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| Inside a Flower by Melina Meza |
A: This is a great question, and it turns out quite a few people in the US have seizures and a diagnosis of epilepsy. Before we get to yoga’s potential role in addressing this question, let’s begin with some background info.
Epilepsy is a disorder of the brain that is characterized by recurring seizures. A seizure is a brief, temporary disturbance in the electrical activity of the brain. A seizure is therefore a symptom of epilepsy. How large a problem is epilepsy? According to the World Health Organization:
"Approximately 50 million people currently live with epilepsy worldwide. The estimated proportion of the general population with active epilepsy (i.e. continuing seizures or with the need for treatment) at a given time is between 4 and 10 per 1000 people. However, some studies in low- and middle-income countries suggest that the proportion is much higher, between 7 and 14 per 1000 people.
Globally, an estimated 2.4 million people are diagnosed with epilepsy each year. In high-income countries, annual new cases are between 30 and 50 per 100 000 people in the general population. In low- and middle-income countries, this figure can be up to two times higher.”
So, you can see, epilepsy is more common than some might imagine. Do we know what causes epilepsy? For better or worse, in 70% of people with epilepsy, the cause is unknown. In the other 30%, the most common causes include head trauma, infection of the brain tissue, brain tumor, stroke, heredity, or a prenatal disturbance of brain development.
About Seizures
All of our brain functions, including feeling, seeing, thinking, and moving our muscles, depend on electrical signals passed between the nerve cells of the brain. In a healthy brain, these electrical signals ebb and flow in a way that allows for all of our brain functions to work uninterrupted. A seizure occurs when too many nerve cells in the brain “fire” too quickly, causing what is commonly referred to as an “electrical storm.”
Observation of those with epilepsy has identified a number of things that can trigger seizures, but keep in mind this varies quite a bit from person to person. The list below is pretty inclusive, but there may be other triggers not listed. The asterisks represent areas where yoga could be helpful in some way:
- Flashing or bright lights
- Lack of sleep *
- Stress *
- Overstimulation *
- Fever
- Heavy alcohol use *
- Hyperventilation *
- Menstrual cycle/hormonal changes *
- Dehydration *
- Certain medications/missed medications
- Nutritional deficiencies
There are different kinds of seizures that those with epilepsy experience. A “generalized seizure,” which was previously called a “grand mal” seizure, involves the entire brain and a loss of consciousness. The variation of generalized seizure known as “tonic-clonic” is characterized by rhythmic jerking of muscles, and is the most dramatic form of seizure to witness. There is another variety of the generalized seizure known as an “absence” seizure, which is characterized by a brief loss of consciousness. Seizures that only involve part of the brain and may or may not include loss of consciousness are known as “partial seizures.” The presentation and symptoms of those seizures is related to the part of the brain affected.
How Yoga Can Help
Typical Western treatment of epilepsy involves prescribing antiepileptic drugs. This is helpful in many cases; however, according to an NIH review paper Yoga for epilepsy:
“25-40% of patients on these medications have uncontrolled seizures, experience adverse effect from medication, suffer from stigmatization and have a higher degree of psychiatric disorders as compared with people with other chronic illnesses.”
Therefore, there is a need to look to other therapies that might improve the situation for these people. What has research shown us about the use of yoga for epilepsy? The paper mentioned one study of yoga for epilepsy that used a simple form of meditation, which resulted in reduced seizures. The effect of meditation was attributed to a reduction in the level of stress, as evidenced by changes in skin resistance and levels of blood lactate and urinary vanillylmandelic acid (signs of stress that are measurable).
The paper also reviewed two other studies that were unblinded (not as good as blinded), randomized controlled trials (RCTs) with a total of 50 participants (adults) with refractory epilepsy (not responding adequately to medications). They compared “classical Indian yoga” (they did not go into detail about what all that included) to control groups who received no intervention or interventions such as yoga‐mimicking exercises or Acceptance and Commitment Therapy. Those in both arms of the study were continued on their antiepileptic drugs. The objectives of the review were to assess whether people with Epilepsy who treated with yoga: a) have a greater probability of becoming seizure free, b) have a significant reduction in the frequency or duration of seizures or both, and c) have a better quality of life.
What did they find? Turned out that the yoga intervention was better when compared with no intervention or interventions other than yoga (postural exercises mimicking yoga—don’t you love it, fake yoga!). There was no difference between yoga and Acceptance and Commitment Therapy, a kind of psychological therapy that sound a lot like the cultivation of equanimity (see 7 Ways to Cultivate Equanimity with Yoga), which we have discussed before. The reviewers did not go into detail about the three objectives above. And they also said they could not make any clear conclusions about yoga’s role in treating epilepsy, due to the usual problems: the small number of studies, the small sample sizes, and the un-blinded nature of these studies. They did emphasize that yoga can only be an add‐on to antiepileptic drugs at the present time and cannot be used as the sole method of intervention. So, if you start practicing yoga, don’t stop your meds.
All that said, I still think that starting a yoga practice under the tutelage of an experienced teacher at a level approviate for the student with epilepsy would be a reasonable thing to try. Yoga can affect many of the triggers of seizures from the list above, most obviously, stress and sleep problems, as well as increasing body awareness that could reduce the tendency to become dehydrated, overstimulated, or hyperventilated. And we have mentioned before that yoga may help in increasing self-awareness of the effects of unhealthy habits and addictions, so it could influence alcohol use as well (see Overcoming Addiction with Yoga). These impacts alone may prove beneficial in reducing the frequency of seizures and improve the lives of many with seizures. And at the very least, a regular yoga practice that is focused on stress management would help someone with epilepsy deal with the stress of having this medical condition.
A special thanks to the Oakland Cerebral Palsy Center for a recent presentation on Epilepsy and Seizures for those of us who teach yoga there!
—Baxter
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