Many adults with epilepsy report that stress can provoke a seizure. Because stress can alter brain chemistry and electrical activity, and disrupt sleep, stress may worsen epilepsy in susceptible people. It can also cause a person to breathe rapidly, or hyperventilate, which makes seizures more likely in some persons, especially those with absence seizures.
Relaxation therapy involves a variety of strategies to reduce stress and foster relaxation. Breathing maneuvers, hypnosis, and other techniques can be employed.
Biofeedback involves learning to control bodily functions that are usually not under voluntary control. One can learn to control these functions by providing information about them to conscious awareness. For example, the heart rate can be modified by listening to a beep every time one’s heart beats and concentrating on lowering or raising the heart rate. Similarly, biofeedback can promote relaxation by lowering the tension in the facial muscles or breathing at a slower rate.
Relaxation therapy and biofeedback can help to improve seizure control in some persons by reducing stress and controlling hyperventilation, but they rarely make someone seizure-free. We need systematic study of these techniques in epilepsy to better define their role. In addition to relaxation therapy and biofeedback, Tai Chi, yoga, and therapeutic massage can also help relieve stress.
Neurofeedback (neuro-EEG feedback, neurotherapy) is a technique that uses operant conditioning of the brain’s electrical activity (EEG) to try and reduce seizure activity. Unlike many CAM therapies, there is good basic science to support this technique. First, a quantitative EEG is obtained to identify abnormal brain rhythms and then target these with conditioning to make them more normal and thereby, hopefully reduce seizure activity. The sessions typically last about one hour, occur 1-3 times per week, and last for 3-12 months. Neurofeedback is a promising technique that has become more popular, although we do not have controlled data to support its use in epilepsy. Also, some practitioners may have limited training and expertise. The Biofeedback Certification Institute of America certifies practitioners and oversees standards.