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Research Article| Volume 106, 107041, May 2020

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Exploring perceived benefits, motives, barriers, and recommendations for prescribing yoga exercises as a nonpharmacological intervention for patients with epilepsy: A qualitative study from Palestine

  • Ramzi Shawahna
    Correspondence
    Corresponding author at: Department of Physiology, Pharmacology and Toxicology, Faculty of Medicine & Health Sciences, An-Najah National University, New Campus, Building: 19, Office: 1340, P.O. Box 7, Nablus, Palestine.
    Affiliations
    Department of Physiology, Pharmacology and Toxicology, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine

    An-Najah BioSciences Unit, Centre for Poisons Control, Chemical and Biological Analyses, An-Najah National University, Nablus, Palestine
    Search for articles by this author
  • Imad Abdelhaq
    Affiliations
    Department of Physical Education, Faculty of Educational Sciences and Teachers' Training, An-Najah National University, Nablus, Palestine
    Search for articles by this author

      Highlights

      • Yoga might play a role in stabilizing the electroencephalogram and the autonomic nervous system in people with epilepsy.
      • Experiences of patients with regard to benefits, motives, barriers, and recommendations of yoga were explored.
      • Perceived benefits of yoga included improvements in management of seizures, psychological, physical, and social well-being.
      • The interviewees recommended tailoring yoga sessions to the needs of people with epilepsy.

      Abstract

      Objectives

      Yoga is believed to play a role in stabilizing the electroencephalogram and the autonomic nervous system, thus might help control seizures in people with epilepsy (PWE). This qualitative study was conducted to explore experiences of Palestinian PWE with regard to benefits, motives, barriers, and recommendations of prescribing yoga exercises as a nonpharmacological intervention.

      Methods

      Purposive and snowball sampling techniques were used to recruit PWE who practiced yoga. Semi-structured in-depth interviews (n = 18) were conducted with the study participants. The interpretive description method was used to qualitatively analyze the data collected during the interviews.

      Results

      Following the thematic analysis adopted for this study, four major themes emerged. These themes were as follows: perceived benefits of yoga, motives to practice yoga, barriers to practice yoga, and recommendations on effective yoga practice for PWE. The perceived benefits included improvements in management of seizures, psychological, physical, and social well-being. People with epilepsy were motivated by the health benefits of yoga. Barriers of adherence to practice included personal and logistic factors. The interviewees recommended tailoring yoga sessions to the needs of PWE.

      Conclusion

      This explorative qualitative study reported perceived benefits, motives, barriers, and recommendations of yoga as a nonpharmacological intervention for PWE. People with epilepsy used yoga as a beneficial nonpharmacological intervention to improve their health and reduce the negative effects of epilepsy on their physical and psychosocial well-being. Future studies are needed to investigate the health benefits of yoga when sessions are tailored to the needs of PWE.

      Keywords

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      References

        • Sazgar M.
        • Young M.G.
        Seizures and epilepsy.
        in: Absolute epilepsy and EEG rotation review: essentials for trainees. Springer International Publishing, Cham2019: 9-46
        • Forsgren L.
        • Beghi E.
        • Oun A.
        • Sillanpaa M.
        The epidemiology of epilepsy in Europe - a systematic review.
        Eur J Neurol. 2005; 12: 245-253
        • Fiest K.M.
        • Sauro K.M.
        • Wiebe S.
        • Patten S.B.
        • Kwon C.S.
        • Dykeman J.
        • et al.
        Prevalence and incidence of epilepsy: a systematic review and meta-analysis of international studies.
        Neurology. 2017; 88: 296-303
        • Thurman D.J.
        • Beghi E.
        • Begley C.E.
        • Berg A.T.
        • Buchhalter J.R.
        • Ding D.
        • et al.
        Standards for epidemiologic studies and surveillance of epilepsy.
        Epilepsia. 2011; 52: 2-26
        • England M.J.
        • Liverman C.T.
        • Schultz A.M.
        • Strawbridge L.M.
        Epilepsy across the spectrum: promoting health and understanding. A summary of the Institute of Medicine report.
        Epilepsy Behav. 2012; 25: 266-276
        • WHO
        Epilepsy in the WHO Eastern Mediterranean region: bridging the gap.
        2010
        • Bhalla D.
        • Lotfalinezhad E.
        • Timalsina U.
        • Kapoor S.
        • Kumar K.S.
        • Abdelrahman A.
        • et al.
        A comprehensive review of epilepsy in the Arab world.
        Seizure. 2016; 34: 54-59
        • Panagariya A.
        • Sharma B.
        • Dubey P.
        • Satija V.
        • Rathore M.
        Prevalence, demographic profile, and psychological aspects of epilepsy in North-Western India: a community-based observational study.
        Ann Neurosci. 2018; 25: 177-186
        • WHO
        Epilepsy: key facts.
        • Asconape J.J.
        The selection of antiepileptic drugs for the treatment of epilepsy in children and adults.
        Neurol Clin. 2010; 28: 843-852
        • Kwan P.
        • Sander J.W.
        The natural history of epilepsy: an epidemiological view.
        J Neurol Neurosurg Psychiatry. 2004; 75: 1376-1381
        • Shawahna R.
        Which information on women's issues in epilepsy does a community pharmacist need to know? A Delphi consensus study.
        Epilepsy Behav. 2017; 77: 79-89
        • Shawahna R.
        • Atrash A.
        • Jebril A.
        • Khalaf A.
        • Shaheen E.
        • Tahboosh H.
        Evaluation of pharmacists' knowledge of women's issues in epilepsy: a cross-sectional study in Palestinian pharmacy practice.
        Seizure. 2017; 46: 1-6
        • Shawahna R.
        • Atrash A.
        • Jebril A.
        • Khalaf A.
        • Shaheen E.
        • Tahboosh H.
        Pharmacists' knowledge of issues in pharmacotherapy of epilepsy using antiepileptic drugs: a cross-sectional study in Palestinian pharmacy practice.
        Epilepsy Behav. 2017; 67: 39-44
        • Singh G.
        • Sander J.W.
        The global burden of epilepsy report: implications for low- and middle-income countries.
        Epilepsy Behav. 2020; 105: 106949
        • Zhang L.
        • Zhu X.
        • Zou X.
        • Chen L.
        Factors predicting uncontrolled seizures in epilepsy with auditory features.
        Seizure. 2019; 65: 55-61
        • McGee R.E.
        • Sajatovic M.
        • Quarells R.C.
        • Johnson E.K.
        • Liu H.
        • Spruill T.M.
        • et al.
        Depression and quality of life among African Americans with epilepsy: findings from the Managing Epilepsy Well (MEW) Network integrated database.
        Epilepsy Behav. 2019; 94: 301-306
        • Kowski A.B.
        • Weissinger F.
        • Gaus V.
        • Fidzinski P.
        • Losch F.
        • Holtkamp M.
        Specific adverse effects of antiepileptic drugs — a true-to-life monotherapy study.
        Epilepsy Behav. 2016; 54: 150-157
        • Perucca E.
        • Meador K.J.
        Adverse effects of antiepileptic drugs.
        Acta Neurol Scand Suppl. 2005; 181: 30-35
        • Cramer J.A.
        Tolerability of antiepileptic drugs: can we determine differences?.
        Epilepsy Behav. 2012; 23: 187-192
        • Doering J.H.
        • Reuner G.
        • Kadish N.E.
        • Pietz J.
        • Schubert-Bast S.
        Pattern and predictors of complementary and alternative medicine (CAM) use among pediatric patients with epilepsy.
        Epilepsy Behav. 2013; 29: 41-46
        • Fox P.
        • Butler M.
        • Coughlan B.
        • Murray M.
        • Boland N.
        • Hanan T.
        • et al.
        Using a mixed methods research design to investigate complementary alternative medicine (CAM) use among women with breast cancer in Ireland.
        Eur J Oncol Nurs. 2013; 17: 490-497
        • Kanhere S.V.
        • Bagadia D.R.
        • Phadke V.D.
        • Mukherjee P.S.
        Yoga in children with epilepsy: a randomized controlled trial.
        J Pediatr Neurosci. 2018; 13: 410-415
        • Roddis J.K.
        • Tanner M.
        Yoga for epilepsy: a Cochrane review summary.
        Int J Nurs Stud. 2019; 100: 103236
        • Panebianco M.
        • Sridharan K.
        • Ramaratnam S.
        Yoga for epilepsy.
        Cochrane Database Syst Rev. 2017; 10CD001524
        • Panebianco M.
        • Sridharan K.
        • Ramaratnam S.
        Yoga for epilepsy.
        Cochrane Database Syst Rev. 2015; 5CD001524
        • Naveen G.H.
        • Sinha S.
        • Girish N.
        • Taly A.B.
        • Varambally S.
        • Gangadhar B.N.
        Yoga and epilepsy: what do patients perceive?.
        Indian J Psychiatry. 2013; 5 (CD001524): S390-S393https://doi.org/10.1002/14651858.CD001524.pub2
        • Yardi N.
        Yoga for control of epilepsy.
        Seizure. 2001; 10: 7-12
        • Streeter C.C.
        • Gerbarg P.L.
        • Saper R.B.
        • Ciraulo D.A.
        • Brown R.P.
        Effects of yoga on the autonomic nervous system, gamma-aminobutyric-acid, and allostasis in epilepsy, depression, and post-traumatic stress disorder.
        Med Hypotheses. 2012; 78: 571-579
        • Subedi S.
        Exploring different types of Hatha yoga for patients with cancer.
        Clin J Oncol Nurs. 2014; 18: 586-590
        • Leeman-Markowski B.A.
        • Schachter S.C.
        Cognitive and behavioral interventions in epilepsy.
        Curr Neurol Neurosci Rep. 2017; 17: 42
        • Sathyaprabha T.N.
        • Satishchandra P.
        • Pradhan C.
        • Sinha S.
        • Kaveri B.
        • Thennarasu K.
        • et al.
        Modulation of cardiac autonomic balance with adjuvant yoga therapy in patients with refractory epilepsy.
        Epilepsy Behav. 2008; 12: 245-252
        • Streeter C.C.
        • Jensen J.E.
        • Perlmutter R.M.
        • Cabral H.J.
        • Tian H.
        • Terhune D.B.
        • et al.
        Yoga Asana sessions increase brain GABA levels: a pilot study.
        J Altern Complement Med. 2007; 13: 419-426
        • Varambally S.
        • George S.
        • Gangadhar B.N.
        Yoga for psychiatric disorders: from fad to evidence-based intervention?.
        Br J Psychiatry. 2019; : 1-3
        • Ottilingam S.
        • Murthy T.
        Psychiatric pioneers in yoga therapy.
        Indian J Psychiatry. 2019; 61: 103
        • Mehta U.M.
        • Gangadhar B.N.
        Yoga: balancing the excitation-inhibition equilibrium in psychiatric disorders.
        Prog Brain Res. 2019; 244: 387-413
        • Bahcecioglu Turan G.
        • Tan M.
        The effect of yoga on respiratory functions, symptom control and life quality of asthma patients: a randomized controlled study.
        Complement Ther Clin Pract. 2019; 101070
        • Das R.R.
        • Sankar J.
        • Kabra S.K.
        Role of breathing exercises and yoga/pranayama in childhood asthma: a systematic review.
        Curr Pediatr Rev. 2019; 15: 175-183
        • Saguil A.
        Effects of yoga in patients with asthma.
        Am Fam Physician. 2017; 96: 159-160
        • Tillin T.
        • Tuson C.
        • Sowa B.
        • Chattopadhyay K.
        • Sattar N.
        • Welsh P.
        • et al.
        Yoga and Cardiovascular Health Trial (YACHT): a UK-based randomised mechanistic study of a yoga intervention plus usual care versus usual care alone following an acute coronary event.
        BMJ Open. 2019; 9e030119
        • Sharma S.
        • Pailoor S.
        • Choudhary Ram N.
        • Shrestha S.
        Development of a yoga module targeting cardiovascular health for patients with post-myocardial left ventricular dysfunction in India.
        Complement Ther Med. 2019; 42: 170-177
        • Greysen H.M.
        • Hong O.S.
        • Katz P.
        The association between yoga use, physical function, and employment in adults with rheumatoid arthritis.
        Holist Nurs Pract. 2019; 33: 71-79
        • Gautam S.
        • Tolahunase M.
        • Kumar U.
        • Dada R.
        Impact of yoga based mind-body intervention on systemic inflammatory markers and co-morbid depression in active rheumatoid arthritis patients: a randomized controlled trial.
        Restor Neurol Neurosci. 2019; 37: 41-59
        • Gandhi S.
        • Palled V.K.
        • Sahu M.
        • Jagannathan A.
        • Khanna M.
        • Jose A.
        Effectiveness of caregivers' yoga module on psychological distress and mental well-being among caregivers of patients admitted to neurological rehabilitation wards of a tertiary care institute, Bengaluru, Karnataka, India.
        J Neurosci Rural Pract. 2019; 10: 657-665
        • Mooventhan A.
        • Nivethitha L.
        Evidence based effects of yoga in neurological disorders.
        J Clin Neurosci. 2017; 43: 61-67
        • Erdogan Yuce G.
        • Muz G.
        Effect of yoga-based physical activity on perceived stress, anxiety, and quality of life in young adults.
        Perspect Psychiatr Care. 2020; ([Epub ahead of print])https://doi.org/10.1111/ppc.12484
        • Lauche R.
        • Sibbritt D.
        • Ostermann T.
        • Fuller N.R.
        • Adams J.
        • Cramer H.
        Associations between yoga/meditation use, body satisfaction, and weight management methods: results of a national cross-sectional survey of 8009 Australian women.
        Nutrition. 2017; 34: 58-64
        • Capovilla G.
        • Kaufman K.R.
        • Perucca E.
        • Moshe S.L.
        • Arida R.M.
        Epilepsy, seizures, physical exercise, and sports: a report from the ILAE Task Force on Sports and Epilepsy.
        Epilepsia. 2016; 57: 6-12
        • Fried T.R.
        Shared decision making—finding the sweet spot.
        N Engl J Med. 2016; 374: 104-106
        • Shawahna R.
        • Qiblawi S.
        • Ghanayem H.
        Which benefits and harms of using fenugreek as a galactogogue need to be discussed during clinical consultations? A Delphi study among breastfeeding women, gynecologists, pediatricians, family physicians, lactation consultants, and pharmacists.
        Evid Based Complement Alternat Med. 2018; 2018: 2418673
        • Shawahna R.
        • Al-Atrash M.
        What do primary healthcare providers and complementary and alternative medicine practitioners in Palestine need to know about exercise for cancer patients and survivors: a consensual study using the Delphi technique.
        Evid Based Complement Alternat Med. 2019; 2019: 7695818
        • Shawahna R.
        • Taha A.
        Which potential harms and benefits of using ginger in the management of nausea and vomiting of pregnancy should be addressed? A consensual study among pregnant women and gynecologists.
        BMC Complement Altern Med. 2017; 17: 204
        • Shawahna R.
        Merits, features, and desiderata to be considered when developing electronic health records with embedded clinical decision support systems in Palestinian hospitals: a consensus study.
        BMC Med Inform Decis Mak. 2019; 19: 216
        • Jaradat N.A.
        • Shawahna R.
        • Eid A.M.
        • Al-Ramahi R.
        • Asma M.K.
        • Zaid A.N.
        Herbal remedies use by breast cancer patients in the West Bank of Palestine.
        J Ethnopharmacol. 2016; 178: 1-8
        • Shawahna R.
        Combining and using the Utrecht method and the analytic hierarchy process to facilitate professional and ethical deliberation and decision making in complementary and alternative medicine: a case study among a panel of stakeholders.
        Evid Based Complement Alternat Med. 2018; 2018: 2315938
        • Shawahna R.
        • Jaradat N.A.
        Ethnopharmacological survey of medicinal plants used by patients with psoriasis in the West Bank of Palestine.
        BMC Complement Altern Med. 2017; 17: 4
        • Shraim N.Y.
        • Shawahna R.
        • Sorady M.A.
        • Aiesh B.M.
        • Alashqar G.S.
        • Jitan R.I.
        • et al.
        Community pharmacists' knowledge, practices and beliefs about complementary and alternative medicine in Palestine: a cross-sectional study.
        BMC Complement Altern Med. 2017; 17: 429
        • Schafer A.
        • Masoud H.
        • Sammour R.
        Mediation of daily stressors on mental health within a conflict context: a qualitative study in Gaza.
        Intervention. 2014; 12: 171-186
        • Takruri L.
        Yoga in Palestine: the search for inner peace amid ongoing conflict.
        The Guardian, London, UK2015
        • Hatuqa D.
        Palestine: peace can be a bit of a stretch.
        Aljazeera, Doha, Qatar2012
        • Tong A.
        • Sainsbury P.
        • Craig J.
        Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups.
        International J Qual Health Care. 2007; 19: 349-357
        • Guest G.
        • Bunce A.
        • Johnson L.
        How many interviews are enough?: an experiment with data saturation and variability.
        Field Methods. 2006; 18: 59-82
        • McCall M.
        • Thorne S.
        • Ward A.
        • Heneghan C.
        Yoga in adult cancer: an exploratory, qualitative analysis of the patient experience.
        BMC Complement Altern Med. 2015; 15: 245
        • Greysen H.M.
        • Greysen S.R.
        • Lee K.A.
        • Hong O.S.
        • Katz P.
        • Leutwyler H.
        A qualitative study exploring community yoga practice in adults with rheumatoid arthritis.
        J Altern Complement Med. 2017; 23: 487-493
        • Middleton K.R.
        • Magana Lopez M.
        • Haaz Moonaz S.
        • Tataw-Ayuketah G.
        • Ward M.M.
        • Wallen G.R.
        A qualitative approach exploring the acceptability of yoga for minorities living with arthritis: ‘where are the people who look like me?’.
        Complement Ther Med. 2017; 31: 82-89
        • Thorne S.
        • Kirkham S.R.
        • MacDonald-Emes J.
        Interpretive description: a noncategorical qualitative alternative for developing nursing knowledge.
        Res Nurs Health. 1997; 20: 169-177
        • Thorne S.
        • Kirkham S.R.
        • O'Flynn-Magee K.
        The analytic challenge in interpretive description.
        Int J Qual Methods. 2004; 3: 1-11
        • Dierckx de Casterle B.
        • Gastmans C.
        • Bryon E.
        • Denier Y.
        QUAGOL: a guide for qualitative data analysis.
        Int J Nurs Stud. 2012; 49: 360-371
        • Bowen G.A.
        Naturalistic inquiry and the saturation concept: a research note.
        Qual Res. 2008; 8: 137-152
        • Morse J.M.
        Emerging from the data: the cognitive processes of analysis in qualitative inquiry.
        in: Critical issues in qualitative research methods. 1994
        • Shawahna R.
        Facilitating ethical, legal, and professional deliberations to resolve dilemmas in daily healthcare practice: a case of driver with breakthrough seizures.
        Epilepsy Behav. 2020; 102: 106703
        • Shawahna R.
        • Abbas A.
        • Ghanem A.
        Medication transcription errors in hospitalized patient settings: a consensual study in the Palestinian nursing practice.
        BMC Health Serv Res. 2019; 19: 644
        • Shawahna R.
        Development of key performance indicators to capture in measuring the impact of pharmacists in caring for patients with epilepsy in primary healthcare: a Delphi consensual study.
        Epilepsy Behav. 2019; 98: 129-138
        • Shawahna R.
        • Odeh M.
        • Jawabreh M.
        Factors promoting clinical inertia in caring for patients with dyslipidemia: a consensual study among clinicians who provide healthcare to patients with dyslipidemia.
        J Natl Med Assoc. 2019; 111: 18-27
        • Shawahna R.
        • Haddad A.
        • Khawaja B.
        • Raie R.
        • Zaneen S.
        • Edais T.
        Medication dispensing errors in Palestinian community pharmacy practice: a formal consensus using the Delphi technique.
        Int J Clin Pharmacol. 2016; 38: 1112-1123
        • Shawahna R.
        • Masri D.
        • Al-Gharabeh R.
        • Deek R.
        • Al-Thayba L.
        • Halaweh M.
        Medication administration errors from a nursing viewpoint: a formal consensus of definition and scenarios using a Delphi technique.
        J Clin Nurs. 2016; 25: 412-423
        • Panjwani U.
        • Selvamurthy W.
        • Singh S.H.
        • Gupta H.L.
        • Thakur L.
        • Rai U.C.
        Effect of Sahaja yoga practice on seizure control & EEG changes in patients of epilepsy.
        Indian J Med Res. 1996; 103: 165-172
        • Lundgren T.
        • Dahl J.
        • Yardi N.
        • Melin L.
        Acceptance and commitment therapy and yoga for drug-refractory epilepsy: a randomized controlled trial.
        Epilepsy Behav. 2008; 13: 102-108
        • Rajesh B.
        • Jayachandran D.
        • Mohandas G.
        • Radhakrishnan K.
        A pilot study of a yoga meditation protocol for patients with medically refractory epilepsy.
        J Altern Complement Med. 2006; 12: 367-371
        • Wang D.
        • Hagins M.
        Perceived benefits of yoga among urban school students: a qualitative analysis.
        Evid Based Complement Alternat Med. 2016; 2016: 8725654
        • Harder H.
        • Parlour L.
        • Jenkins V.
        Randomised controlled trials of yoga interventions for women with breast cancer: a systematic literature review.
        Support Care Cancer. 2012; 20: 3055-3064
        • Hunt M.R.
        Strengths and challenges in the use of interpretive description: reflections arising from a study of the moral experience of health professionals in humanitarian work.
        Qual Health Res. 2009; 19: 1284-1292