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ALTERNATIVE THERAPIES FOR EPILEPSY STEVEN V. PACIA M.D. NYU Comprehensive Epilepsy Center Stress and Seizures Stress and Seizures

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alternative therapies for epilepsy

ALTERNATIVE THERAPIES FOR EPILEPSY

STEVEN V. PACIA M.D.

NYU Comprehensive Epilepsy Center

stress and seizures3
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 seizures4
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 seizures5
Stress and Seizures

Magarinos, et al. PNAS 1997

exercise
Exercise
  • Hyperlipidemia, hypertension, obesity, coronary artery disease, osteoporosis, diabetes
  • Stress reduction and mood effects- Beta- endorphins and catecholamines
exercise and epilepsy8
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
slide13
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  • No one historical reference to the beginning of yoga; no written manuscript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.
slide14
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
slide16
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

yoga and epilepsy20
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.