Meditation and epilepsy: A still hung jury

Influence of mindfulness meditation on intracranial EEG parameters in epileptic and non-epileptic brain areas

OBJECTIVE

Mind-wandering is a pervasive human brain state and, when in excess, may promote negative affect and neuropsychiatric conditions. Mindfulness meditation may promote alternate brain states, improving affect and reducing stress. An understanding of the neural basis between these brain states could thus advance treatment of neuropsychiatric conditions, including those associated with epilepsy.

METHODS

To explore the neural basis of mindfulness meditation versus mind-wandering, we enrolled eight patients in a trial of structured mindfulness meditation and open mind-wandering who underwent stereo electroencephalography (sEEG) within the mesial temporal lobe for seizure localization. Electrophysiology was compared between mind-wandering and mindfulness separately for epileptic and non-epileptic MTL. Using fitting-one-over-f modeling, periodic components of electrophysiology were compared in canonical frequency bands of theta (4-8 Hz), alpha (8-13 Hz), beta (13-30 Hz), and gamma (30-55 Hz). Aperiodic components of the power spectra were assessed by the model offset, knee, and exponent.

RESULTS

We found a significant reduction in gamma power (30-55 Hz) within the mesial temporal lobe (MTL) during mindfulness meditation compared with mind-wandering in non-epileptic (p = 1.20E-4) but not in epileptic MTL (p = 0.352).There was also a significant difference between epileptic versus non-epileptic MTL in gamma power between conditions (p = 0.011). There were no significant changes in power across any frequency band within epileptic mesial temporal MTL between brain states. Conversely, there were significant differences between mind-wandering and mindfulness within epileptic MTL in aperiodic components (offset, knee, and exponent, all p < 0.05), while no differences in aperiodic components were seen in non-epileptic MTL (all p > 0.70).

SIGNIFICANCE

Intracranial electrophysiologic modulations between brain state (mind-wandering versus mindfulness) may differ between epileptic and non-epileptic MTL. Modulations in gamma activity in non-epileptic MTL may represent functional changes in brain state, while aperiodic changes in epileptic MTL may modulate propensity for seizures.

Adverse Events of Mind-Body Interventions in Children: A Systematic Review

Mind-body interventions (MBIs) are one of the top ten complementary approaches utilized in pediatrics, but there is limited knowledge on associated adverse events (AE). The objective of this review was to systematically review AEs reported in association with MBIs in children. In this systematic review the electronic databases MEDLINE, Embase, CINAHL, CDSR, and CCRCT were searched from inception to August 2018. We included primary studies on participants ≤ 21 years of age that used an MBI. Experimental studies were assessed for whether AEs were reported on or not, and all other study designs were included only if they reported an AE. A total of 441 were included as primary pediatric MBI studies. Of these, 377 (85.5%) did not explicitly report the presence/absence of AEs or a safety assessment. There were 64 included studies: 43 experimental studies reported that no AE occurred, and 21 studies reported AEs. There were 37 AEs found, of which the most serious were grade 3. Most of the studies reporting AEs did not report on severity (81.0%) or duration of AEs (52.4%). MBIs are popularly used in children; however associated harms are often not reported and lack important information for meaningful assessment.

Adverse events in meditation practices and meditation-based therapies: a systematic review

OBJECTIVE

Meditation techniques are widely used as therapy and wellbeing practices, but there are growing concerns about its potential for harm. The aim of the present study is to systematically review meditation adverse events (MAEs), investigating its major clinical categories and its prevalence.

METHOD

We searched PubMed, PsycINFO, Scopus, Embase and AMED up to October 2019. Eligible studies included original reports of meditation practices (excluding related physical practices such as Yoga postures) with adult samples across experimental, observational and case studies. We identified a total of 6742 citations, 83 of which met the inclusion criteria for MAEs with a total of 6703 participants who undertook meditation practice.

RESULTS

Of the 83 studies analysed, 55 (65%) included reports of at least one type of MAE. The total prevalence of adverse events was 8.3% (95% CI 0.05-0.12), though this varied considerably across types of studies - 3.7% (95% CI 0.02-0.05) for experimental and 33.2% (95% CI 0.25-0.41) for observational studies. The most common AEs were anxiety (33%, 18), depression (27%, 15) and cognitive anomalies (25%, 14); gastrointestinal problems and suicidal behaviours (both 11%, 6) were the least frequent.

CONCLUSION

We found that the occurrence of AEs during or after meditation practices is not uncommon, and may occur in individuals with no previous history of mental health problems. These results are relevant both for practitioners and clinicians, and contribute to a balanced perspective of meditation as a practice that may lead to both positive and negative outcomes.

Cognitive and Behavioral Interventions in Epilepsy

PURPOSE OF REVIEW

Cognitive and behavioral treatments for epilepsy offer several advantages, as they are relatively low cost, are non-invasive, lack serious side effects, and facilitate patient participation. Their role in the management of epilepsy, however, is unclear. The following manuscript will critically review the efficacy data regarding psychological treatments for seizure reduction.

RECENT FINDINGS

Encouraging results have been found for the cognitive behavioral therapy-based Reiter/Andrews approach and mindfulness or arousal-based programs (e.g., yoga, meditation, relaxation, and biofeedback). Most studies attained responder rates between 45 and 90%. Cognitive and behavioral interventions may be considered as low-risk adjuncts to standard therapies. Efficacy data are limited, however, by small numbers of subjects, inadequate randomization, controls, and blinding, brief trial durations, varying methodologies, and variability in the presentation of results. Additional clinical trials are warranted.

EEG Derived Neuronal Dynamics during Meditation: Progress and Challenges

Meditation advances positivity but how these behavioral and psychological changes are brought can be explained by understanding neurophysiological effects of meditation. In this paper, a broad spectrum of neural mechanics under a variety of meditation styles has been reviewed. The overall aim of this study is to review existing scientific studies and future challenges on meditation effects based on changing EEG brainwave patterns. Albeit the existing researches evidenced the hold for efficacy of meditation in relieving anxiety and depression and producing psychological well-being, more rigorous studies are required with better design, considering client variables like personality characteristics to avoid negative effects, randomized controlled trials, and large sample sizes. A bigger number of clinical trials that concentrate on the use of meditation are required. Also, the controversial subject of epileptiform EEG changes and other adverse effects during meditation has been raised.

Spatially Nonlinear Interdependence of Alpha-Oscillatory Neural Networks under Chan Meditation

This paper reports the results of our investigation of the effects of Chan meditation on brain electrophysiological behaviors from the viewpoint of spatially nonlinear interdependence among regional neural networks. Particular emphasis is laid on the alpha-dominated EEG (electroencephalograph). Continuous-time wavelet transform was adopted to detect the epochs containing substantial alpha activities. Nonlinear interdependence quantified by similarity index S(X∣Y), the influence of source signal Y on sink signal X, was applied to the nonlinear dynamical model in phase space reconstructed from multichannel EEG. Experimental group involved ten experienced Chan-Meditation practitioners, while control group included ten healthy subjects within the same age range, yet, without any meditation experience. Nonlinear interdependence among various cortical regions was explored for five local neural-network regions, frontal, posterior, right-temporal, left-temporal, and central regions. In the experimental group, the inter-regional interaction was evaluated for the brain dynamics under three different stages, at rest (stage R, pre-meditation background recording), in Chan meditation (stage M), and the unique Chakra-focusing practice (stage C). Experimental group exhibits stronger interactions among various local neural networks at stages M and C compared with those at stage R. The intergroup comparison demonstrates that Chan-meditation brain possesses better cortical inter-regional interactions than the resting brain of control group.

Potential role of self-induced EEG fast oscillations in predisposition to seizures in meditators

Meditation is a mental exercise practiced widely as an antistress measure and in the belief that it possesses remedial efficacy for a number of medical ailments, especially neurological disorders. Further, there is a general belief that meditation is an absolutely safe practice devoid of any harmful effects. However, with the advent of neuroimaging techniques, the possibility of adverse effects has been raised in recent times. One such issue that has been debated is the potential epileptogenic versus antiepileptic influence exerted by meditation. This brief article attempts to study the potential role of meditation-induced EEG fast oscillations in the predisposition to seizures in meditation practitioners with epilepsy.

EEG paroxysmal gamma waves during Bhramari Pranayama: a yoga breathing technique

Here we report that a specific form of yoga can generate controlled high-frequency gamma waves. For the first time, paroxysmal gamma waves (PGW) were observed in eight subjects practicing a yoga technique of breathing control called Bhramari Pranayama (BhPr). To obtain new insights into the nature of the EEG during BhPr, we analyzed EEG signals using time-frequency representations (TFR), independent component analysis (ICA), and EEG tomography (LORETA). We found that the PGW consists of high-frequency biphasic ripples. This unusual activity is discussed in relation to previous reports on yoga and meditation. It is concluded this EEG activity is most probably non-epileptic, and that applying the same methodology to other meditation recordings might yield an improved understanding of the neurocorrelates of meditation.

Modulation of cardiac autonomic balance with adjuvant yoga therapy in patients with refractory epilepsy

The practice of yoga regulates body physiology through control of posture, breathing, and meditation. Effects of yoga on autonomic functions of patients with refractory epilepsy, as quantified by standardized autonomic function tests (AFTs), were determined. The yoga group (n=18) received supervised training in yoga, and the exercise group (n=16) practiced simple routine exercises. AFTs were repeated after 10 weeks of daily sessions. Data were compared with those of healthy volunteers (n=142). The yoga group showed significant improvement in parasympathetic parameters and a decrease in seizure frequency scores. There was no improvement in blood pressure parameters in either group. Two patients in the yoga group achieved normal autonomic functions at the end of 10 weeks of therapy, whereas there were no changes in the exercise group. The data suggest that yoga may have a role as an adjuvant therapy in the management of autonomic dysfunction in patients with refractory epilepsy.