ALTERNATIVE THERAPIES FOR EPILEPSY

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

2. Stress and Seizures

3. 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

4. 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

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

6. Exercise and Epilepsy

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

8. 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)

9. 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

10. 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)

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

12. Yoga and Epilepsy

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 YOGA • Originated 5000 years ago in India emerging as a tradition around 500 B.C. • No one historical reference to the beginning of yoga; no written manuscript • From Sanskrit – “to make whole” or “union of the mind, body, and soul” • Disease- body is out of balance.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

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

15. YOGA Types • Hatha • Ashtanga • Bikram • Jivamukti • Therapeutic- Hatha, Kripalu, Iyengar, Viniyoga

16. 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

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

18. Cerebral blood flow and Meditation Newberg, et al 2001

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

20. 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)

21. 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

22. 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.