ALTERNATIVE THERAPIES FOR EPILEPSY

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ALTERNATIVE THERAPIES FOR EPILEPSY

• STEVEN V. PACIA M.D.
• NYU Comprehensive Epilepsy Center

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Stress and Seizures
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Stress and Seizures

• You laugh at me for the fearful agonies you say
  I suffer over a coming sermon, but I really
  think sermons have something to do with it
  (seizures)preparing them takes a good deal out
  of me. -Lewis
  Carroll
• c.1861

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Stress and Seizures

• Ramaratnam et al.,2000 Patient survey -stress
  cited as most important seizure precipitant
• Spector et al, 2000- structured interview of 100
  patients cited stress and depression as top
  precipitants
• Spatt et al, 1998- 149 adults w/ epilepsy cited
  psychological stress as most frequent sz
  precipitant

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Stress and Seizures
Magarinos, et al. PNAS 1997
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Exercise and Epilepsy
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Exercise

• Hyperlipidemia, hypertension, obesity, coronary
  artery disease, osteoporosis, diabetes
• Stress reduction and mood effects- Beta-
  endorphins and catecholamines

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Exercise and Epilepsy

• Fear of inducing seizures/injury
• Patients w/ epilepsy exercise less (Jalava et
  al.,1997
• Several small studies indicate better sz control
  w/ exercise (Denio et al.,1989 Nakken et
  al.,1990 Eriksen et al., 1994)

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Exercise Induced Seizures

• Numerous case reports
• Arida et al, 1999- rat seizure model and
  exercise
• 10 incidence of exercise induced seizures
  (Nakken,1999)
• Esquivel et al, 1990- Study of childhood absence
  epilepsy and exercise

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Exercise- Additional benefits

• General recommendations including opportunistic
  exercise (UK stair study)
• Osteoporosis and AEDS (Feskanich et al 2002)
• Mood and Anxiety disorders (Roth, 1994 Eriksen
  1994 Nakken 1990)

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Exercise Recommendations

• Supervised program
• Tailoring for seizure type
• Padded exercise areas, seated bikes, helmets
• Swimming
• Auras and warning signs

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Yoga and Epilepsy
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YOGA

• Originated 5000 years ago in India emerging as a
  tradition around 500 B.C.
• No one historical reference to the beginning of
  yoga no written manuscript
• From Sanskrit to make whole or union of the
  mind, body, and soul
• Disease- body is out of balance. Yoga brings
  body into a state of balance, homeostasis, and
  optimal health.

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YOGA

• Breath control (Pranayama)
• Postures (Asanas)
• Relaxation (Yoga Nidra or Shavasana)
• Meditation

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YOGA Types

• Hatha
• Ashtanga
• Bikram
• Jivamukti
• Therapeutic- Hatha, Kripalu, Iyengar, Viniyoga

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YOGA

• Health benefits- BP, HR, Joint ROM, Balance,
  Alertness, memory, concentration, circulation
• Clinical Studies- asthma (incresed VC),
  arthritis, Type 2 DM, CTS, hypertension
• Yoga and the brain
• EEG studies
• Functional imaging

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EEG and Meditation
Aftanas LI, et al. 2001
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Cerebral blood flow and Meditation
Newberg, et al 2001
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PET Scan during Meditation
Lou, et al. 1999
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Yoga and Epilepsy

• In one survey stress cited as most important
  seizure precipitant (Ramaratnam et al.,2000)
• Preliminary uncontrolled studies suggest sz
  reduction in those practicing yoga regularly
  (Panjwani,1995 1996)

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NYU Study

• Refractory seizures, anxiety or depression
• Baseline seizure frequency, BAI, BDI, and QOL
  survey
• No medication changes
• 6 months of supervised yoga - minimum 2
  classes/wk
• Complications and results

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Conclusions

• Alternative techniques aimed at stress reduction
  may reduce seizures and improve mood in patients
  with epilepsy.
• Comprehensive Epilepsy Centers must take a lead
  role in evaluating and combining alternative
  therapies w/ traditional therapy.