ALTERNATIVE THERAPIES FOR EPILEPSY: ALTERNATIVE THERAPIES FOR EPILEPSY STEVEN V. PACIA M.D. NYU Comprehensive Epilepsy Center


Stress and Seizures: Stress and Seizures


Stress and Seizures: 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


Stress and Seizures: 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


Stress and Seizures: Stress and Seizures Magarinos, et al. PNAS 1997


Exercise and Epilepsy: Exercise and Epilepsy


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


Exercise and Epilepsy: 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)


Exercise Induced Seizures: 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


Exercise- Additional benefits: 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)


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


Yoga and Epilepsy: Yoga and Epilepsy


YOGA: YOGA Originated 5000 years ago in India emerging as a tradition around 500 B.C. No one historical reference to the beginning of yoga; no written manuscript From Sanskrit – “to make whole” or “union of the mind, body, and soul” Disease- body is out of balance.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.


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


YOGA Types: YOGA Types Hatha Ashtanga Bikram Jivamukti Therapeutic- Hatha, Kripalu, Iyengar, Viniyoga


YOGA: 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


EEG and Meditation: EEG and Meditation Aftanas LI, et al. 2001


Cerebral blood flow and Meditation: Cerebral blood flow and Meditation Newberg, et al 2001


PET Scan during Meditation: PET Scan during Meditation Lou, et al. 1999


Yoga and Epilepsy: 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)


NYU Study: 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


Conclusions: 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.