Yoga for epilepsy.
BACKGROUND
Stress is considered an important precipitating factor for seizures. Yoga is believed to induce relaxation and stress reduction. The effect of yoga on the EEG and the autonomic nervous system have been reported. Yoga would be an attractive therapeutic option for epilepsy (if proved effective), in view of its nonpharmacological nature, minimal side effects and international acceptance.


OBJECTIVE
To assess the efficacy of yoga in the treatment of patients with epilepsy.


METHODS
We searched the Cochrane Epilepsy Group trial register, the Cochrane Controlled Trials Register (The Cochrane Library Issue 4, 1998), MEDLINE for articles published up to the middle of 1998, and also registries of the research council for complimentary medicine were searched. In addition, we searched the references of all the identified studies. Finally, we contacted the members of the Neurological Society of India, several neurophysiology institutions and yoga institutes to seek any ongoing studies or studies published in nonindexed journals or unpublished studies.


METHODS
Randomized control trials and controlled clinical trials of treatment of epilepsy with yoga.


METHODS
The data were extracted independently by both reviewers and any discrepancies were resolved by discussion. The main outcomes assessed were percentage of patients rendered seizure free, number of patients with more than 50% reduction in seizure frequency or seizure duration and the overall reduction in seizure frequency. Analyses were on an intention to treat basis.


RESULTS
Only one study met the selection criteria, and recruited a total of 32 patients, 10 to sahaja yoga and 22 to control treatments. Antiepileptic drugs were continued in all. Randomization was by roll of a dice. The results of this study are as follows: (i) Four patients treated with yoga were seizure free for six months compared to none in the control groups. The Odds Ratio (OR) (95% Confidence Interval (CI)) for yoga versus sham yoga group was 14.5 (0.7, 316.7) and for yoga versus no treatment group 17.3 (0.8, 373.5). (ii) Nine patients in the yoga group had more than 50% reduction in seizure frequency compared to only one among the controls. The OR (95% CI) for yoga versus sham yoga group was 81 (4.4, 1504.5) and for the yoga versus no treatment group was 158.3 (5.8, 4335.9). (iii) There was a decline in the average number of attacks per month compared to the baseline frequency among the patients treated with yoga. The weighted mean difference ( 95% CI) between yoga versus sham yoga group was -2.1 (-3.1, -1.0) and for the yoga versus no treatment group -1.1 (-1.8, -0.4). (iv) More than 50% reduction in seizure duration was found in seven of the 10 patients treated with yoga, compared to none among the 22 controls. The OR (95%CI) for yoga versus sham yoga group was 45 (2.0, 1006.8) and for yoga versus no treatment group 53.57 (2.4, 1187.3).


CONCLUSIONS
No reliable conclusions can be drawn regarding the efficacy of yoga as a treatment for epilepsy. Further studies are necessary to evaluate the efficacy of yoga in the treatment of epilepsy.
Ramaratnam
S
S
Department of Neurology, Apollo Hospitals, 21 Greams Lane, Off Greams Road, Madras, Tamil Nadu, India, 600006. rsridharan@vsnl.com
Sridharan
K
K
D000529:Complementary Therapies; D004827:Epilepsy / Q000209:etiology / Q000628:therapy*; D006801:Humans; D013315:Stress, Psychological / Q000150:complications / Q000628:therapy; D015013:Yoga