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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

STEVEN V. PACIA M.D.

NYU Comprehensive Epilepsy Center



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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

  • 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

  • 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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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.