The Brain Deserves More Attention than the Joints
Say "spa" and most people picture joints, backs or kidneys. But the nervous system — brain, spinal cord, peripheral nerves — has its own place in the Czech indication list at Mariánské Lázně (Marienbad), and the spa environment offers it something you will not get in hospital: calm, forest and a regular rhythm.
This article separates two things. What is documented: the neurological diagnoses treated here and the studies on the effect of a spa stay on stress and sleep. And what is experience: the silence, the forest and a slow morning on the colonnade. Both have their value; we simply do not want to speak of them in the same language.
What Stress Does to the Head
Long-term stress shows in sleep, concentration and mood sooner than a person is willing to admit. The good news: experiments with walks in nature show that the brain reacts quickly to a change of environment. In 63 healthy adults, activity of the amygdala — the region associated with fear and stress — during stress tasks fell after a one-hour walk in the forest, whereas after a walk along a busy street it stayed the same (Sudimac et al., 2022, Mol Psychiatry). It was a single walk in healthy people. Even so, it is a good reason to start the spa day in the forest.
What the Spa Environment Offers the Nervous System
1. The Forest on the Doorstep
The Slavkov Forest surrounding Mariánské Lázně is a source of phytoncides — volatile substances that conifers release into the air and to which the forest owes its scent. Studies on forest bathing (shinrin‑yoku), however, mainly measure stress: a meta-analysis of eight studies found lower salivary cortisol after time in the forest than in the city, short-term and with a possible influence of expectation (Antonelli et al., 2019, Int J Biometeorol); a meta-analysis of twenty studies described a short-term reduction in anxiety (Kotera et al., 2020, Int J Ment Health Addict). In 38 healthy adults, a 90-minute walk in nature reduced rumination — the turning over of negative thoughts — as well as activity in the brain region associated with it (Bratman et al., 2015, PNAS); the sample was small. More in the article on forest bathing in the Slavkov Forest.
2. Carbonic Baths
CO₂ baths — both water and dry — are among the most typical treatments of Mariánské Lázně. According to a review of the specialist literature, they increase skin blood flow and produce a sensation of warmth; the review's authors at the same time call for methodologically better studies (Pagourelias et al., 2011, Int J Biometeorol). For neurological patients, spa physicians include them as a relaxing, circulation-promoting treatment alongside rehabilitation; inclusion is decided by the physician according to the state of the circulatory system.
3. The Terrain Cure and Exercise
From the brain's point of view, exercise is the best-documented part of the spa regimen. A meta-analysis of 35 randomised trials in older adults found that regular exercise for at least four weeks raises the resting level of BDNF — a protein that supports the growth and survival of nerve cells (Gholami et al., 2024, Exp Gerontol). Blood BDNF is a laboratory indicator, not a clinical outcome; even so, it is one of the reasons neurologists recommend regular exercise. The terrain cure in Mariánské Lázně combines walking along marked routes with time in the forest — and the physician prescribes it with gradients matched to your fitness.
4. The Drinking Cure as a Morning Ritual
The drinking cure at the springs is prescribed in Mariánské Lázně according to the indication — most often for diseases of the digestive and urinary systems and for metabolic disorders. For the nervous system its value is different: the morning walk to the colonnade, a cup from the spring and a slow stroll are a fixed point of the day around which the rest of the regimen is composed. Which springs and how much is determined by the spa physician.
5. Silence
This is something no hospital can offer. In Mariánské Lázně there is silence — real silence, not just muffled noise. In the morning in the forest park above the Singing Fountain you hear your own footsteps and nothing more. It is not a treatment; it is an experience people come back for — and for a head full of notifications, perhaps the most valuable part of the stay.
Neurological Indications in Mariánské Lázně
Mariánské Lázně is listed in the Czech indication list (Decree No. 2/2015 Coll., group VI — nervous system diseases) for the following diagnoses:
- Polyneuropathy with paretic symptoms (VI/2) — comprehensive care 28 days or contributory care 21 days
- Root syndromes with irritation-destructive syndrome (VI/3) — comprehensive care 21 days
- Conditions after injuries and surgery of the brain, spinal cord and peripheral nerves with movement disorders and signs of returning function (VI/6) — comprehensive care 28 days
- Neuromuscular diseases, primary, secondary and degenerative (VI/8) — comprehensive care 28 days
- Syringomyelia with paretic symptoms (VI/9) — comprehensive care 21 days
- Parkinson's disease (VI/11) — comprehensive care 21 days
The foundation of treatment in this group is intensive rehabilitation and physiotherapy, complemented by balneotherapy and physical therapy. The length of a covered stay is governed by the specific item of the list; for repeat stays it tends to be shorter. For guests insured in the Czech Republic, the referral for spa care is issued by the treating neurologist or general practitioner, and the treatment plan is drawn up by the spa physician at the initial examination.
What the Research Says about Parkinson's Disease
For Parkinson's disease there is also a controlled study of spa treatment as a whole: in a French randomised crossover trial with 31 patients, three weeks of spa treatment improved quality of life, part IV of the UPDRS scale and psychological well-being four weeks after the cure, and treatment costs during the spa period were slightly lower (Brefel‑Courbon et al., 2003, Mov Disord). The sample was small and the effect is documented short-term. A literature review from 2022 found three studies that described improvements in motor function, balance and quality of life after spa rehabilitation in Parkinson's disease; the authors add that the literature is still limited (Maccarone et al., 2022, Int J Biometeorol).
Stress, Sleep and Insomnia: What Is Documented
Stress and insomnia are not a separate spa indication; a stay for them is paid for as a self-paying guest. The studies show, however, that the spa regimen acts on both. In 243 people with moderate to high stress, eleven days of balneotherapy reduced stress, anxiety, depressive symptoms and sleep disturbances, and part of the effect lasted six months (Rapolienė et al., 2026, BMC Complement Med Ther); the results rest on self-assessment. In 362 "sub-healthy" adults in China, five months of regular bathing led to fewer sleep disturbances and less psychological stress than in the control group (Yang et al., 2018, Int J Biometeorol); the study was not randomised. And in 83 Polish older adults with osteoarthritis, the insomnia score fell from 6.97 to 4.78 during 21 days of spa treatment (Onik et al., 2026, Healthcare); the study had no control group.
One thing needs saying clearly: a spa stay does not replace neurological, psychiatric or psychotherapeutic care. If you suffer from long-term insomnia, anxiety, depression or burnout, a spa stay is a complement to the treatment led by your doctor, not an alternative to it.
A Weekly Programme for the Nervous System
The following programme is an example; the specific plan is drawn up by the spa physician at the initial examination according to your diagnosis and fitness.
| Day | Programme |
|---|---|
| Mon | Initial medical examination, terrain cure |
| Tue | Carbonic bath, group relaxation |
| Wed | Individual physiotherapy, drinking cure |
| Thu | Forest bathing, peat wrap |
| Fri | Dry CO₂ bath, yoga |
| Sat | Free programme, walk to Kladská |
| Sun | Final consultation, recommendations for home |
Prevention of Neurodegenerative Diseases
The report of the Lancet standing Commission on dementia prevention lists among the modifiable risk factors, among others, physical inactivity, high blood pressure, depression, social isolation and hearing loss (Livingston et al., 2024, Lancet); this is a summary of observational data. A spa stay offers an environment where several of these factors can be worked on at once:
- Regular exercise under the guidance of a physiotherapist
- Regular sleep in a quiet environment
- Company — shared treatments, concerts on the colonnade, walks in a group
- Less stress
- A blood pressure check at the initial examination and an exercise regimen you take home with you
A preventive stay is not covered by health insurance; you come as a self-paying guest. Prevention is the investment that pays off most of all. More about preventive care at the spa.
When a Stay Is Not Suitable
Diseases in the acute stage and conditions at risk of destabilisation are among the general contraindications to spa care. For neurological diagnoses, the suitability of spa treatment is decided by the treating neurologist and then by the spa physician at the initial examination.
