Proponents of meditation tout its ability to reduce seizures in people with epilepsy, while those more skeptical contend that regular practice of meditation could in fact induce epileptic seizures. So, how much of this debate is based on real clinical data and how much on opinion? To answer this question, Epilepsy.com writer, Jenna Martin, interviewed Erik K. St. Louis, M.D., Assistant Professor of Neurology Co-Director, Iowa Comprehensive Epilepsy Program and co-author of the recently published article, “Meditation and epilepsy: A still hung jury” 1 and another forthcoming review on the subject2.

1. What prompted your interest in studying the relationship between meditation and epilepsy?

Our interest in this subject was kindled by a young patient that I had seen who developed new onset mesial temporal lobe epilepsy, who lacked other epilepsy risk factors, and had been a lifelong practitioner of meditation.  I was aware of recent research that had shown evidence for physiological neuronal hypersynchrony seen on electroencephalograms (EEG) during meditation.  While I thought the potential relationship between her meditative practice and her development of epilepsy was probably no more than a chance coincidence, I started to review the literature and was surprised to see that there were a few previous (although nebulously described) case reports of potential associations of epilepsy with meditation.

Conversely, there were also small treatment trials demonstrating possible benefits of seizure reduction with meditative techniques.  Coincidentally, a few opinion pieces concerning epilepsy and meditation started to surface in the medical literature around this time last year.  There seemed to be two schools of thought on a possible relationship between meditation and epilepsy.  Some suggested the possibility that the neuronal hypersynchrony and “psychic” type mental imagery that may accompany meditation may actually reflect the occurrence of simple partial seizures provoked by meditation. On the other hand, many  proponents of meditation objected strongly to this suggestion, citing a few small past treatment trials that had suggested that meditation may reduce seizures in those with known epilepsy.  I made contact with a physician colleague who had personal experience in meditation, who was also keenly interested in objectively and impartially reviewing this literature and proposing future prospective research on the subject of meditation and epilepsy.  So, the examination and suggestion for future research in meditation and epilepsy seemed to us to be an unsettled issue with tremendous public health relevance (given the widespread practice of meditation).

2. In your recent article you discuss the possibility that meditation may precipitate epilepsy while pointing out the flaws of this theory. Can you explain in simple terms how meditation might predispose the brain to seizures?

Meditation has been shown to facilitate physiological (i.e., normal) neural hypersynchrony (the coordinated firing of neurons) in EEG studies, especially in limbic brain areas that are frequently involved in seizure generation.  While unproven, there has been concern raised that the regular practice of inducing neural hypersynchrony by meditation could theoretically raise the risk of “training” neurons to fire in a hypersynchronous fashion, giving rise to the risk of pathological neural hypersynchrony that may give rise to epileptic seizures.

3. There are many types of meditation, and persons who practice meditation achieve variable changes in the level of cognition and brain states. How does this impact the hypothesis that meditation could invoke seizures?

There are several different methods of performing meditative practice.  Each could evoke a different pattern of hypersynchronous neural firing, giving rise to differential risk of precipitating acute seizures, or creating an epileptic tendency.

4. In your article, you point out that well-designed retrospective and prospective clinical studies are needed in order to definitively answer the questions of whether meditation promotes the development of epileptic seizures in susceptible individuals. Can you describe what these studies would look like?

Given the heated discussion in the literature recently, which our articles may only  continue to fuel (1-2), I wish to first state clearly that I am a non-meditator, and have no preconceived agenda regarding the potential relationship of meditation and epilepsy.  However, I think the subject is interesting and of great practical importance in public health, given the millions of worldwide meditators.  As an epilepsy practitioner, I am also intrigued at the possibility of exploiting meditation as a complementary therapy for our patients who suffer from seizures, particularly those with refractory epilepsy, if it can be proven to be a safe and effective therapy.

While there have been past anecdotes of possible aggravation of epilepsy or creation of de novo epilepsy by meditation, I actually remain quite skeptical that this occurs.  To better prove the safety of meditation for both the general population without epilepsy, as well as those patients with epilepsy who may wish to practice it, several different types of studies are necessary.

Retrospective epidemiological research could give us some idea of whether epilepsy is more common in practitioners of meditation compared to the non-meditating population at large.  Prospective studies of practitioners of meditation without epilepsy utilizing the video-EEG technique would be of great interest to determine whether behavioral psychic meditative phenomenon have an epileptic basis, or if meditation may lead to activation of epileptiform EEG discharges.

Additionally, the therapeutic potential of meditation requires additional prospective study to prove whether it may be safely and confidently applied in different epilepsy syndromes.  Large prospective clinical trials of meditation and sham meditation techniques involving patients with different types of epilepsy are needed.

5. Are there any such studies forthcoming?

We are interested in identifying funding sources for this research, and collaborating with both willing practitioners of meditation and those suffering from epilepsy to explore meditation as a potential therapy.  Just to be clear, we have current ongoing research projects that have started at this time, so please  don’t contact us yet to hope to learn about study enrollment or progress.  However, do stay tuned!  , We hope to have some pilot data from a mounting project ready to share within the next year.

Reference:

1. St. Louis EK, Lansky EP.  Meditation and epilepsy: a still-hung jury.  Medical Hypotheses 2006; 67 (2): 247-50.

2. Lansky EP, St. Louis EK. Transcendental meditation®: a double-edged sword in epilepsy? Epilepsy Behav 2006;(in press).