Lifestyle Interventions for Epilepsy

(LIFE Trial)

Overseen By Arden Bischof, MS

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Imad Najm MD

Disqualifiers: Non-epileptic seizures, Chronic illness, Pregnancy, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: Unknown

Duration: 3 months

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial tests whether lifestyle changes, such as yoga, music, and cognitive behavioral therapy (a talk therapy focused on changing thought patterns), can help people with epilepsy who continue to have seizures despite medication. The goal is to determine if these activities can reduce seizure frequency and improve overall quality of life. Participants may be suitable if they have epilepsy, experience at least one seizure a month, and do not plan to change their seizure medication. As an unphased study, this trial provides a unique opportunity to explore alternative therapies that might enhance quality of life.

Do I need to stop my current medications for the trial?

The trial does not specify that you need to stop your current medications. In fact, it mentions no anticipated anti-seizure medication adjustments, suggesting you can continue your current treatment.

Is there any evidence suggesting that this trial's treatments are likely to be safe?

Research shows that the treatments in this study—yoga, cognitive behavioral therapy (CBT), and music therapy—are safe for people with epilepsy.

For yoga, studies indicate it is generally safe and may help lower stress and seizures. Specifically, one study found that practicing yoga reduced the number of seizures and stress levels over a year.

CBT is proven to be safe and effective for people with epilepsy. Research shows that CBT not only reduces seizures but also improves mood and quality of life without increasing the risk of harmful effects.

Music therapy is also considered safe. Studies report it can significantly reduce the number of seizures, with some findings showing up to a 33% decrease.

Overall, these lifestyle treatments are well-tolerated and have not shown major safety concerns for people with epilepsy. They focus on improving stress management, which can help reduce seizures. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about the Lifestyle Interventions for Epilepsy trial because it explores new ways to manage epilepsy beyond standard medication. The trial includes yoga, cognitive behavioral therapy (CBT), and music therapy, each offering unique benefits. Yoga focuses on meditation and mindfulness, which can help reduce stress and potentially lower seizure frequency. CBT provides psycho-educational strategies for stress management, aiming to improve mental health alongside seizure control. Music therapy introduces creative self-expression as a tool for stress reduction, which might also decrease seizure occurrences. These alternative approaches could complement existing treatments and improve overall quality of life for those with epilepsy.

What evidence suggests that this trial's treatments could be effective for epilepsy?

Research has shown that Yoga, Cognitive Behavioral Therapy (CBT), and Music Therapy, all separate interventions in this trial, can help reduce seizures in people with epilepsy.

Participants in the Yoga intervention group may experience improved quality of life and fewer seizures by promoting mindfulness and reducing stress. Studies indicate that yoga is more effective than doing nothing or trying other non-yoga methods.

The CBT intervention group has demonstrated a significant reduction in seizure frequency and improvements in anxiety and depression among people with epilepsy. One study found that patients who underwent CBT had better seizure control compared to those who only practiced relaxation techniques.

Participants in the Music Therapy intervention group may benefit from a 24% decrease in seizure activity. Personalized music therapy has proven effective in managing seizures for individuals whose epilepsy does not respond to other treatments. ^{1 2 6 7 8}

Who Is on the Research Team?

Imad Najm, MD

Principal Investigator

The Cleveland Clinic

Are You a Good Fit for This Trial?

Adults aged 18-75 with medication-resistant epilepsy, experiencing at least one seizure a month, can join this study. They must be able to consent and participate in yoga, music therapy or CBT without changing their seizure meds. Excluded are those with non-epileptic seizures, recent similar therapy, other trials' participation, serious chronic illnesses that affect safety in the study, intensive treatments like chemotherapy, pregnancy/postpartum status within six weeks.

Inclusion Criteria

I can understand and agree to the study on my own.

I am willing to try yoga, music therapy, or cognitive behavioral therapy.

I don't expect to change my seizure medication soon.

Exclusion Criteria

You are unable to see.

I have seizures triggered by music.

Participants with a diagnosed, symptomatic, chronic illness (i.e., significant psychiatric concerns, liver, gastrointestinal, respiratory, renal, cardiac, etc.) who, based on primary investigator review, will not be able to safely or effectively participate in the study

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive behavioral and wellness-based interventions including yoga, cognitive behavioral therapy, and music therapy to reduce seizure frequency and improve quality of life

3 months

Weekly virtual sessions

Follow-up

Participants are monitored for seizure frequency, stress, and quality of life improvements

9 months

Monthly check-ins

What Are the Treatments Tested in This Trial?

Interventions

• Cognitive Behavioral Therapy
• Music
• Yoga

Trial Overview The trial is testing if yoga, cognitive behavioral therapy (CBT), or music can help reduce seizures in adults who don't respond well to epilepsy drugs. Participants will be randomly assigned to one of these interventions and monitored for changes in their seizure frequency.

How Is the Trial Designed?

Group I: Yoga Experimental Treatment 1 Intervention

The goal for the yoga intervention is to provide participants with instructor-guided safe, gentle yoga focused on meditation, breathing exercises, and mindfulness techniques to promote well-being and stress reduction. We aim for participants to utilize the skills and strategies taught through this intervention to reduce seizure frequency, anxiety symptoms, disability, and improve quality of life. Participants enrolled in the Yoga intervention group will receive one month of Instructor-Guided 70-minute virtual live yoga classes, twice per week, led by an experienced yoga therapist and co-instructor. During Months 2-3 participants in the Yoga Intervention will receive one 70-minute virtual live yoga class per week. Each session will have a set of specific poses, breathing exercises, meditation, and yoga philosophies developed by our yoga experts.

Group II: Music Experimental Treatment 1 Intervention

The aim of this intervention is for participants to learn and develop skills to reduce stress which may, in turn, decrease seizure frequency and improve quality of life. Participants will be exposed to a variety of ways that they might incorporate music into their daily lives as a means of self-expression, coping, and stress reduction. Participants enrolled in the Music Intervention group will receive one month of Instructor-Guided Intervention 70-minute virtual live music therapy sessions, twice per week, led by an experienced music therapist and co-instructor. An two months of a 70-minute virtual live music therapy session once per week.

Group III: Cognitive Behavioral Therapy Experimental Treatment 1 Intervention

The goal of the Cognitive Behavioral Therapy (CBT) intervention is to provide patients with psycho-educational and behavioral health strategies to promote seizure prevention and stress management skills. We aim for participants to utilize the skills and strategies taught through this intervention to reduce seizure frequency, depression and anxiety symptoms, disability and improve quality of life. Participants enrolled in the CBT intervention group will receive 3 months of Instructor-Guided 90-minute, virtual group counseling session, once per week, led by a psychologist and a co-therapist.

Group IV: Standard of Care Active Control 1 Intervention

Participants randomized to the Standard of Care Control Group will receive their usual standard epilepsy care. For Months 1-3 participants will receive weekly online surveys as well as brief monthly calls checking-in and collecting their seizure frequency. Participants will continue to receive brief monthly calls for checking-in and collection of seizure frequency Months 4-12. Upon completion of the study, participants will receive access to online materials for all intervention modalities if they wish.

Group V: Enhanced Standard of Care Active Control 1 Intervention

Participants randomized to the Enhanced Standard of Care Control Group will receive their usual standard epilepsy care and weekly scheduled, scripted, follow-up phone calls from a study team member to check-in on their health, epilepsy management, and seizure frequency. Upon completion of the study, participants will receive access to online materials for all intervention modalities if they wish.

Who Is Running the Clinical Trial?

Imad Najm MD

Lead Sponsor

Trials

1

Recruited

1,000+

The Cleveland Clinic

Lead Sponsor

Trials

1,072

Recruited

1,377,000+

Published Research Related to This Trial

This randomized controlled trial will assess the effectiveness of a 10-week internet-delivered cognitive behavioral therapy (iCBT) program for treating posttraumatic stress disorder (PTSD) in a sample of at least 72 participants, aiming to replicate previous positive findings.

The study will also explore how changes in PTSD symptoms relate to factors like intolerance of uncertainty and emotion regulation, potentially revealing important mechanisms behind the effectiveness of CBT for PTSD.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Internet-based cognitive behavioural therapy (iCBT) for posttraumatic stress disorder versus waitlist control: study protocol for a randomised controlled trial. Allen, AR., Newby, JM., Smith, J., et al.[2022]

The review of psychological interventions for epilepsy, including relaxation therapy and cognitive behavioral therapy, found no significant evidence that these methods effectively reduce seizure frequency, based on three small trials with a total of 50 participants.

While some psychological methods showed potential benefits for improving anxiety and understanding of epilepsy, the overall lack of robust evidence and methodological issues in the studies indicate that more rigorous trials are necessary to determine their efficacy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Psychological treatments for epilepsy. Ramaratnam, S., Baker, GA., Goldstein, L.[2019]

The review of psychological interventions for epilepsy, including relaxation therapy and cognitive behavioral therapy, found no significant evidence that these methods effectively reduce seizure frequency, based on three small trials involving 50 patients.

While some psychological methods showed potential benefits for improving anxiety, depression, and knowledge about epilepsy, the overall lack of robust evidence and methodological issues in the studies indicate that more rigorous trials are necessary to determine their efficacy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Psychological treatments for epilepsy. Ramaratnam, S., Baker, GA., Goldstein, L.[2018]

A study involving 85 traumatized refugees showed that a manualized cognitive behavioral therapy (CBT) incorporating exposure therapy, mindfulness, and acceptance and commitment therapy led to positive treatment outcomes, with 42% of patients benefiting significantly from structured CBT.

The effectiveness of the therapy was enhanced by using multiple methods and encouraging patients to complete homework assignments, indicating that refugees can actively participate in structured CBT despite their challenges.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Cognitive behavioral psychotherapeutic treatment at a psychiatric trauma clinic for refugees: description and evaluation. Buhmann, C., Andersen, I., Mortensen, EL., et al.[2021]

The Bergen 4-day treatment (B4DT) significantly reduced panic disorder symptoms in 30 patients, with a large effect size (d = 4.32) post-treatment and an even larger effect (d = 4.91) at the 3-month follow-up, indicating lasting benefits.

80% of patients achieved remission after treatment, and high treatment satisfaction was reported, with no dropouts, suggesting that B4DT is a feasible and effective intervention for panic disorder and associated anxiety and depression symptoms.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The Bergen 4-day treatment for panic disorder: replication and implementation in a new clinic. Iversen, HM., Eide, TO., Harvold, M., et al.[2022]

Lifestyle modifications, such as weight loss, regular exercise, reduced alcohol intake, and dietary changes, are safe and effective treatments for hypertension in elderly patients, yet they are often underutilized by healthcare providers.

These lifestyle changes not only lower blood pressure but also decrease the risk and severity of related health issues, making them a preferable option compared to medication, with minimal contraindications.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The Evidence for Lifestyle Modification in Lowering Blood Pressure in the Elderly. Stanton, JA., Lowenthal, DT.[2019]

A randomized controlled trial with 18 participants showed that both Acceptance and Commitment Therapy (ACT) and yoga significantly reduced seizure frequency and duration in individuals with drug-refractory epilepsy over a 12-month period.

ACT was found to be more effective than yoga in reducing the seizure index and improving quality of life, as measured by the WHOQOL-BREF, while both therapies positively impacted quality of life according to different assessment tools.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Acceptance and Commitment Therapy and yoga for drug-refractory epilepsy: a randomized controlled trial. Lundgren, T., Dahl, J., Yardi, N., et al.[2022]

A psychological treatment program combining acceptance and commitment therapy (ACT) with behavioral seizure control was evaluated in a randomized controlled trial with 27 participants suffering from drug-refractory epilepsy, showing significant improvements in quality of life and seizure control compared to supportive therapy.

The ACT group demonstrated lasting benefits at six and twelve months, suggesting that this short-term psychotherapy approach, alongside anticonvulsant medications, may help reduce long-term disability associated with epilepsy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Evaluation of acceptance and commitment therapy for drug refractory epilepsy: a randomized controlled trial in South Africa--a pilot study. Lundgren, T., Dahl, J., Melin, L., et al.[2022]

The review of psychological interventions for epilepsy, including relaxation therapy and cognitive behavioral therapy (CBT), found no significant evidence that these methods effectively reduce seizure frequency, with most studies being of poor quality.

While some studies suggested CBT may improve quality of life and reduce depression in individuals with epilepsy, the overall lack of reliable evidence indicates that more rigorous trials are necessary to determine the efficacy of these psychological treatments.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Psychological treatments for epilepsy. Ramaratnam, S., Baker, GA., Goldstein, LH.[2020]

The PHLAME study is evaluating two different strategies to improve nutrition and physical activity among firefighters: a team-centered approach and an individual one-on-one approach, comparing both to a usual-care control group.

If successful, the team-centered model could be a cost-effective way to promote healthier behaviors in firefighters and potentially in other team environments, while the individual approach uses established counseling techniques to support personal behavior change.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Promoting Healthy Lifestyles: Alternative Models' Effects (PHLAME). Moe, EL., Elliot, DL., Goldberg, L., et al.[2019]

Unhealthy lifestyle behaviors contribute to approximately 63% of all deaths globally, highlighting the urgent need for lifestyle medicine to address chronic diseases.

Adhering to 'low-risk lifestyle' behaviors and ideal cardiovascular health metrics has been shown to improve mortality rates, yet the prevalence of healthy living in the population remains low, indicating significant challenges in implementing lifestyle medicine programs.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Lifestyle medicine: the future of chronic disease management. Kushner, RF., Sorensen, KW.[2013]

A randomized clinical trial involving 135 patients will compare the online efficacy of trial-based cognitive therapy (TBCT), mindfulness-based health promotion (MBHP), and positive psychotherapy (PPT) in reducing PTSD symptoms during the COVID-19 pandemic.

The study aims to show that all three therapies can effectively reduce PTSD symptoms, anxiety, and depression, with no significant differences expected among them, highlighting the potential for flexible online treatment options for PTSD.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A Randomized Clinical Trial to Assess the Efficacy of Online-Treatment with Trial-Based Cognitive Therapy, Mindfulness-Based Health Promotion and Positive Psychotherapy for Post-Traumatic Stress Disorder during the COVID-19 Pandemic: A Study Protocol. Duran, ÉP., Hemanny, C., Vieira, R., et al.[2022]

An 8-week web-based cognitive behavioral therapy program combined with mindfulness and yoga showed significant reductions in PTSD symptoms (effect size d=1.60), depression, anxiety, and improvements in mindfulness among 22 participants aged 18-35.

Participants also exhibited a notable decrease in peak pupil dilation, indicating healthier autonomic functioning, although heart rate variability did not show significant changes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A Web-Based Cognitive Behavioral Therapy, Mindfulness Meditation, and Yoga Intervention for Posttraumatic Stress Disorder: Single-Arm Experimental Clinical Trial. Kirk, MA., Taha, B., Dang, K., et al.[2022]

A 6-week lifestyle intervention program for 15 German patients, which included a low-fat vegetarian diet and aerobic exercises, led to significant dietary changes and improved quality of life, demonstrating its feasibility in a rehabilitation setting.

Despite both the intervention and control groups receiving the same lipid-lowering medication (Pravastatin), the lifestyle changes did not provide additional benefits in lowering lipid levels beyond what the medication achieved.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Life style changes in patients with myocardial infarct in the framework of intramural and ambulatory rehabilitation--results of a German pilot study]. Scherwitz, LW., Brusis, OA., Kesten, D., et al.[2013]

Incorporating interpersonal communication skills, such as motivational interviewing and brief action planning (BAP), can significantly enhance lifestyle medicine practices by helping patients adopt and maintain healthier behaviors like improved diet and exercise.

Motivational interviewing focuses on engaging patients through empathy and active listening, while BAP provides a structured approach for setting specific, achievable health goals, making it easier for patients to commit to and follow through on their health changes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Using motivational interviewing and brief action planning for adopting and maintaining positive health behaviors. Cole, SA., Sannidhi, D., Jadotte, YT., et al.[2023]

Citations

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Cognitive and behavioral interventions in epilepsy - PMC In a randomized study, seizure frequency was significantly reduced in the CBT group compared to a relaxation control, maintained at 3 months following treatment ...

2. sciencedirect.com sciencedirect.com/science/article/abs/pii/S1525505024003627

A systematic review and meta-analysis of randomized ... A significant improvement in seizure freedom rates, anxiety, and quality of life was found with CBT. No significant differences were found in terms of suicidal ...

3. epilepsybehavior.com epilepsybehavior.com/article/S1525-5050(23)00527-9/abstract

Effectiveness of CBT for reducing depression and anxiety in ... Conclusion. The result of our study showed that Cognitive behavioral therapy is a superior therapy for treating anxiety and depression in epilepsy patients. CBT ...

4. thelancet.com thelancet.com/journals/lanpsy/article/PIIS2215-0366(20)30128-0/fulltext

Cognitive behavioural therapy for adults with dissociative ... However, improvements were observed in a number of clinically relevant secondary outcomes following CBT plus standardised medical care when compared with ...

5. cureepilepsy.org cureepilepsy.org/news/outcomes-in-the-treatment-of-psychogenic-nonepileptic-seizures-pnes-with-cognitive-behavioral-therapy-informed-psychotherapy/

Outcomes in the Treatment of Psychogenic Nonepileptic ... Attending at least 7 sessions of cognitive behavioral therapy-informed psychotherapy in longer than 3 months was effective for seizure control, depression, and ...

6. epilepsy.com epilepsy.com/complications-risks/moods-behavior/cognitive-therapies

Cognitive Therapies | Mood & Behavior Living with epilepsy can affect many parts of life. Cognitive behavioral therapy (CBT) is used to reduce depression, anxiety, and anger.

7. epilepsybehavior.com epilepsybehavior.com/article/S1525-5050(24)00362-7/abstract

Cognitive behavioral therapy in adults with functional seizures A significant improvement in seizure freedom rates, anxiety, and quality of life was found with CBT. No significant differences were found in terms of suicidal ...

8. pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov/39181107/

Cognitive behavioral therapy in adults with functional ... Conclusions: There is high-quality evidence supporting the efficacy and safety of CBT in treating FS. Future research should investigate whether combining CBT ...