Panebianco Mariangela, Sridharan Kalpana, Ramaratnam Sridharan
Department of Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, Clinical Sciences Centre for Research and Education, Lower Lane, Liverpool, UK, L9 7LJ.
Cochrane Database Syst Rev. 2015 May 2(5):CD001524. doi: 10.1002/14651858.CD001524.pub2.
This is an updated version of the original Cochrane review published in The Cochrane Library, Issue 1, 2002.Yoga may induce relaxation and stress reduction, and influence the electroencephalogram and the autonomic nervous system, thereby controlling seizures. Yoga would be an attractive therapeutic option for epilepsy if proved effective.
To assess whether people with epilepsy treated with yoga:(a) have a greater probability of becoming seizure free;(b) have a significant reduction in the frequency or duration of seizures, or both; and(c) have a better quality of life.
We searched the Cochrane Epilepsy Group Specialized Register (26 March 2015), the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, 26 March 2015), MEDLINE (Ovid, 1946 to 26 March 2015), SCOPUS (1823 to 9 January 2014), ClinicalTrials.gov (26 March 2015), the World Health Organization (WHO) International Clinical Trials Registry Platform ICTRP (26 March 2015), and also registries of the Yoga Biomedical Trust and the Research Council for Complementary Medicine. In addition, we searched the references of all the identified studies. No language restrictions were imposed.
The following study designs were eligible for inclusion: randomised controlled trials (RCT) of treatment of epilepsy with yoga. Eligible participants were adults with uncontrolled epilepsy comparing yoga with no treatment or different behavioural treatments.
Three review authors independently selected trials for inclusion and extracted data. The following outcomes were assessed: (a) percentage of people rendered seizure free; (b) seizure frequency and duration; (c) quality of life. Analyses were on an intention-to-treat basis. Odds ratio (OR) with 95% confidence intervals (95% Cl) were estimated for the outcomes.
Two unblinded trials recruited a total of 50 people (18 treated with yoga and 32 to control interventions). Antiepileptic drugs were continued in all the participants. Baseline phase lasted 3 months in both studies and treatment phase from 5 weeks to 6 months in the two trials. Randomisation was by roll of a die in one study and using a computerised randomisation table in the other one but neither study provided details of concealment of allocation and were rated as unclear risk of bias. Overall, the two studies were rated as low risk of bias (all participants were included in the analysis; all expected and pre-expected outcomes were reported; no other sources of bias). The overall OR with 95% confidence interval (CI) was: (i) seizure free for six months - for yoga versus sham yoga ORs of 14.54 (95% CI 0.67 to 316.69) and for yoga versus no treatment group 17.31 (95% CI 0.80 to 373.45); for Acceptance and Commitment Therapy (ACT) versus yoga ORs of 1.00 (95% Cl 0.16 to 6.42; (ii) reduction in seizure frequency - the Mean Difference between yoga versus sham yoga group was -2.10 (95% CI -3.15 to -1.05) and for yoga versus no treatment group -1.10 (95% CI -1.80 to -0.40); (iii) more than 50% reduction in seizure frequency - for yoga versus sham yoga group ORs of 81.00 (95% CI 4.36 to 1504.46) and for the yoga versus no treatment group 158.33 (95% CI 5.78 to 4335.63); ACT versus yoga ORs of 0.78 (95% Cl 0.04 to 14.75); (iv) more than 50% reduction in seizure duration - for yoga versus sham yoga group ORs of 45.00 (95% CI 2.01 to 1006.75) and for yoga versus no treatment group 53.57 (95% CI 2.42 to 1187.26); ACT versus yoga ORs of 0.67 (95% Cl 0.10 to 4.35). In addition in Panjwani 1996 the authors reported that the one-way analysis of variance revealed no statistically significant differences between the three groups. A P-Lambda test taking into account the P values between the three groups also indicated that the duration of epilepsy in the three groups was not comparable. No data were available regarding quality of life. In Lundgren 2008 the authors reported that there was no significant difference between the yoga and ACT groups in seizure free rates, 50% or greater reduction in seizure frequency or seizure duration at one year follow-up. The yoga group showed significant improvement in their quality of life according to the Satisfaction With Life Scale (SWLS) (P < 0.05), while the ACT group had significant improvement in the World Health Organization Quality of Life-BREF (WHOQOL-BREF) scale (P < 0.01).
AUTHORS' CONCLUSIONS: Study of 50 subjects with epilepsy from two trials reveals possible beneficial effect in control of seizures. Results of the overall efficacy analysis show that yoga treatment was better when compared with no intervention or interventions other than yoga (postural exercises mimicking yoga). There was no difference between yoga and Acceptance and Commitment Therapy. However no reliable conclusions can be drawn regarding the efficacy of yoga as a treatment for uncontrolled epilepsy, in view of methodological deficiencies such as limited number of studies, limited number of participants randomised to yoga, lack of blinding and limited data on quality-of-life outcome. Physician blinding would normally be taken to be the person delivering the intervention, whereas we think the 'physician' would in fact be the outcome assessor (who could be blinded), so that would be a reduction in detection bias rather than performance bias. In addition, evidence to inform outcomes is limited and of low quality. Further high-quality research is needed to fully evaluate the efficacy of yoga for refractory epilepsy.
这是发表于《考科蓝系统评价》2002年第1期的原始考科蓝综述的更新版本。瑜伽可能会诱导放松和减轻压力，并影响脑电图和自主神经系统，从而控制癫痫发作。如果证明有效，瑜伽将成为一种有吸引力的癫痫治疗选择。
评估接受瑜伽治疗的癫痫患者：(a) 无癫痫发作的可能性是否更高；(b) 癫痫发作的频率或持续时间是否显著降低，或两者都降低；以及(c) 生活质量是否更好。
我们检索了考科蓝癫痫小组专业注册库（2015年3月26日）、考科蓝对照试验中心注册库（CENTRAL，《考科蓝系统评价》，2015年3月26日）、MEDLINE（Ovid，1946年至2015年3月26日）、SCOPUS（1823年至2014年1月9日）、ClinicalTrials.gov（2015年3月26日）、世界卫生组织（WHO）国际临床试验注册平台ICTRP（2015年3月26日），以及瑜伽生物医学信托基金和补充医学研究理事会的注册库。此外，我们还检索了所有已识别研究的参考文献。未设语言限制。
以下研究设计符合纳入条件：瑜伽治疗癫痫的随机对照试验（RCT）。符合条件的参与者为癫痫未得到控制的成年人，将瑜伽与不治疗或不同行为治疗进行比较。
三位综述作者独立选择纳入试验并提取数据。评估了以下结局：(a) 无癫痫发作的人数百分比；(b) 癫痫发作频率和持续时间；(c) 生活质量。分析采用意向性分析。对结局估计了比值比（OR）及95%置信区间（95%CI）。
两项非盲法试验共招募了50人（18人接受瑜伽治疗，32人接受对照干预）。所有参与者均继续使用抗癫痫药物。两项研究的基线期均持续3个月，两项试验的治疗期从5周至6个月不等。一项研究通过掷骰子进行随机分组，另一项研究使用计算机随机化表，但两项研究均未提供分配隐藏的详细信息，且被评为偏倚风险不明确。总体而言，两项研究被评为低偏倚风险（所有参与者均纳入分析；报告了所有预期和预先预期的结局；无其他偏倚来源）。总体OR及95%置信区间（CI）为：(i) 六个月无癫痫发作——瑜伽与假瑜伽相比，OR为14.54（95%CI 0.67至316.69），瑜伽与未治疗组相比，OR为17.31（95%CI 0.80至373.45）；接纳与承诺疗法（ACT）与瑜伽相比，OR为1.00（95%CI 0.16至6.42）；(ii) 癫痫发作频率降低——瑜伽与假瑜伽组之间的平均差值为-2.10（95%CI -3.15至-1.05），瑜伽与未治疗组之间为-1.10（95%CI -1.80至-0.40）；(iii) 癫痫发作频率降低超过50%——瑜伽与假瑜伽组相比，OR为81.00（95%CI 4.36至1504.46），瑜伽与未治疗组相比，OR为158.33（95%CI 5.78至4335.63）；ACT与瑜伽相比，OR为0.78（95%CI 0.04至14.75）；(iv) 癫痫发作持续时间降低超过50%——瑜伽与假瑜伽组相比，OR为45.00（95%CI 2.01至1006.75），瑜伽与未治疗组相比，OR为53.57（95%CI 2.42至1187.26）；ACT与瑜伽相比，OR为0.67（95%CI 0.10至4.35）。此外，在Panjwani 1996中，作者报告单因素方差分析显示三组之间无统计学显著差异。考虑三组之间P值的P-Lambda检验也表明三组癫痫持续时间无可比性。无生活质量方面的数据。在Lundgren 2008中，作者报告在一年随访时，瑜伽组和ACT组在无癫痫发作率、癫痫发作频率降低50%或更多或癫痫发作持续时间方面无显著差异。根据生活满意度量表（SWLS），瑜伽组的生活质量有显著改善（P < 0.05），而ACT组在世界卫生组织生活质量简表（WHOQOL-BREF）量表上有显著改善（P < 0.01）。
两项试验中对50名癫痫患者的研究揭示了瑜伽在控制癫痫发作方面可能具有的有益效果。总体疗效分析结果表明，与不干预或非瑜伽干预（模仿瑜伽的姿势练习）相比，瑜伽治疗效果更好。瑜伽与接纳与承诺疗法之间无差异。然而，鉴于研究数量有限、随机分配到瑜伽组的参与者数量有限、缺乏盲法以及生活质量结局数据有限等方法学缺陷，无法就瑜伽作为未控制癫痫的治疗方法的疗效得出可靠结论。通常认为医生盲法是指实施干预的人，而我们认为“医生”实际上可能是结局评估者（可以设盲），这样将减少检测偏倚而非实施偏倚。此外，用于指导结局的证据有限且质量较低。需要进一步的高质量研究来全面评估瑜伽对难治性癫痫的疗效。
