Improve Epilepsy with Mindfulness

Improve Epilepsy with Mindfulness

 

By John M. de Castro, Ph.D.

 

“Short-term mindfulness-based therapy significantly improves quality of life and reduces anxiety and seizures in patients with drug-resistant epilepsy.” – Pauline Anderson

 

Epilepsy, also known as seizure disorder, is a chronic disorder that includes a wide variety of neurological dysfunctions with the common property of unpredictable seizures of the brain. The seizures can vary widely from individual to individual in intensity, duration, frequency and parts of the brain affected. Epilepsy occurs to about 4% of the population sometime during their lifetime with about 150,000 new cases each year in the U.S. The first order treatment for Epilepsy is anti-seizure drugs which are effective for about 70% of the cases. These drugs can produce mild side effects of feeling tired, stomach upset or discomfort, dizziness, or blurred vision. In some cases, surgery is called for, removing the portion of the brain where the seizures originate.

 

Epilepsy sufferers often have high levels of anxiety and depression, poor quality of life, and cognitive problems. These secondary symptoms may actually worsen the epilepsy. Hence, there is a need to find safe and effective additional or alternative treatments for epilepsy. Mindfulness training has been shown to produces changes in the brain and has been shown to be effective in treating anxietydepression, and cognitive problems. So, it is possible that mindfulness training may help with drug resistant epilepsy. Indeed, research has shown that mindfulness training can markedly improve epilepsy symptoms in individuals who do not respond to anti-seizure drugs.

 

In today’s Research News article “Mindfulness-based interventions in epilepsy: a systematic review” see summary below or view the full text of the study at:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5360054/

Wood and colleagues review the published research literature on the effectiveness of mindfulness training on the symptoms of epilepsy. They identified three published randomized controlled trials employing group based mindfulness training. They found that the only study that measured anxiety and seizures reported that mindfulness training produced significant reduction in anxiety and in both the frequency and the intensity of epileptic seizures. All three studies reported significant reductions in depression and increases in the knowledge and skills to deal with depression. They also reported improvements in the quality of life of the patients living with epilepsy.

 

Since there were only three published studies included in the review conclusions must be tempered and obviously more research is needed. But, the results reported are interesting and potentially important. It appears that mindfulness training can reduce anxiety and depression in epilepsy patients like it does in healthy individuals and those with other physical and mental issues. But, importantly it also appears to improve the core problem with epilepsy, the seizures themselves. Since, this latter result is based upon a single study, it needs to be replicated in future studies. Hence, the evidence suggests that mindfulness training may be an important adjunctive or stand-alone treatment for epilepsy.

 

So, improve epilepsy with mindfulness.

 

“Mindfulness therapy helped to increase the quality of life of these patients regarding more than just their seizures, and it is certainly a type of therapy that is not harmful.” – RSC Diagnostics

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

Wood, K., Lawrence, M., Jani, B., Simpson, R., & Mercer, S. W. (2017). Mindfulness-based interventions in epilepsy: a systematic review. BMC Neurology, 17, 52. http://doi.org/10.1186/s12883-017-0832-3

 

Abstract

Background

Mindfulness based interventions (MBIs) are increasingly used to help patients cope with physical and mental long-term conditions (LTCs). Epilepsy is associated with a range of mental and physical comorbidities that have a detrimental effect on quality of life (QOL), but it is not clear whether MBIs can help. We systematically reviewed the literature to determine the effectiveness of MBIs in people with epilepsy.

Methods

Medline, Cochrane Central Register of Controlled Trials, EMBASE, CINAHL, Allied and Complimentary Medicine Database, and PsychInfo were searched in March 2016. These databases were searched using a combination of subject headings where available and keywords in the title and abstracts. We also searched the reference lists of related reviews. Study quality was assessed using the Cochrane Collaboration risk of bias tool.

Results

Three randomised controlled trials (RCTs) with a total of 231 participants were included. The interventions were tested in the USA (n = 171) and China (Hong Kong) (n = 60). Significant improvements were reported in depression symptoms, quality of life, anxiety, and depression knowledge and skills. Two of the included studies were assessed as being at unclear/high risk of bias – with randomisation and allocation procedures, as well as adverse events and reasons for drop-outs poorly reported. There was no reporting on intervention costs/benefits or how they affected health service utilisation.

Conclusion

This systematic review found limited evidence for the effectiveness of MBIs in epilepsy, however preliminary evidence suggests it may lead to some improvement in anxiety, depression and quality of life. Further trials with larger sample sizes, active control groups and longer follow-ups are needed before the evidence for MBIs in epilepsy can be conclusively determined.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5360054/

Improve Epilepsy with Mindfulness

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Improve Epilepsy with Mindfulness

 

By John M. de Castro, Ph.D.

 

“We found benefits of short-term psychotherapy on patients with drug-resistant epilepsy. Mindfulness therapy was associated with greater benefits than social support alone in quality of life, mood, seizure frequency, and verbal memory.” – Venus Tang

 

Epilepsy, also known as seizure disorder, is a chronic disorder that includes a wide variety of neurological dysfunctions with the common property of unpredictable seizures of the brain. The seizures can vary widely from individual to individual in intensity, duration, frequency and parts of the brain affected. Epilepsy occurs to about 4% of the population sometime during their lifetime with about 150,000 new cases each year in the U.S. The first order treatment for Epilepsy is anti-seizure drugs which are effective for about 70% of the cases. These drugs can produce mild side effects of feeling tired, stomach upset or discomfort, dizziness, or blurred vision. In some cases, surgery is called for, removing the portion of the brain where the seizures originate.

 

The 30% of epilepsy sufferers who do not respond to drugs are not only afflicted with uncontrollable seizures but also have high rates of anxiety and depression, poor quality of life, and cognitive problems. These secondary symptoms may actually worsen the epilepsy. Hence, there is a need to find safe and effective treatments for drug resistant epilepsy. Mindfulness training has been shown to produces changes in the brain and has been shown to be effective in treating anxiety, depression, and cognitive problems. So, it is possible that mindfulness training may help with drug resistant epilepsy.

 

In today’s Research News article “Pay Attention: Mindfulness in Epilepsy.” See:

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1455665217790733/?type=3&theater

or see summary below or view the full text of the study at:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4988075/

Koubeissi provides a commentary on a study by Tang et. al “Mindfulness-Based Therapy for Drug-Resistant Epilepsy: An Assessor-Blinded Randomized Trial.” In this study, they recruited patients with drug resistant epilepsy and randomly assigned them to receive either social support or mindfulness-based therapy. Treatment occurred every other week for a total of four sessions. They found that the patients treated with mindfulness-based therapy had significantly greater reductions in depression, anxiety, and seizure frequency, and improvements in delayed memory. Importantly, these patients also reported a clinically significant increase in quality of life. Hence, they found that only four sessions of mindfulness-based therapy were very effective in improving the symptoms of drug resistant epilepsy.

 

Koubeissi commented on the importance of the finding of improved quality of life, with the mindfulness-based therapy group showing significant clinical improvement. He claims that this is what is most important to the patients. He attributes the improvements to the ability of mindfulness to improve anxiety, depression, and cognitive problems. By focusing attention on the present moment, mindfulness interrupts the past and future based thinking that results in fear, anxiety, worry, and catastrophizing. He concludes that these reductions relax the patient, allowing them to simply focus on the present symptoms and thereby prevent the exacerbation of the epilepsy. In other words, he concludes that mindfulness doesn’t directly improve epilepsy. Rather, it does so indirectly by preventing the amplification of the symptoms by anxiety and depression.

 

So, improve epilepsy with mindfulness.

 

“One of the scariest things about being epileptic is that you develop this fear of having a seizure in public. I started practicing mindful breathing in order to cope with this anxiety, and it’s especially helpful if I’m somewhere crowded or loud.” – Mango Helath

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts

 

Study Summary

Koubeissi, M. (2016). Pay Attention: Mindfulness in Epilepsy. Epilepsy Currents, 16(4), 245–246. http://doi.org/10.5698/1535-7511-16.4.245

 

OBJECTIVE: To investigate the effectiveness of mindfulness-based therapy (MT) and social support (SS) in patients with drug-resistant epilepsy. METHODS: We performed an assessor-blinded randomized control trial. Sixty patients with drug-resistant epilepsy were randomly allocated to MT or SS (30 per group). Each group received 4 biweekly intervention sessions. The primary outcome was the change in the total score of the Patient-Weighted Quality of Life in Epilepsy Inventory (QOLIE-31-P). Secondary outcomes included seizure frequency, mood symptoms, and neurocognitive functions. The assessors were blinded to the patient’s intervention grouping. Results were analyzed using general linear model with repeated measure. RESULTS: Following intervention, both the MT (n=30) and SS (n=30) groups had an improved total QOLIE-31-P, with an improvement of +6.23 for MT (95% confidence interval [CI] +4.22 to +10.40) and +3.30 for SS (95% CI +1.03 to +5.58). Significantly more patients in the MT group had a clinically important improvement in QOLIE-31-P (+11.8 or above) compared to those who received SS (11 patients vs. 4 patients). Significantly greater reduction in depressive and anxiety symptoms, seizure frequency, and improvement in delayed memory was observed in the MT group compared with the SS group. CONCLUSIONS: We found benefits of short-term psychotherapy on patients with drug-resistant epilepsy. Mindfulness therapy was associated with greater benefits than SS alone in quality of life, mood, seizure frequency, and verbal memory. CLASSIFICATION OF EVIDENCE: This study provides Class II evidence that mindfulness-based therapy significantly improves quality of life in patients with drug-resistant epilepsy.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4988075/

 

Awakening-like Experiences Occur with Epilepsy in the Insula

mystical experiences epilepsy2 Gschwing

By John M. de Castro, Ph.D.

 

“Dostoevsky described his seizures in a letter to a friend: “I feel entirely in harmony with myself and the whole world, and this feeling is so strong and so delightful that for a few seconds of such bliss one would gladly give up 10 years of one’s life, if not one’s whole life.”” – Anil Ananthaswamy

 

Millions of people worldwide perform practices, such as meditation, yoga, and prayer, to achieve a spiritual awakening. Others use drugs such as peyote, ayahuasca  and psilocybin to induce spiritual awakenings. If successful, these people report unique profound experiences that permanently alter their lives and the way they perceive the world. These experiences have many characteristics many of which are unique to the experiencer, their religious context, and their present situation. They include a state of ecstasy, bliss, love and joy, a sense of ultimate freedom and belonging, a transcendence of space and time, a sense of lacking control over the event, a greater sense of meaning and purpose of life, a sense of timelessness, a sense of having encountered ultimate reality, a sense of sacredness, a sense that one cannot adequately describe the richness of this experience. But, the common, central feature of all of these experiences is a sense on oneness, that all things are contained in a single thing, a sense of union with the universe and/or God and everything in existence.

 

The fact that these experiences can be induced by drugs and that drugs have their effects by altering the chemistry of the nervous system, has led to the notion that perhaps these experiences are not actually spiritual but rather simply an altered state of the brain produced by drugs or intense spiritual practices. An important observation in this regard is that alterations of the brain can make it more likely that an individual will have a spiritual experience. Spiritual experiences can occur occasionally with epileptic seizures. This may provide clues as to what neural structures are involved in spiritual experiences.

 

In today’s Research News article “Ecstatic Epileptic Seizures: A Glimpse into the Multiple Roles of the Insula.” See:

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1278188525538404/?type=3&theater

or below or view the full text of the study at:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4756129/

Gschwind and Picard review published cases of individuals who report spiritual experiences with the onset of an epileptic seizure. Their review led them to hypothesize that the focal area for the production of spiritual experiences is the insular cortex. This is a large piece pf cerebral cortex that has been enfolded with growth of the cortex and does not appear on the surface. It has been covered and is buried deep inside at the juncture of the parietal, temporal, and frontal lobes. The insula is highly interconnected with a wide variety of other cortical and subcortical areas of the brain. It has been implicated in consciousness and appears to play a role in diverse functions usually linked to emotion or the regulation of the body’s homeostasis. These functions include perception, motor control, self-awareness, cognitive functioning, and interpersonal experience. So, the insula would appear to be well situated to produce and affect higher level experiences.

 

Gschwind and Picard review cases of spiritual (ecstatic) experiences that occur with epileptic seizures either located in or affecting the activity of the insula. In addition, they review cases where direct electrical stimulation of the insula produce reports of spiritual-like experiences in awake humans. This together with the widespread interconnectivity of the insula and its suspected role in higher conscious experience, makes a case that the insula is the area of the brain that is central to spiritual (ecstatic) experiences.

 

The reviewed information is highly complex and the conclusions are speculative. They are far from proving the case that the insula is responsible for spiritual (ecstatic) experiences. But, it provides sufficient enticing evidence that further scrutiny of this area and its association to these experiences should be undertaken. It should be mentioned that no area in the brain works alone. Rather complex behaviors and experiences are produced by the joint action of large numbers of areas throughout the brain. So, pointing to the insula only suggests that it may be central to the disparate neural system underlying spiritual (ecstatic) experiences.

 

That spiritual (ecstatic) experiences can be produced by epileptic seizures and by electrical stimulation of the brain, combined with the fact that drugs that alter brain chemistry can also produce these experiences, suggests that neural systems may underlie all spiritual experiences. This should not be surprising as the experiences are physical in nature, very unusual sensory experiences, but physical experiences nonetheless. So, it should be as no surprise that a physical entity, the brain, may underlie them. It has yet to be conclusively shown, however, the experiences produced by epilepsy, stimulation, or drugs is the same as that reported by mystics and spiritual seekers. This also leaves open the question as to what it is that’s registering and aware of. these experiences. It appears that regardless of what produces them, the underlying awareness registering them is unchanged.

 

“The anterior insula may be where all manner of feelings, including bodily pleasures and pains; sights, sounds and smells; emotions, expectations and intentions; and even the sense of one’s physical surroundings are integrated into a unified sense of a “self” moving through time.

If this hypothesis is true, then disturbances to the anterior insula would likely cause disturbances to the usual sense of self-awareness.Jim Schnabel

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are available at the Contemplative Studies Blog http://contemplative-studies.org/wp/

 

Study Summary

Gschwind, M., & Picard, F. (2016). Ecstatic Epileptic Seizures: A Glimpse into the Multiple Roles of the Insula. Frontiers in Behavioral Neuroscience, 10, 21. http://doi.org/10.3389/fnbeh.2016.00021

 

Abstract

Ecstatic epileptic seizures are a rare but compelling epileptic entity. During the first seconds of these seizures, ecstatic auras provoke feelings of well-being, intense serenity, bliss, and “enhanced self-awareness.” They are associated with the impression of time dilation, and can be described as a mystic experience by some patients. The functional neuroanatomy of ecstatic seizures is still debated. During recent years several patients presenting with ecstatic auras have been reported by others and us (in total n = 52); a few of them in the setting of presurgical evaluation including electrical brain stimulation. According to the recently recognized functions of the insula, and the results of nuclear brain imaging and electrical stimulation, the ecstatic symptoms in these patients seem to localize to a functional network centered around the anterior insular cortex, where we thus propose to locate this rare ictal phenomenon. Here we summarize the role of the multiple sensory, autonomic, affective, and cognitive functions of the insular cortex, which are integrated into the creation of self-awareness, and we suggest how this system may become dysfunctional on several levels during ecstatic aura.