CINCINNATI—Despite the wide range of treatments available for people living with epilepsy, at least one third will continue to experience frequent seizures. For those who do not respond well to medical treatments, there is an increasing interest in behavioral interventions for epilepsy.
A new study by researchers at the University of Cincinnati (UC) looked at use of mindfulness-based therapies—muscle relaxation, deep diaphragmatic breathing and focused attention techniques—to reduce stress and the frequency of seizures in patients with treatment-resistant epilepsy. The results are published in the Feb. 14, 2018, issue of Neurology, the medical journal of the American Academy of Neurology.
“The field of stress represents a focus of both clinical and translational research in epilepsy,” says Michael Privitera, MD, director of the UC Epilepsy Center, professor in the Department of Neurology and Rehabilitation Medicine at the UC College of Medicine and a co-author on the study. “Studies show that stress is the most frequently endorsed seizure trigger and an increase in stress can correlate with an increase in seizures. Therefore, we hypothesized that introducing stress-reducing behavior modifications could work to complement anti-epileptic drug treatments.”
The study enrolled 66 patients and provided two behavioral interventions: one group of patients were instructed to adopt a practice of deep diaphragmatic breathing as well as controlled muscle tensing and relaxing while a control group used focused attention techniques coupled with extremity movements without the muscle exercises.
Progressive muscle relaxation is the practice of holding or tensing a muscle group for a few seconds as you inhale, and then relaxing the muscle again as you exhale, repeated with all muscle groups in the body. Participants listened to an audio recording to guide them through the practice, taking about 5 to 15 minutes daily.
In addition, the second group of patients was asked to write down their daily activities of a previous day. All participants kept twice-daily electronic diaries of mood and stress variables, and adherence rate was high—with a nearly 85 percent diary completion rate.
Both techniques showed improvement in patients. Compared to baseline, seizure frequency reduced in the group practicing muscle relaxation by an average of 29 percent, and the focused attention group reduced by 25 percent. “Both groups showed a statistically significant reduction of seizures. Only the muscle relaxation group showed a significant reduction of self-reported stress,” says Privitera.
“Stress reduction techniques like progressive muscle relaxation and deep diaphragmatic breathing are simple, low cost and low risk adjuncts to medication that this study found could effectively reduce seizures in even the most resistant cases,” says Sian Cotton, PhD, professor in the Department of Family and Community Medicine at the UC College of Medicine and director for both the UC Center for Integrative Health and Wellness and UC Health Integrative Medicine.
“The study confirms that a behavioral stress reduction approach was effective and well-adopted by patients. The progressive muscle relaxation successfully reduced stress, but the connection to how it reduced seizures remains unknown. I think this highlights the need for larger studies of this kind which target behavioral therapy techniques to improve the quality of life for patients with epilepsy,” says Privitera.
Additional authors on the study include: Sheryl Haut, MD, and Richard Lipton, MD, Montefiore Medical Center and the Albert Einstein College of Medicine; Susannah Cornes, MD, University of California San Francisco; Alok Dwivedi, PhD, Texas Tech University Health Sciences Center; and Jeffrey Strawn, MD, University of Cincinnati College of Medicine.
This study was supported by an unrestricted grant from the Shor Foundation for Epilepsy Research and an unrestricted grant from the Epilepsy Foundation.