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|Year : 2013
: 55 | Issue : 7 | Page
|Yoga and epilepsy: What do patients perceive?
GH Naveen1, S Sinha2, N Girish3, AB Taly2, S Varambally1, BN Gangadhar1
1 Department of Psychiatry, Advanced Center for Yoga, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
2 Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
3 Department of Epidemiology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
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|Date of Web Publication||8-Aug-2013|
| Abstract|| |
Context: Benefit of yoga therapy in the management of epilepsy is emerging. However, there is no data available about the knowledge, attitude and practice (KAP) of yoga amongst people living with epilepsy (PLWE).
Aims: This study was designed to explore the KAP about yoga among PLWE.
Settings and Design: The study was conducted on 300 PLWE attending the neurology out-patient services of a tertiary care hospital.
Methodology: Three hundred PLWE (male:female=173:127; age: 31.6±12.4 years) attending the neurology out-patient services of a neuropsychiatry hospital were administered a pre-tested KAP questionnaire.
Results: About 87.4% were on regular anti-epileptic drugs and half (50.3%) on monotherapy. Use of complementary and alternative medicine by the respondents included: Ayurveda (26.7%), yoga (25.6%) and homeopathy (16.3%) or folk medicine (29.1%). Nearly 33.7% of the respondents reported that yoga is beneficial in managing epilepsy. More than half the respondents (54.8%) were willing to practice yoga. Those who practiced yoga opined that regular practice of yoga might reduce dosage of medication (62.8%), their side effects (51.3%) and frequency of seizures (54.5%). Majority of the patients were willing to practice yoga, if yoga services were offered.
Conclusion: The gaps in KAP identified in this study point to the need for more systematic effort to bring about awareness of yoga in patients with epilepsy.
Keywords: Attitude, epilepsy, knowledge, practice, yoga
|How to cite this article:|
Naveen G H, Sinha S, Girish N, Taly A B, Varambally S, Gangadhar B N. Yoga and epilepsy: What do patients perceive?. Indian J Psychiatry 2013;55, Suppl S3:390-3
| Introduction|| |
An estimated 6.0 million Indians have epilepsy.  While pharmacotherapy is the mainstay of treatment, factors that determine the health seeking behavior and compliance to treatment include adverse effects with standard anti-epileptic drugs (AEDs),  costs of newer drugs and co-morbidities such as depression, migraine and anxiety. , These aspects influence people living with epilepsy (PLWE) to seek other methods of treatment.
Amidst an increased interest in traditional complementary and alternate systems of medicine ,, yoga with its significant positive effects on mental health , is considered helpful in the treatment of various systemic and neurological disorders including epilepsy. , Yoga is popular, acceptable to the majority and also generally held to be useful and beneficial by the patients. Earlier evidence suggests the usefulness of meditation (Sahaj Yoga) practice in patients with epilepsy and later studies have demonstrated evidence for the use of yoga (Asanas, breathing exercises, relaxation techniques and meditation) as an adjuvant in management of epilepsy, possibly through its influence on the autonomic nervous system. ,,,, There are a few studies which have elicited the patient's knowledge and attitude towards yoga and related it to service delivery. ,,,, However, the perception of benefit in different medical conditions varies.
Hence, the present study was undertaken to assess the knowledge, attitude and practice (KAP) about yoga among PLWE and to ascertain their willingness to utilize yoga as an adjuvant therapy.
| Methodology|| |
Sample and setting
The study was conducted at a tertiary care university teaching hospital for neuropsychiatric disorders in South India. Consecutive patients aged ≥15 years attending the neurological services with a diagnosis of epilepsy who could understand instructions were recruited. Patients with severe neurological and psychiatric illness were excluded. The study was approved by the institutional ethics committee and consent was obtained from the subjects.
The components for the questionnaires used for the survey were arrived at by a consensus amongst the investigators. These questionnaires were administered among 50 PLWE as a pilot study and based on the results from the pilot study, were modified. The modified questionnaires included details of demographics, duration of epilepsy, dosage and type of AEDs, compliance, the duration patients would be willing to practice yoga if offered it, problems related to epilepsy, and utilization of treatment other than allopathy etc.
Three hundred consenting PLWE were interviewed using the pre-tested yoga and epilepsy KAP assessment questionnaire [Appendix 1] [Additional file 1]. The coverage rate was 92% (300/326; 9 did not give consent and 17 were unable to understand the instructions).
Data collected was scrutinized for completeness. Student t-test and Chi-square test were used to test the significance in mean values or proportions respectively. P<0.05 was taken to be significant.
| Results|| |
The respondents' age ranged between 15 and 80 years (mean: 31.6±12.4 years). The sample consisted of 173 males (57.7%) and 127 females (43.3%). About two-fifths (38.7%) had a secondary education and majority (65%) were from an urban area. The duration of epilepsy ranged from 10 months to 9 years and 41.3% had a seizure frequency of >2-3 times/year. Majority of the patients (87.4%) were on AEDs for more than a year and 50.3% were on monotherapy. Common medications used were carbamazepine (51.0%), phenytoin (37.3%) and phenobarbitone (30.3%). Most of the patients (72.1%) reported to be regularly taking their AEDs and more than half (54.8%) had experienced side effects [Table 1]. Further, two-thirds reported that their daily activities were significantly affected (65%), and were experiencing financial burden (57.7%) after onset of the illness.
Interestingly, more than a fourth (28.7%) reported to have used other systems of medicine. These included ayurveda (26.7%), yoga (25.6%) and homeopathy (16.3%) or folk medicine (29.1%).
Benefits of yoga
58.2% of the respondents opined that yoga is a healthy way of living (58.2%), a science which improves the physical, mental and spiritual well-being of a person (48.0%), and a tool to bring a balance between body and mind (46.6%). More than half of the respondents (53.6%) opined that yoga is a potent method of treatment. Positive KAP was noted to be significant among respondents who had more than 10 years of formal education thereby emphasizing the impact of schooling. About one-third agreed that yoga is beneficial in different clinical conditions: Anxiety and depression (44.6%), arthritis (43.7%), obesity (44.4%), headache (35%), diabetes (35.5%), hypertension (34%), sinusitis (33.6%), asthma (30%) and paralysis (24.8%).
Yoga and epilepsy
Nearly one-third (33.7%) reported that yoga is beneficial in managing epilepsy and opined that: Regular practice of yoga would be useful (42.3%); it reduces dose of medication (33.6%), the side effects of medicine (30.1%) and frequency of seizures (30.2%).
One-fifth (19.2%) of those practicing yoga were doing so regularly and majority did Ashtanga or Hatha Yoga (79.5%) [Appendix 2] [Additional file 2]. Greater proportions of those who had practiced yoga opined that regular practice of yoga might reduce dosage of medication (62.8%), the side effects of medicine (51.3%) and frequency of seizures (54.5%).
Yoga in epilepsy care
More than half of the respondents (54.8%) were willing to practice yoga. Majority (42.3%) committed to practice for more than a year, while nearly one-third (31.3%) desired to practice for more than 1 month but less than 1 year. Only about one-fourth (23.9%) agreed to come to the hospital for the yoga sessions and the others (76.1%) preferred to do yoga at their own home settings. Greater proportions of those regular on medication were willing to practice for >1 month (34.7%) or >1 year (35.7%) than those who were irregular on their medication.
In the bivariate analysis, regarding willingness to practice yoga or opining that yoga would reduce frequency of seizures, reduces medicine dose or their side effects, the proportions were statistically not significant with respect to gender and place of residence. However, a statistically significant proportion of males reported that yoga was definitely useful in the management of epilepsy (P=0.03).
More patients who had experienced side effects were willing to practice yoga daily ( P=0.04), so also those with significantly affected daily activities, although the difference in the latter did not reach statistical significance ( P=0.08).
Amongst those regularly taking medications and having experienced side effects, statistically significant proportions felt that yoga would reduce the frequency of seizures and reduce the dosage of medicines but opined that it cannot reduce the side effects of the medicines. The difference was significant with respect to urban location of residence compared to those from rural background ( P=0.04).
| Discussion|| |
In the present study, about one-third of patients reported a positive connotation regarding yoga, particularly among those who had experienced side effects. Interestingly, the PLWE were pragmatic (willing to accept yoga practice for more than a year but within their residential premises) and also optimistic (reduction in frequency of seizures, dosage of medicines). These points of view challenge the notion that patients are passive recipients of care.
A study in patients with schizophrenia has detailed the challenges faced in adding yoga as an adjuvant therapy on regular basis. The primary one seems to be logistic difficulties in coming for yoga regularly such as travelling long distances to the yoga center, lack of family support, financial problems, time constraint, and so on. 
Main-streaming the Ayurveda, Yoga and Naturopathy, Unani, Siddha, and Homoeopathy (AYUSH) systems of medicine is one of the important strategies of the Government of India. Towards this end there have been efforts to introduce clinical services. Integrated and holistic care should not be restricted to mere provision of services. The emergent need is to educate people and create awareness about benefits of individual systems of medicine, thereby popularizing AYUSH. This paper has bridged an important gap in health service delivery by highlighting yoga therapy in the management of epilepsy from a patient's viewpoint.
| Acknowledgments|| |
We thank Mr. Sushrutha and Mr. Bhagath of Swami Vivekananda Yoga Anusandhana Samsthana for their help with transliteration
| References|| |
|1.||Sridharan R, Murthy BN. Prevalence and pattern of epilepsy in India. Epilepsia 1999;40:631-6. |
|2.||Dhanaraj MJ, Jayavelu A. Factors influencing anti-epileptic drug non-compliance. Ann Indian Acad Neurol 2004;7:369-74. |
|3.||Gaitatzis A, Trimble MR, Sander JW. The psychiatric comorbidity of epilepsy. Acta Neurol Scand 2004;110:207-20. |
|4.||Babu CS, Satishchandra P, Sinha S, Subbakrishna DK. Co-morbidities in people living with epilepsy: Hospital based case-control study from a resource-poor setting. Epilepsy Res 2009;86:146-52. |
|5.||Tandon M, Prabhakar S, Pandhi P. Pattern of use of complementary/alternative medicine (CAM) in epileptic patients in a tertiary care hospital in India. Pharmacoepidemiol Drug Saf 2002;11:457-63. |
|6.||Pilkington K, Kirkwood G, Rampes H, Richardson J. Yoga for depression: The research evidence. J Affect Disord 2005;89:13-24. |
|7.||Pilkington K, Rampes H, Richardson J. Complementary medicine for depression. Expert Rev Neurother 2006;6:1741-51. |
|8.||Becker I. Uses of yoga in psychiatry and medicine. In: Muskin P, editor. Complementary and Alternative Medicine and Psychiatry. Washington DC: American Psychiatric Press; 2000. |
|9.||Brown RP, Gerbarg PL. Sudarshan Kriya Yogic breathing in the treatment of stress, anxiety, and depression. Part II - Clinical applications and guidelines. J Altern Complement Med 2005;11:711-7. |
|10.||Sathyaprabha TN, Satishchandra P, Pradhan C, Sinha S, Kaveri B, Thennarasu K, et al. Modulation of cardiac autonomic balance with adjuvant yoga therapy in patients with refractory epilepsy. Epilepsy Behav 2008;12:245-52. |
|11.||Saxena VS, Nadkarni VV. Nonpharmacological treatment of epilepsy. Ann Indian Acad Neurol 2011;14:148-52. |
|12.||Rajesh B, Jayachandran D, Mohandas G, Radhakrishnan K. A pilot study of a yoga meditation protocol for patients with medically refractory epilepsy. J Altern Complement Med 2006;12:367-71. |
|13.||Deepak KK, Manchanda SK, Maheshwari MC. Meditation improves clinicoelectroencephalographic measures in drug-resistant epileptics. Biofeedback Self Regul 1994;19:25-40. |
|14.||Panjwani U, Selvamurthy W, Singh SH, Gupta HL, Thakur L, Rai UC. Effect of Sahaja yoga practice on seizure control and EEG changes in patients of epilepsy. Indian J Med Res 1996;103:165-72. |
|15.||Panjwani U, Gupta HL, Singh SH, Selvamurthy W, Rai UC. Effect of Sahaja yoga practice on stress management in patients of epilepsy. Indian J Physiol Pharmacol 1995;39:111-6. |
|16.||Lundgren T, Dahl J, Yardi N, Melin L. Acceptance and commitment therapy and yoga for drug-refractory epilepsy: A randomized controlled trial. Epilepsy Behav 2008;13:102-8. |
|17.||Say RE, Thomson R. The importance of patient preferences in treatment decisions - Challenges for doctors. BMJ 2003;327:542-5. |
|18.||Chandramoulesswaran V, Dhanaraj M, Rangaraj R, Vengatesan A. Patients' preferences towards antiepileptic drug therapy following first attack of seizure. Neurol India 2006;54:387-9. |
|19.||Rastogi S. Effectiveness, safety, and standard of service delivery: A patient-based survey at a pancha karma therapy unit in a secondary care Ayurvedic hospital. J Ayurveda Integr Med 2011;2:197-204. |
|20.||Guha Mazumdar P, Gupta K. Indian system of medicine and women's health: A clients' perspective. J Biosoc Sci 2007;39:819-41. |
|21.||Baspure S, Jagannathan A, Kumar S, Varambally S, Thirthalli J, Venkatasubramanain G, et al. Barriers to yoga therapy as an add-on treatment for schizophrenia in India. Int J Yoga 2012;5:70-3. |
Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore - 560 029, Karnataka
Source of Support: The research was done under the Advanced Centre for Yoga - Mental Health and Neurosciences, a collaborative centre of NIMHANS and the Morarji Desai Institute of Yoga, New Delhi, Conflict of Interest: None
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