they knocked from Normal and from this potentially high functioning states to being always sleeping and being unable to function. So we'll come back to this gamma activity spectrum hypothesis. But one of the possibilities is that normal is in the middle and meditation. It's somewhere between intellectual discharges and epilepsy. Why is it important in our center here? Well, I think anyone who knows me has seen these slides before. You know, the movers and the shakers in the history of humanity have had epilepsy. John of Arc, Socrates Van Gogh, Dostoyevsky, ST Paul, Alexander the Great. The list goes on and on our history of humanity has been created in part by patients who have had epilepsy. So it is an incredibly important disorder for us to figure out and find out. How do we get people better? At the same time, it is fascinating to learn and find out truly what seizures are and how intellectual discharges can potentially increase our creativity without going all the way to full blown epilepsy. So the FBI grant that our team was likely to receive for this coming year will be regarding interception and meditation, and we would love to invite anyone who is able and willing to collaborate on this. We're building a team to be able to answer some of these questions. Some of the points here would be capturing high gamma in the product civil area, as is proven by AEG using stereoscopic in patients who have meditation or potential version of meditation, which we in the Western society would call prayer. We would go ahead and ask these patients who undergo mindfulness exercises before their stereo gee implantation, and we can compare those two baseline patients who do not go through these meditation sessions. We can investigate the insular MacDill er stereo G implantation and ask patients to meditate and see if there's short term or long term change in their actual brain activity. And we most certainly would love to answer this question. Can we figure out what is going on with high gamma and meditators and also high gamma high frequency oscillations and intellectual seizure like activity? Another fascinating concept here would be B M I applications. So as we were advancing in the world of brain machine interface, we know that the neural noise is a significant downside of everything that we do. Meditators can reduce that, and we could potentially enhance the brain machine interfaces by allowing patients to meditate prior to implantation, thereby significantly decreasing the signal to noise ratio. So future directions here just to pitch it to the wider neurosurgical community. We can do in Tropic of Testing of neurosurgeons to see what actually happens in that magical moment in the operating room where you truly feel in the groove and everything in the case is going well and your focus just on the tumor in front of you, and we can do that with a fairly easy device that is gonna be unobtrusive to most work with the microscope. We could go ahead and check what intracranial stimulation via stereo G or some of the chronic implanted devices like our innocent precepts conduce to augment meditation. We can evaluate the closed loop implants for meditation by a feedback. Can we tell something to patients nowadays to give them a level off potential meditation that they're reaching? If these devices are already there to treat some of their disorders, we have most certainly agreed that exercise causes benefit is a benefit. Unfortunately, what is neglected on, and I think neglected in the surgical community, is this idea that meditation is the exercise for the brain, and it can cause significant benefits to ourselves, to our trainees. And what I want to introduce is potential initiation of some of these projects with our residents, a team. And while initially it is, ah, time sync, uh, over progression and meditation, the which you're able to accomplish with a short meditation session can be akin to eight hours of sleep. And that, I think, is something that we need to focus on since we know time is limited for all of us. So with this. I would like to thank the collaborators on the Grant Helen, neighbor Jake Young and Allison Waters as well as our entire comprehensive epilepsy team. And if there is any time for feedback or questions, we would really appreciate it. Thank you so much for your time. Thanks. Talked about here. Really Beautiful talk would go ahead, Alex. Sorry, Dr Harrison. Just want to ask a question. E think the from a nurse. We just standpoint the natural follow question is, in terms of modulation, what we could do to modulate some of these circuits. Has there been a research look in tow, specifically activating the amygdala, potentially dampening the response. Thio achieve a somewhat Alex Honnold like output, if you will, where we have a damp in the middle response specifically patients with the C d or who have rumination issues that they're unable to achieve a high quality of life due to this hyperactivity of the circuit. So not specifically with meditation. Uh, there is a middle a stimulation that may improve memory. And there's a midlist stimulation research out there right now for something like even depression. So most certainly this has been done, but again, a guys help out if you can. If you're interested. I've been unable to find any study that specifically tries to trigger that circuit in augmentation of meditation and this incredible concept off, potentially allowing you to function in a much higher plane. Less emotional and more logical. Great, thank you. Dead is, um, depression and hyperactivity on that same scale. You know, I've had friends and have colleagues whose kids have been on the various medications. Um, on the one hand, they take a D H D type medications to stimulate their activity, and they perform better on those medications. Those medicine cations can provoke suicide ality. They can provoke all kinds of problems. And then there are people with anxiety and depression who take anti depressants, who say, You know, everything's great, but they can't think very well anymore. And they don't do as well on tests. Have there been SCG studies of people on that spectrum of medication? So the SCG studies that are just coming out right now actually out of, uh, your former school UCSF with Eddie Chang are starting to investigate depression aside from any other co morbidity. So you know, we're really able to do this right now only with patients who have a co morbidity, like epilepsy. They're doing this straight for depression there, implanting stereo G. And they're monitoring for about 10 days. And they're evaluating this entire circuit, including the limbic lobe and dorsal lateral prefrontal cortex, central lateral prefrontal cortex. And they're seeing where in that circuit as their day to day moved changes. Uh, they're potentially able to influence. And what they want to do is they do want to implant in RMS device later on in those areas. Doctor May Brick has a lot of incredible and obviously strong, justifiable opinions regarding why that research potentially is not gonna be as fruitful as we would want. Because, of course, you know, her team has found some of these circuits already, and Dr Capelle and her are doing these implantation now on getting patients better. I will have to look specifically for medication induced evaluations of stereo. I'm not aware of this as of yet, but that's such a great potential avenue to proceed Right. Medication is such a blunt tool that affect it's all over. You may already have. You may already have patients who are on those meds whose data you can mind now that you have so many. So you know, another comment head. It's such a good lecture you're giving, and I can. I've heard you give various parts of it. I can see the maturation of your thought. You know, you may you may be ready for review to write a review paper or some sort of descriptive discussion of what you just presented it. Z really interesting. And I'm sure that would get a lot of interest. Thank you for saying that. Yep, will definitely do that. I think the more we talk about this, the more the interest is created in the community and the more will be able to collaborate. We reached out to Dr Davidson and Wisconsin. So we're going to start that collaboration, hopefully springtime. So we'll have some good feedback for you guys shortly. It had been a great talk, you know, to your final comments. I mean, it's great to get this talk as a follow up to Dr Benton's presentation. Um, last week on leadership in her mention of amygdala hijacking and the brief discussion of emotional intelligence, how strongly do you feel that that in terms of resident wellness and even faculty wellness that we should actually be consistently meditating. I mean, how strong is the evidence that this will improve our performances, neurosurgeons and and improve our well being? Sure. Well, if you are willing to draw the line that is not connected right now to say multitasking, what we call multitasking is important. Nurse search. If you're willing to draw the line, that's something like an attentional blink test, where you're able to switch from one problem to another instantaneously without carrying over emotional liability from the previous task. If you're able to say that's important nurse surgery, then the answer is yes, right. No one has really done that in literature. The only downside I see is again the classic method of training for us right now includes a significant amount of an emotional challenge. All right, that's what we call pooping. Uh, that's how we lock something into a memory of a student and a junior attending. I don't know if we have quite found a better, different way to do this. Most certainly they exist, but they would require a lot Mawr route Force memorization persons again, just doctor medicine, asking you a question and you don't know the answer, and you will never forget it again in your life. So I think we're moving away from what is known as the Socratic method. We know that that is a significant stress to an individual, but the same time we have to be cautious in the field of neurosurgery if we truly do that. Because what we're doing when, um when you know the attendings pimp the residents is you are checking how you would respond to stressful situation. So whichever way you think about it, meditation is going to help. It just may make pimping less effect if you know that you're dampening your potential emotional outcry to a challenging question. Thank you. Well, guys, thank you so much. I I look forward, you know? Please call email. Let us know what you think. Let us know. E o. Come, come. Someone broke up. Hello? Uh, started about instead of quick question. Um, in terms of your clinical experience with patient compliance, uh, given the cultural back personally I want can hear it. Yeah, you go on. No, I'll be Your bandwidth is low. I'm going to cut your sure, but let's go ahead and you know it. So I know a few people first to a, uh, wrong. Sorry, Abby. Let's go ahead and do this via maybe an email to the group. Or if you want Thio, type it into the, uh, into the chat. Um, well, I hope that your data doesn't show that I can't ask questions anymore. Hopefully it won't evolve that quickly. You know, one of the interesting questions that does arises what is required to learn and to form memories. It's a whole different question than how do you multitask? Um, you know, formation of memories requires intention. It requires some level of activation does not happen passively. Uh, and there is some degree of stress associated with that state of mind. So, um, you know the meditation might help you get from transition from one active state to the next. But there is something about learning that requires a high degree of activation, and certainly neurosurgery brings you through some stressful times. That's such an excellent point. And the coolest part of literature coming out of Emory, where they're doing a Magdala stimulation to augment memory is something magical happens they're able to bypass the stress so they stimulate the amygdala. But the patient does not feel the stress, but the memory improves. So in a way, there may exist a shortcut where that emotional liability is not there. But the memories actually imprinted much better just because of a specific and appropriate activation of them. Agreed? Agree. All right, well, I was fantastic. We look forward to more, Ted. Thanks very much. Great, Great.