Biomedical subjects

S Ramaratnam

Publications and source records attributed to S Ramaratnam.

4 recordsLinked to original sources

PubMed2001

Psychological treatments for epilepsy.

BACKGROUND: Psychological interventions such as relaxation therapy, cognitive behaviour therapy, EEG bio-feedback and educational interventions have been used alone or in combination in the treatment of epilepsy, to reduce the seizure frequency and improve the quality of life. OBJECTIVES: To assess whether the treatment of epilepsy with psychological methods is effective in reducing seizure frequency and/or leads to a better quality of life. SEARCH STRATEGY: We searched the Cochrane Epilepsy Group trial register, the Cochrane Controlled Trials Register (Cochrane Library Issue 2, 2001), MEDLINE using OVID (1966 - May 2001) and cross references from identified publications. SELECTION CRITERIA: Randomized or quasi-randomized studies assessing one or more types of psychological or behaviour modification techniques for patients with epilepsy. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed the trials for inclusion and extracted data. Primary analyses were by intention to treat. Outcomes included reduction in seizure frequency, and quality of life. MAIN RESULTS: We found three small trials (50 patients) of relaxation therapy. They were of poor methodological quality and a meta-analysis was therefore not undertaken. No study found a significant effect of relaxation therapy on seizure frequency. One trial found cognitive behavioural therapy to be effective in reducing depression, among people with epilepsy with a depressed affect, whilst another did not. One trial of group cognitive therapy found no significant effect on seizure frequency. Two trials of combined relaxation and behaviour therapy and one of EEG bio-feedback and two of educational interventions did not provide sufficient information to assess their effect on seizure frequency. Combined use of relaxation and behaviour modification was found beneficial for anxiety and adjustment in one study. In one study EEG bio-feedback was found to improve the cognitive and motor functions in subjects with greatest seizure reduction. Educational interventions were found to be beneficial in improving the knowledge and understanding of epilepsy, improving compliance to medication and improving social competencies. REVIEWER'S CONCLUSIONS: In view of methodological deficiencies and limited number of patients studied, we have found no reliable evidence to support the use of these treatments and further trials are needed.

Biofeedback, Psychology↗

PubMed2001

Yoga for epilepsy: methodological issues.

This article deals with the methodological issues that might be encountered in designing and conducting a randomized controlled study of the efficacy of yoga in the treatment of epilepsy. Methodological issues relating to patient selection, randomization, blinding, type of intervention, outcome measures and analysis are highlighted.

Complementary Therapies↗

PubMed2000

Yoga for epilepsy.

BACKGROUND: Stress is considered an important precipitating factor for seizures. Yoga is believed to induce relaxation and stress reduction. The effect of yoga on the EEG and the autonomic nervous system have been reported. Yoga would be an attractive therapeutic option for epilepsy (if proved effective), in view of its nonpharmacological nature, minimal side effects and international acceptance. OBJECTIVES: To assess the efficacy of yoga in the treatment of patients with epilepsy. SEARCH STRATEGY: We searched the Cochrane Epilepsy Group trial register, the Cochrane Controlled Trials Register (The Cochrane Library Issue 4, 1998), MEDLINE for articles published up to the middle of 1998, and also registries of the research council for complimentary medicine were searched. In addition, we searched the references of all the identified studies. Finally, we contacted the members of the Neurological Society of India, several neurophysiology institutions and yoga institutes to seek any ongoing studies or studies published in nonindexed journals or unpublished studies. SELECTION CRITERIA: Randomized control trials and controlled clinical trials of treatment of epilepsy with yoga. DATA COLLECTION AND ANALYSIS: The data were extracted independently by both reviewers and any discrepancies were resolved by discussion. The main outcomes assessed were percentage of patients rendered seizure free, number of patients with more than 50% reduction in seizure frequency or seizure duration and the overall reduction in seizure frequency. Analyses were on an intention to treat basis. MAIN RESULTS: Only one study met the selection criteria, and recruited a total of 32 patients, 10 to sahaja yoga and 22 to control treatments. Antiepileptic drugs were continued in all. Randomization was by roll of a dice. The results of this study are as follows: (i) Four patients treated with yoga were seizure free for six months compared to none in the control groups. The Odds Ratio (OR) (95% Confidence Interval (CI)) for yoga versus sham yoga group was 14.5 (0.7, 316.7) and for yoga versus no treatment group 17.3 (0.8, 373.5). (ii) Nine patients in the yoga group had more than 50% reduction in seizure frequency compared to only one among the controls. The OR (95% CI) for yoga versus sham yoga group was 81 (4.4, 1504.5) and for the yoga versus no treatment group was 158.3 (5.8, 4335.9). (iii) There was a decline in the average number of attacks per month compared to the baseline frequency among the patients treated with yoga. The weighted mean difference ( 95% CI) between yoga versus sham yoga group was -2.1 (-3.1, -1.0) and for the yoga versus no treatment group -1.1 (-1.8, -0.4). (iv) More than 50% reduction in seizure duration was found in seven of the 10 patients treated with yoga, compared to none among the 22 controls. The OR (95%CI) for yoga versus sham yoga group was 45 (2.0, 1006.8) and for yoga versus no treatment group 53.57 (2.4, 1187.3). REVIEWER'S CONCLUSIONS: No reliable conclusions can be drawn regarding the efficacy of yoga as a treatment for epilepsy. Further studies are necessary to evaluate the efficacy of yoga in the treatment of epilepsy.

Complementary Therapies↗

PubMed2000

Lamotrigine add-on for drug-resistant partial epilepsy.

BACKGROUND: Epilepsy is a common neurological disorder, affecting almost 0.5 to 1% of the population. Nearly 30% of patients with epilepsy are refractory to currently available drugs. Lamotrigine is one of the newer antiepileptic drugs and is the topic of this review. OBJECTIVES: To examine the effects of lamotrigine on seizures, side effects, cognition and quality of life, when used as an add-on treatment for patients with drug-resistant partial epilepsy. SEARCH STRATEGY: We searched the Cochrane Epilepsy Group trials register, the Cochrane Controlled Trials Register (Cochrane Library Issue 1, 2000), MEDLINE (January 1966 to December 1999) and reference lists of articles. We also contacted the manufacturers of lamotrigine (Glaxo-Wellcome). SELECTION CRITERIA: Randomized placebo controlled trials, of patients with drug-resistant partial epilepsy of any age, in which an adequate method of concealment of randomization was used. The studies may be double, single or unblinded. For crossover studies, the first treatment period was treated as a parallel trial. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed the trials for inclusion and extracted data. Primary analyses were by intention to treat. Outcomes included 50% or greater reduction in seizure frequency, treatment withdrawal (any reason), side effects, effects on cognition, and quality of life. MAIN RESULTS: We found three parallel add-on studies and eight cross-over studies, which included 1243 patients (199 children and 1044 adults). The overall Peto's Odds Ratio (OR) and 95% confidence intervals (CIs) across all studies for 50% or greater reduction in seizure frequency was 2.71 (1.87, 3.91) indicating that lamotrigine is significantly more effective than placebo in reducing seizure frequency. The overall OR (95%CI) for treatment withdrawal (for any reason) is 1.12 (0.78, 1. 61). The 99% CIs for ataxia, dizziness, nausea, and diplopia do not include unity, indicating that they are significantly associated with lamotrigine. The limited data available preclude any conclusions about effects on cognition and quality of life, though there may be minor benefits in affect balance (happiness) and mastery. REVIEWER'S CONCLUSIONS: Lamotrigine add-on therapy is effective in reducing the seizure frequency, in patients with drug-resistant partial epilepsy. Further trials are needed to assess the long term effects of lamotrigine, and to compare it with other add-on drugs.

Anticonvulsants↗