Panebianco, Mariangela

Restivo, Domenico

Rodolico, Alessandro

Signorelli, Maria

Zavanone, Chiara

University of Liverpool Repository

 Effects of Yoga on Seizure Frequency and Quality of Life for People with Refractory Epilepsy: A Systematic Literature Review1MedDocs PublishersReceived: Nov 03, 2020Accepted: Dec 18, 2020Published Online: Dec 23, 2020Journal: Journal of Psychiatry and Behavioral SciencesPublisher: MedDocs Publishers LLCOnline edition: http://meddocsonline.org/Copyright: © Panebianco M (2020). This Article isdistributed under the terms of Creative Commons Attribution 4.0 International License*Corresponding Author(s): Mariangela PanebiancoDepartment of Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liver-pool, Clinical Sciences Centre for Research and Educa-tion, Lower Lane, L9 7LJ, Liverpool, 29 Errol Street, L177DQ, Liverpool, UK.Tel: +39-349-2807975, Fax: +44-7597-185500; Email: m.panebianco@liverpool.ac.ukJournal of Psychiatry and Behavioral SciencesOpen Access | Research ArticleCite this article: Panebianco M, Signorelli M, Rodolico A, Restivo D, Zavanone C. Effects of Yoga on Seizure Frequency and Quality of Life for People with Refractory Epilepsy: A Systematic Literature Review. J Psychiatry Behav Sci. 2020; 3(1): 1044.AbstractIntroduction: Epilepsy is a common neurological disor-der affecting almost 0.5% to 1% of the population.People who have seizures more frequently have psychi-atric disorders like anxiety, depression and low quality of life as compared with those with other chronic illness.Yoga is an ancient Indian technique of promoting health through exercises, regulation of breathing, and meditation. Yoga may induce relaxation and stress reduction.Method: We performed a systematic review of the lit-erature. We searched the PubMed database (January 2019) for publications using the term “yoga” and “meditation” as keywords. The aim of this review was to evaluate the effects of yoga on seizure frequency and quality of life in patients with refractory epilepsy, comparing yoga with no treatment or different behavioural treatments. Results: Electronic database search yielded 140 records, of which only 2 randomized controlled trials were selected for the metanalysis, recruiting a total of 50 participants. Re-sults of the overall efficacy analysis showed that yoga treat-ment was better when compared with no intervention or with different behavioural treatments. No adverse effects with yoga treatment. The yoga group showed significant im-provement in their quality of life according to the Satisfac-tion With Life ScaleConclusions: Yoga would be a good therapeutic option for epilepsy, in add-on to common AEDs, in view of its non-pharmacological nature, minimal adverse effects and inter-national acceptance. Further high-quality research and fur-ther trials are needed to fully evaluate the efficacy of yoga for refractory epilepsy.Mariangela Panebianco1,3; Maria Signorelli2; Alessandro Rodolico2; Domenico Restivo3; Chiara Zavanone41Department of Molecular and Clinical Pharmacology, Institute of Translational Medicine, Clinical Sciences Centre for Research and Education, University of Liverpool, UK.2Department of Clinical and Molecular Biomedicine, University of Catania, Italy.3Department of Neurology, Garibaldi Hospital of Catania, Italy. 4Department of Neurology, Pitié-Salpêtrière Hospital, University of Paris, France.Keywords: Yoga; Refractory epilepsy; Seizure frequency; Qual-ity of life; Stress reduction.MedDocs Publishers2Journal of Psychiatry and Behavioral SciencesIntroductionEpilepsy is characterized by recurrent and unprovoked sei-zures, constituting a transient sign and symptom of abnormal, excessive electrical activity in the cerebral cortex. Epilepsy is on the most common serious neurological conditions worldwide, with significant psychological and psysical morbidity [13]. Stress is the most common self-reported seizure precipitant in mul-tiple surveys and many people with epilepsy believe stress re-duction improves seizure control [11].Integrative, nonpharmacologic treatments may be a desider-able adjunct to medication in many people with epilepsy [12]. Non-pharmacological interventions include the following: Spe-cialized diets, psychological interventions for example Cogni-tive-Behavioural Therapy (CBT), yoga, acupuncture, relaxation therapy [4]. Yoga is an ancient technique of promoting health through exercises, regulation of breathing, and meditation. Yoga started roughly 5,000 years ago in the Indian subcontinent as part of the Ayurvedic healing science [1]. There are various types of yoga involving postural exercises (anasas), breath control (pra-nayama) and meditation [8].Yoga has therapeutic benefits not only for various mental disorders, but also for some physical diseases, most of which are related to mental factors or mental states, or are aggravated by stress [2].Scientific literature has reported that yoga training alleviates stress [9], increases quality of life and decreases psychiatric problems for those who have epilepsy [6,7,14] and decreases seizure frequency stimulating the vagus nerve [3]. A recent analysis have documented that no reliable conclusions can be drawn regarding the efficacy of yoga as a treatment for uncon-trolled epilepsy, in view of methodological deficiencies such as limited number of studies and limited number of participants randomised to yoga [8]. The aim of this review was to evaluate whether uncontrolled epileptic patients treated with yoga have a significant reduction in the seizure frequency (number of seizures per month) and improve quality of life, comparing yoga with no treatment or different behavioural treatment.MethodsWe performed a systematic review of the literature, report-ing the efficacy of yoga treatment for people of all age and both genders with all types of epilepsy, and with seizures uncon-trolled with one or more AEDs (drug-resistant epilepsy).We searched the PubMed database for articles in English (January 2019), using the terms ‘‘yoga and meditation’’ as key-words. We searched the reference lists of identified papers and articles were also identified through searches of the authors own files. Cross-references were used for search completion. We selected all full-text published articles. Abstracts and un-published articles were excluded. Two authors (MP and MS) independently assessed cases for inclusion. Any disagreements were resolved by discussion with a third author (AR). ResultsThe search revealed 140 records identified from the databas-es in Electronic searches and 66 records remained after dupli-cates and irrelevant articles were removed. 39 full-text articles were excluded for the following reasons: 16 studies were not randomised trials; 6 studies did not study an eligible popula-tion; 10 studies did not an yoga intervention; 7 studies because insufficient information was available. Two studies were identi-fied as ongoing study. Two studies were included in the review and in meta-analyses (Figure 1). Lundgren et al. [5], a single centre trial, randomised 18 sub-jects (12 males and 6 females), aged 18 to 55 years (mean age 23.8 ± 2.7) with uncontrolled epilepsy and had two treatment arms: Yoga (8 patients) and ACT (10 patients). Panjwani et al. [10], another single centre trial, randomised 32 subjects (2 males and 30 females) aged 15 to 35 years (mean age 22.7 ± 2.6) with drug-resistant epilepsy to one of three treatment arms: Sa-haja yoga (10 patients); exercises mimicking sahaja yoga (10 pa-tients); and control group without any intervention (12 patients ). Baseline phase lasted 3 months in both studies and treatment phase from 5 weeks to 6 months in the two trials. Our population consisted of 50 participants (18 treated with yoga and 32 to control investigations), 14 males and 36 females, with a mean age of 23.2 years (range 15-55 years).Overall, the two studies were rated as: Unclear risk of bias (no details of concealment of allocation), high risk of bias (par-ticipants, yoga instructor and outcome assessors were not blinded), and low risk of bias (all participant were included in the analysis; all expected and pre-expected outcomes were re-ported).In Lundgren study the authors reported that there was no significant difference between the yoga and ACT groups in 50% or greater reduction in seizure frequency or seizure duration at one year follow-up. The yoga group showed significant im-provement in their quality of life according to the Satisfaction with Life Scale (p<0.01). In Panjwani study the authors reported that the differences were found to be statistically significant be-tween the groups for seizure frequency (p<0.05). No data were available regarding quality of life. Both trials showed no adverse effects with yoga treatment (Table 1).Figure 1: Flow diagram of systematic review 3Journal of Psychiatry and Behavioral SciencesMedDocs PublishersTable 1: Summary of findings of included studies.Lundgren 2008 Yoga (n=8)Acceptance and Commitment Therapy (ACT) (n=10)Mean age (years) 25.8 21.9Gender M = 5, F = 3 M = 7, F = 350% or greater reduction in seizure frequency7/8 (88%) 9/10 (90%)Adverse effects 0 0Panajwani 1996 Yoga (n=10) Mimicking exercises (n=10) Control group (n=12)Mean age (years) 24.6 23.7 19.7Gender M = 1, F = 9 M = 1, F = 9 M = 0, F = 1250% or greater reduction in seizure frequency9/10 (90%) 1/10 (10%) 0/12 (0%)Adverse effects 0 0 0ConclusionsYoga treatment can reduce seizure frequency when com-pared with no intervention or with other behavioural treat-ments, like postural exercises and mimicking exercises, but no significant difference between yoga and ACT. In fact, analysis of 50 subjects with epilepsy from 2 trials have revealed beneficial effect in control of seizures. Moreover, yoga can improve the quality of life.The major limitation of this systematic review was inad-equate sample size. So further research is needed to evaluate the efficacy of yoga in epilepsy. At present yoga can be considered an attractive therapeutic option for epilepsy, in add-on to common AEDs, in view of its non-pharmacological nature, minimal adverse effects and inter-national acceptance. Declaration of interest Dr Panebianco declares that has no conflict of interest re-lated to the content of this article. The author certify that she has no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; education-al grants; participation in speakers’ bureaus; membership, em-ployment, consultancies, stock ownership, or other equity in-terest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional rela-tionships, affiliations, knowledge or beliefs) in the subject mat-ter or materials discussed in this manuscript. References1.  Anand BK. Yoga and medical sciences. Indian J Physiol Pharma-col. 1991; 35: 84-87. 2.  Bilderbeck AC, Brazil IA, Farias M. Preliminary evidence that yoga practice progressively improves mood and decreases stress in a sample of UK prisoners. Evidence-Based Complementary and Alternative Medicine. 2015.3.  Brown RP, Gerbarg PL. Sudarshan Kriya yogic breathing in the treatment of stress,  anxiety, and depression: part Ineurophysi-ologic model. J Altern Complement Med. 2005; 11: 189-201. 4.  Jackson CF, Makin SM, Marson AG, Kerr M. Non-pharmacolog-ical interventions for people with epilepsy and intellectual dis-abilities. Cochrane Database of Systematic Reviews. 2015.5.  Lundgren T, Dahl J, Yardi N, Melin L. Acceptance and Commit-ment Therapy and yoga for drug-refractory epilepsy: A rand-omized controlled trial. Epilepsy Behav. 2008; 13: 102-108.6.   Miller JJ, Fletcher K, Kabat-Zinn J. Three year follow-up and clini-cal implications of a mindfulness meditation-based stress re-duction intervention in the treatment of anxiety disorders. Gen Hosp Psychiat. 1995; 17: 192-200. 7.   Nespoor K. Use of yoga in psychiatry. Cas Lek Cesk. 1994; 133: 295-7. 8.   Panebianco M, Sridharan K, Ramaratnam S. Yoga for epilepsy. Cochrane Database Syst Rev. 2015.9.   Panjwani U, Gupta HL, Singh SH, Selvamurthy W, Rai UC. Effect of Sahaja yoga practice on stress management in patients of epilpsy. Indian J Physiol Pharmacol. 1995; 39: 111-116.10.  Panjwani U, Selvamurthy W, Singh SH, Gupta HL, Thakur L, Rai UC. (1996) Effect of Sahaja yoga practice on seizure control and EEG changes in patients of epilepsy. Indian J Med Res;     103: 165-172. 11.  Privitera M, Polak E, Fleck A, Haut SR. Stress management inter-vention for living with epilepsy: results of a RCT. Epilepsia. 2015; 56.12.  Privitera M, Walters M, Lee I, Polak E, Fleck A, et al. Character-istics of people with self-reported stress-precipitated seizures. Epilepsy & Behavior. 2014; 41: 74-77.13.  Ramaratnam S, Panebianco M, Marson AG. Lamotrigine add-on for drug-resistant epilepsy. Cochrane Database Syst Rev. 2017; 3.14.  Yardi N. Yoga for control of epilepsy. Seizure. 2001; 10: 7-12.

Effects of Yoga on Seizure Frequency and Quality
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Effects of Yoga on Seizure Frequency and Quality of Life for People with Refractory Epilepsy: A Systematic Literature Review

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