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Integrating Mind, Brain, Body, and Spirit in Treating Epilepsy (Cont.)
Biofeedback
The possibility that one can voluntarily control the spikes and slow waves indicating seizure activity on an electroencephalogram-n has fascinated researchers since biofeedback's earliest days. As yet, despite some promising work, no simple and certain procedure has been developed.
An early breakthrough came in the work of Barry Sterman (1982), which was followed by confirming studies by Joel Lubar (Lubar et al. 1981) and others. From this work came, for a time, a hospital-based electroencephalogram laboratory procedure to teach persons with epilepsy how to control their brain wave states and eliminate or reduce their seizures. It succeeded in 50 to 60 percent of the cases, but the process was lengthy and expensive in terms of cost, lab use, and technician time. Further, there was no way to determine in advance who would be helped by the procedure, and it has now fallen into disuse.
A simpler procedure has been developed by neurologist Joel Reiter and psychologist Donna Andrews at the Andrews/ Reiter Epilepsy Research Program in Santa Rosa, California (Reiter, Andrews, Janis 1987). Since seizures are more likely to occur in the theta brain wave range (4 to 7 cycles per second), Andrews and Reiter teach clients how to maintain a greater degree of alpha state (B to 12 cycles per second) and to recognize and avoid the bodily sensations that accompany slower theta rhythms. Andrews uses this method in conjunction with relaxation techniques, intervention strategies, and psychology.
The number of training sessions needed to learn biofeedback varies from person to person. Reiter and Andrews do not consider it universally successful and use it as one of several tools. The most recent surge of interest in biofeedback comes from Niels Birbaumer at the University of Tubingen, Germany. This newer method involves learning to recognize and then control certain "slow brain potentials" with the aid of computers and television monitors as well as EEG equipment. Initial work has been promising. When I visited the Epilepsy Center at Bethel in November 1991, I watched on the monitors in an adjoining office while a man of 31 practiced the technique in the lab next door. He had already reduced his seizures from eight to four a month.
However, the method's wide and successful use seems unlikely at present, according to Dr. Birbaumer's presentation to the 50tli Anniversary Meeting of the American Psychosomatic Society in April 1992. The procedure is lengthy-in the case of the patient at Bethel, 28 sessions over an 11-week period; expensive--costly under the relatively benevolent German health care system, prohibitive under the present American system; and the outcome is problematic. People under 40-45 are helped the most, Dr. Birbaumer states; people over 45, not at all (at least in experiments conducted so far).
Stress Management and Relaxation
Other behavioral strategies aim more at preventing rather than intervening in seizures and rely on altering or eliminating seizure-triggering circumstances and conditions. For a long time clinicians denied that stress precipitated seizures, but today it is more generally accepted.
ADVANCES, The journal of Mind-Body Health Vol.8, No.4 Fall 1992
RICHARD
The most prominent stress management method applied to epilepsy is progressive muscle relaxation. It has been subjected to intermittent research since the mid-1970s, when Mostofsky and Balaschak (1977) reported successes with its use. In the early 1980s Mariah Snyder (1983) at the University of Minnesota School of Nursing mounted another research study in which three of four committed participants reduced seizure frequency. The most recent studies from Steven Whitman and colleagues at Northwestern University Medical School confirm beneficial results (The Relaxation Project 1990). This team created a training video, workbook, and five audiotapes on progressive muscle relaxation for persons with epilepsy. The program can be readily integrated into treatmentand should be.
Donna Andrews, as well as many people with seizures, believe that seizures can be blocked with deep diaphragmatic breathing. There is little research here. Currently, a study is in progress under Herbert Benson at the Mind /Body Medical Institute of the New England Deaconess Hospital/Harvard Medical School. The study will test whether the "relaxation response" with its component of deepened breathing can help prevent seizures.
Nutrition
In terms of prevention, I briefly want to mention some potentially important developments in the area of nutrition.* In a recent study (Ogunmehan and Hwang 1990) twentyfour children whose seizures were not controlled by medication were divided into two groups, experimental and control, and the experimental group took 400 IU's of vitamin E dairy for tl-iree months in addition to their aiiticonvulsant drugs. The vitamin E, it should be emphasized, was "add-on" therapy. Six of the experimental twelve reduced their seizures 90 to 100 percent; four, 60 to 90 percent; two were noncompliint. No toxic
rcir 1 review of additional aspects of prevention, I refer reader.% to my book, written with Joel Reiter,
EI)ilep.,;y:A New Alyliri)acit (Richard and Reiter 1990).
effects of 400 IU's of vitamin E were reported. The researchers write:
The clinical effect of vitamin E did not appear to be influenced by age, sex, duration of epilepsy, number of seizures, type of epilepsy, or neurologic deficit.
Would a similar regimen help adults? A few young adults, severely handicapped and with cerebral palsy, were part of another vitamin E study (Higashi, Tamari, Ikeda 1980). For these young people, vitamin E proved ineffective.
Would normal adults be affected? I know of no such study, but, obviously, one should be conducted. Would 400 IU's of vitamin E be sufficient to make a difference in seizure activity? There is no answer at present. Eight hundred IU's were given in a study of vitamin E and the immune system at the Tufts Human Nutrition Center on Aging, and no side effects were reported. As much as 1,200 IU's are sometimes taken in cancer prevention regimens without adversities and reactions. But at such levels an adult is on his/her own. It should be stressed again that vitamin E has not proved to be a primary anticonvulsant but works as add-on therapy with anticonvulsant medication.
Behavioral techniques, both intervenlive and preventive, need to be integrated into a comprehensive treatment model for epilepsy. In combination, medical and behavioral approaches currently hold the highest likelihood for seizure control and, possibly, elimination and for the return to a reasonably normal life for the person afflicted with epilepsy. | 
