IEC 2025 | Mechanisms of self-control in epilepsy: modulation of epileptic spikes by emotion and relaxation

This is also a question that is particularly close to me since the studies that are conducted at Oregon Health and Science University for the possibilities what patients can do on their own against epilepsy to overcome the attitude of being a victim of a terrible condition that affects one’s brain to become self-empowered and do something against your disease and become self-effective. So there have been a number of studies in particular published by Rosa Michaelis but also our study at Oregon Health and Science University that it’s possible for patients to reduce their seizure frequency by relaxation methods and to recognize triggers for epileptic seizures. So in this study that I presented at the meeting in Lisbon, we tried to explore physiological mechanisms, both of how seizures arise from sleep, the most common trigger for epileptic seizures. So we tried to see if there are physiologic measurements that can explore the effect of stress. So we had 14 patients that underwent EEG testing during these they were asked to enter states of emotional stress in particular anxiety and anger by imagining situations in which they had felt fearful or angry and then we measured their physiologic changes. Interestingly we found that anxiety or fear indeed increased epileptic spikes as we expected on the other hand anger did not. I come back to that why that probably was not the case. Then we explored the physiologic effect of relaxation techniques which patients learned in this study to reduce their seizure frequency. And interestingly also contrary to our expectation we found that the five-minute period of relaxation actually increased rather than decreased the frequency of epileptic spikes. Now how do we understand that? Well it’s well known that at the beginning of sleep and relaxation typically epileptic spikes increase at first and then decrease later. Similar activity also happens with the vagus nerve stimulator so we can surmise from this that a period of relaxation or sleep may be an opportunity for the safe blowing off of seizure potential so we do relaxation but we are careful for that not to go too deep so as to trigger an epileptic seizure but to allow in the period of relaxation the blowing off of epileptic spikes as seizure potential. And this is also my understanding of why anger did not increase spikes because anger increases mental presence and cognition and may increase the potential for epilepsy but this does not come into appearance until later when we relax. In the clinical experience of working with patients of methods for self-management we have come to be aware that there are periods when people relax after a stressful situation the so-called relaxation hole that during this period of relaxation then seizures may happen so the potential for epileptic seizures that arises from stress kind of gets stored up and then can be released later when the inhibitory effect of mental presence is no longer there and our study is the first to try to explore these physiological mechanisms and I hope that more are to come. Hopefully even we might have a session on this at the next meeting of the International League Against Epilepsy in Amsterdam in 2027.

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