Yoga Poses and Workouts
Few studies of yoga and epilepsy have been done. One study looked at yoga in three small groups of patients, all with uncontrolled seizures (26). Ten patients were prescribed a 6-month trial of yoga. Another group performed postures that only mimicked yoga. The third group did not perform yoga. Seizure frequency was reduced by 86 in the yoga group, but no change in seizure frequency occurred in the remaining two groups. Additionally, the yoga group exhibited less signs of stress after completing the yoga trial (27). This finding was based on physiologic measures of stress, such as the galvanic skin response. These results have not been replicated by other investigators.
Yoga has developed in India over the past 5,000 years. It has exploded in popularity as a means to maintain general health, to reduce stress, and to complement standard medical therapy. Yoga literally means to yoke together or to make whole. There are several types of yoga, but the type most applicable to complementary medicine is hatha yoga or versions of it. The main components of hatha yoga are meditation, controlled breathing, and physical postures. Although elements of yoga are found in ancient Hindu spir itual texts, practicing yoga is not necessarily a religious activity for most people. Many patients need to be reassured that yoga is not at odds with their religious beliefs. Yoga is also not a competitive sport. One need not be a contortionist or gymnast to do it. Therapeutic yoga programs require instructors to be sensitive to the needs and abilities of the individual. Yoga may be practiced at many levels, and patients of all body types and abilities may derive benefits. Yoga...
Comprehensive epilepsy centers offer the latest in medical and surgical treatments to alleviate the crippling effects of recurrent seizures however, despite our best efforts, many patients have poorly controlled seizures or suffer from commonly associated depression or anxiety. With growing frequency, patients and their physicians are looking to complementary techniques, especially nonpharmacologic ones, to reduce the burden of seizures and to ease anxiety and depression. Exercise and yoga have well-established health benefits. Preliminary studies suggest that both may improve the quality of life for patients with epilepsy. Patients with uncontrolled seizures cite stress as one of the most important seizure precipitants (1). Stress management may be accomplished through aerobic exercise and yoga, and some physicians are interested in these techniques as complementary therapies for patients with uncontrolled seizures (1,2). Unfortunately, many patients with seizures are counseled...
Yoga Yoga is a technique that often places more emphasis on the physical aspects of achieving an altered state of consciousness. Essential to this form of yoga is the adoption of an appropriate physical posture that can enhance concentration and the regulation of word repetition (6).
In an elegant study, Telles and colleagues (10) proved a similar point by studying the effectiveness of yoga relaxation techniques. They compared oxygen consumption with respiratory and heart rates during cyclic activation by using a yoga posture alternating with Shavasana (the corpse posture), and by using Shavasana alone. To their surprise, they found more reduction in oxygen consumption during cyclic activation than during the lying down posture.
Meditation induces relaxation and attentional changes. Whether attentional changes and changes in relaxation during meditation influence these areas in the brain remains to be tested. Perhaps through these changes, meditation may normalize the activity of thalamocortical circuits and produce a normal pattern of EEG frequencies. Some also propose that meditation may boost some naturally occurring endogenous antiepileptic chemical substances in the brain. Results from our study appear to be mediated through nonautonomic and nonstress mechanisms, as evidenced by specific EEG changes. Another Indian study claimed a reduction in stress after Sahaja Yoga intervention in epileptics (32).
At the NYU Comprehensive Epilepsy Center, we offer yoga to our patients. We hope to confirm yoga's ability to reduce seizure frequency and to improve anxiety and depression. While studies are still in progress, we receive positive feedback from nearly all participants. Instructors have tailored the program to the abilities of each patient, and even patients who have never been in exercise programs enjoy yoga. In addition to yoga, patients appreciate the camaraderie of the group. No adverse effects of yoga for epilepsy have been reported in the medical literature. In our experience, seizures during yoga class are rare. When seizures do occur, they often happen in patients new to the program and anxious about the experience. Invariably, patients become more comfortable as they learn yoga. Controlled breathing is performed gently and slowly to avoid hyperventilation, which can cause seizures in susceptible patients. Although joint and musculoskeletal injuries may rarely result from...
Despite its popularity, only a limited number of research studies have been undertaken with yoga. Unfortunately, many of them are small or have significant flaws. The effects of yoga on symptoms observed in multiple sclerosis (MS) have undergone limited investigation. One well-designed study evaluated the effects of yoga on MS symptoms (1). In this study, 69 people with MS were treated for six months with a conventional exercise program, yoga, or no intervention. Those treated with yoga or conventional exercise showed decreased fatigue. No effect on mood or cognitive function was noted with the use of yoga or conventional exercise. In other studies, anxiety and stress have been reduced with yoga this effect may be long-lasting. Several studies in the general population indicate that yoga may relieve depression. People with pain, including headaches and low back pain, may benefit from yoga. Some reports document decreased muscle stiffness with yoga, but this has not been formally...
Hatha yoga and meditation for neurological conditions. In Oken BS, ed. Complementary Therapies in Neurology. London Parthenon Publishing, 2004, pp. 159-167. Ross R. Yoga as a therapeutic modality. In Weintraub MI, Micozzi MS, eds. Alternative and Complementary Treatments in Neurologic Illness. New York Churchill Livingstone, 2001, pp. 75-92.
Haldeman et al. (29,30) reported that stroke, often associated with cervical manipulation, is a rare, remote, and unpredictable risk, with causes that include both minor and major traumas. Haldeman found examples of stroke following minor trauma, such as those experienced during yoga, archery, and getting one's hair washed, as well as after major trauma, such as a car accident. Currently accepted estimates of the frequency of a stroke resulting in serious neurologic complications or death following manipulation are between 1 and 3 per million adjustments, and one in 400,000 patients (20,30,31). The most commonly accepted estimate of the risk of stroke (with or without serious neurologic complications) following manipulation is 1 in 1,000,000 patients (20,31).
Oxygen consumption and respiration following two yoga relaxation techniques. Appl Psychophysiol Biofeedback 2000 25 221-227. 13. Bagchi BK, Wenger MA. Electrophysiologic correlations of some yoga exercises. Electroencephalogr Clin Neurophysiol 1957 7(suppl) 132-149. 16. Desiraju T. Neurophysiologic assessment of brain states in meditation and yoga. Proceedings of the Satellite Symposium on States of Consciousness. World Congress of Neurology, New Delhi. Oct. 20-21, 1989. 22. Okuma T, Kogu E, Ikeda K, et al. The EEG of yoga and Zen practitioners. Electroencephalogr Clin Neurophysiol 1957 (suppl 9) 51. 32. Panjwani U, Gupta, Singh SH, et al. Effect of Sahaja Yoga practice on stress management in patients of with epilepsy. Indian J Physiol Pharmacol 1995 39 111-116.
In additional to a plethora of antiepileptic drugs (AEDs) commonly used today, a number of nonpharmacological options are available. Two of these approaches, the ketogenic diet (high-fat, low-protein, and low-carbohydrate) and vagal nerve stimulation (implantation of a stimulating device in the chest wall), are well supported by the literature. In addition, after chiropractic adjustments (often directed to the upper cervical region), several case studies (2,34-38) have documented improvements in patients with epileptic seizures. The use of acupuncture, yoga, and a host of supplements has been met with much more limited success.
Sussman, Dent, and Lichtman (2000) designed an innovative school quit-smoking program that featured interactive activities, such as games and talk shows, alternative medicine techniques (i.e., yoga, relaxation, and meditation), and behavioral strategies for smoking cessation. Two hundred and fifty-nine students enrolled in the program at 12 schools and another 76 students served as standard care controls (smoking status surveyed at baseline and at 3 months). Objective measures of cigarette smoking were used. Elective class credit and class release time were offered for participation in the program.
Yoga may be performed in groups or individually. Yoga techniques may be learned in classes, which are about 60 minutes in length. Group classes cost between 15 and 30, and private sessions are 25 to 35 per hour. Benefiting from yoga requires an ongoing commitment several hours per week over weeks to months generally are required. Yoga classes often are available through recreation centers, the YMCA, and schools. A listing of yoga teachers is available each year in the July August issue of the Yoga Journal (2020 Milvia Street, Berkeley CA 94704 510-486-2858 ). Pathways Exercise Video for People with Limited Mobility is a video showing yoga poses designed for people with MS. Information about the southern California yoga and MS program may be obtained from the southern California chapter of the National Multiple Sclerosis Society at www.nationalmssociety.org CAL home or 2440 S. Sepulveda Boulevard, 115, Los Angeles CA 90064 (800-344-4867 or 310-479-4456). General information on yoga is...
Much of this book is devoted to methods of reducing stress and harmful responses to it. It is clear that there are many ways to achieve the same goal. Whether we use progressive relaxation, neurofeedback, yoga, exercise, or another method, consistency and comfort with the techniques are critical to ensure a lasting clinical response. As comprehensive epilepsy centers continue to embrace these techniques for their patients, more practitioners will become familiar with and sensitive to the special needs of people with epilepsy. Neurologists treating patients with seizures will also become more comfortable prescribing stress reduction therapies for their patients.
Many possible exercise programs are possible for people with MS. They may include stretching exercises, walking, running, and a range of other exercises that may be appropriate for all levels of physical functioning. Hydrotherapy, or aquatic therapy, refers to exercising in water. This form of exercise is especially well-suited for some people with MS because water eliminates the risk of injuries from falling, and cool water may prevent body warming while exercising. In addition, exercise may be obtained by using unconventional approaches, such as yoga and t'ai chi, both of which are discussed elsewhere in this book.
Many patients cannot exercise for prolonged periods or participate in strenuous activities, but even modest levels of exercise may be beneficial. In a study of post-menopausal women, 41 lower risk of hip fracture occurred in women who walked at least 4 hours each week, compared with those who walked for less than 1 hour (19). For patients with epilepsy who are unwilling or unable to exercise, and for those patients whose seizures occur frequently with aerobic exercise, other forms of physical fitness, such as yoga, may be safe and effective alternatives.
Several studies have investigated the benefits of acupuncture, yoga, and various supplements in epilepsy patients. In general, these studies show minimal, if any, clinical benefits derived from any of these approaches. The Cochrane Collaboration reviewed the evidence of the effects of yoga in epilepsy patients (40). Only one study met the reviewers' selection criteria, and they felt that no reliable conclusions could be drawn regarding the efficacy of yoga as an epilepsy treatment (40).
Yoga J July August 1997 96-103. Nayak NN, Shankar K. Yoga a therapeutic approach. Phys Med Rehabil Clin N Amer 2004 15 783-798. Oken BS, Kishiyama S, Zajdel D, et al. Randomized controlled trial of yoga and exercise in multiple sclerosis. Neurol 2004 62 2058-2064. Pilkington K, Kirkwood G, Rampes H, et al. Yoga for depression the research evidence. J Affect Disord 2005 89 13-24.
Exercise may provide beneficial effects for many different MS symptoms. Because of its many benefits, some form of exercise should be a component of a broad-based treatment plan. As explained in Chapter 20 on exercise, conventional and unconventional exercise programs are available. Conventional exercise programs may be developed with a physical therapist. Hydrotherapy, or water exercise, may be especially well-suited for people with MS who have leg weakness or walking difficulties. Unconventional exercise programs that may provide beneficial effects for those with MS include t'ai chi and yoga.
As noted throughout this book, people with epilepsy often experience high levels of stress. Exercise and yoga are excellent ways to manage stress, but people with seizures are often advised not to exercise, and they may not be told about the potential health benefits of yoga. Lack of exercise has many negative health consequences, whether or not someone has epilepsy, including obesity, cardiovascular disease, thinning of the bones, and depressed mood. Epilepsy specialists are reconsidering whether people with epilepsy should be encouraged to exercise and participate in other forms of movement therapy, such as yoga. Dr. Pacia discusses these topics in this chapter and suggests that exercise and yoga may be beneficial for people with epilepsy, particularly for reducing stress and maintaining bone health. He reports the results of small studies and suggests the need for large-scale studies. People who have a history of seizures induced by exercise or hyperventilation should probably...
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