Yoga Improves Epilepsy-Related Stigma, Seizure Control, and Quality of Life

Manjari Tripathi, MD

In a recently published sham-controlled trial, findings showed that a yoga-based intervention in conjunction with psychoeducation can reduce epilepsy-related stigma, anxiety symptoms, and cognitive impairment in patients with epilepsy. Simultaneously, it may also improve the overall quality of life and train mindfulness in these groups of patients.¹

The study featured 160 patients with epilepsy, aged 18-60 years, who were randomly assigned 1:1 to either yoga and psychoeducation or sham yoga and psychoeducation. To be eligible for the study, patients had scores of at least 4 on the Kilifi Stigma Scale (KSS). Patients who presented with psychogenic nonepileptic seizures (PNES) alone were excluded, while patients with epilepsy and comorbid PNES were included in the trial.

Individuals in the yoga intervention group underwent loosening practices, breathing exercises, meditation, and positive affirmations. The sham yoga module consisted of exercises that mimic the yoga asanas, but the participants were not provided instructions on 2 key components of yoga, namely slow and synchronized breathing, and attention to the body movements and sensations during practice. Felt stigma, demonstrated by changes on the KSS, was the primary outcome in the study.

Led by senior author Manjari Tripathi, MD, an assistant professor of neurology at the All India Institute of Medical Sciences, New Delhi, those in the intervention arm reported significant reduction in felt stigma as compared with the control arm at the 6-month follow-up (Cohen’s d = .23; 95% CI, –0.08 to 0.55; P = .006). In addition, the proportion of patients having at least a 50% reduction in seizure frequency and complete seizure remission at the end of the 6-month follow-up was significantly higher in the intervention group (OR, 4.11 [95% CI, 1.34-14.69] vs OR, 7.4 [95% CI, 1.75-55.89]). Similar differences were observed after 3 months as well.

"Yoga offers an efficacious method to address these comorbidities in a clinical setting," the study authors wrote. "Second, the psychoeducation module developed in this study can easily be delivered by a nurse, medical student, or health care worker. Therefore, the intervention assessed in this trial can be potentially disseminated online or using prerecorded videos using minimal resources."

READ MORE: FDA Clears IND for Gene Therapy Candidate ETX101 in Dravet Syndrome

At the 6-month time point, investigators also observed significant decreases in anxiety, demonstrated through the General Anxiety Disorder-7, and improvements in quality of life, defined using the Quality of Life in Epilepsy Inventory-10, through the yoga intervention. Similar changes were also observed with respect to trait mindfulness and cognitive impairment. Notably, there was no significant improvements in train rumination, cognitive reappraisal, and emotional suppression in both the intent-to-treat group and per-protocol analysis.

In terms of treatment adherence, on average, participants in the intervention group completed 60% of the supervised sessions, while those in the control group attended approximately 54%. Between the intervention and control group, the self-reported median level of home practice was 80% and 60%, respectively. Although these rates of adherence are comparable or greater than previous studies of similar nature, these may still be a source of bias in the analysis, the study authors noted.

"Another interesting finding of this study was the consistently significant increase in trait mindfulness in the intervention group as per both ITT and PP analysis. Mindfulness has been described as the ‘nonjudgmental attention to experiences in the present moment’ and a cognitive skill which can be im- proved with training," Tripathi et al wrote. "It can be hypothesized that yoga improves neuropsychological outcomes in patients with epilepsy by positively modulating trait mindfulness."

REFERENCE
1. Kaur K, Sharma G, Dwivedi R, et al. Effectiveness of yoga intervention in reducing felt stigma in adults with epilepsy. Neurology. 2023;101(23)e2388-e2400. doi:10.1212/WNL.00000000000207944