Relaxation Techniques

Relax Your Mind

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Typical absence seizures petit mal seizures

Absences may be precipitated by fatigue, drowsiness, relaxation, photic stimulation or hyperventilation. Typical absence seizures develop in childhood or adolescence and are encountered almost exclusively in the syndrome of idiopathic generalized epilepsy (see pp. 17-19). Variations from this typical form include the myoclonic absence, absence with perioral myoclonia or with eyelid myoclonia. Whether or not these are distinct entities is controversial (see pp. 17-18).

Spread of Metabolic Activation during Seizures

During the latent period between the status epi-lepticus and development of spontaneous seizures, in PN21 and adult rats, there were decreases in metabolic activation in forebrain regions corresponding to the damaged areas. At the end of the latent period, metabolic increases in the brainstem occurred (139). Additionally, this model with lithium-pilocarpine status epilepticus induced on PN21 has been used in MRI studies for prediction of epilepsy development (152, 153). Rats with no MRI abnormalities did not develop epilepsy. Spontaneous seizures developed in two groups with visible MRI abnormalities in one group and without visible abnormalities but with changes in T2 relaxation times in the other. These MRI changes did not correlate with neuronal damage, suggesting that subcellular changes may be responsible for the future development of spontaneous seizures (152, 153).

The Many Types of Magnetic Resonance Examination

Reformatting of the two-dimensional image in any plane and with any slice thickness. This is akin to the ability to reformat (or remontage) the electroencephalogram (EEG) data after it is acquired if it is acquired digitally. This is important for dealing with partial volume effects and for volume measurement techniques. Techniques are also available that can help to quantify tissue characteristics such as the T2 or T1 relaxation times. This requires different sequences and provides different information from that obtained with standard anatomic imaging techniques. MR can also identify biochemical aspects of a selected region of the brain by MR spectroscopy (MRS) and can provide low-resolution images of these metabolites using chemical shift imaging (CSI). These techniques can be used to identify specific metabolites and their relative concentrations in specific areas of the brain (Chapter 13).

Psychological therapies to reduce seizure frequency

These are known as 'countermeasures' and various different approaches have been attempted, including hypnosis, meditation, yoga, biofeedback, operant or classical conditioning, and changing arousal levels. Stress reduction techniques of various types are very commonly employed in epilepsy, and have undoubted benefit, although there are few controlled studies in this important area. There is a report of hypnosis that reduced Jacksonian seizures on one patient from 35 to 5 per week. Meditation (of various forms) and yoga (and similar techniques) are commonly employed by patients with epilepsy, and have an enthusiastic following. There is at least one open study of meditation that showed a moderate benefit in reducing seizures and also changes in EEG parameters. Similarly, relaxation methods are widely practised and there are at least four controlled studies that show benefit. In one study a 29 decrease in the frequency of seizures occurred in those trained in progressive muscular...

Other Types of Pain Relief

Using a progressive relaxation technique, various muscle groups are relaxed one by one in order to help detect tension and then release it 5. Imagery. This technique uses the mind to form mental pictures that can aid in relaxation. 7. Warm showers or a bath. Warm water is an effective tool for relaxation.

Quantitative Measurements of Hippocampal Sclerosis

Also, just because a measurement is reported as a number does not necessarily mean that it is a totally objective measurement or that a high degree of subjective skill is not needed for the acquisition of that number. Similarly, once a number is derived, we can become totally oblivious to the assumptions and compromises that went into acquiring that number, and mistakenly confuse it with objective reality. What this means, really, is that if you use numbers to make decisions, you need to know something about how they were acquired, what they mean, and what their limitations are. This is also true of such statistically based methods as voxel-based morphology and relaxometry (discussed below). In the context of temporal lobe epilepsy these numbers (hippocampal volumes and T2 relaxation times) are a means of reaching a diagnosis, and trying to standardize information and objectify the thresholds at which significant abnormality is diagnosed. As in all medical measurements, the clinical...

Correlation of Hippocampal T2signal Increase with Hippocampal Volume Deficit

In contrast to elaborate volumetric assessment, the measurement of T2 relaxometry is a quick technique and can be implemented in large studies and measured routinely by the radiographer or reporting radiologist (319). The measured value of both hippocampal volume and the T2 time are inversely correlated with each other (218, 247, 318, 320). The inverse correlation between T2 signal and hippocampal volumes is present in the ipsilateral hippocampus but not in the contralateral hippocampus (318). This indicates that a marked volume loss is associated with a significant increase in T2 relaxation time, or in other words that an atrophic

Quantitative Extrahippocampal Abnormality in Patients with Epilepsy

The vast majority of quantitative MR studies using T2 relaxometry are focused on the hippocampus in patients with pathologically proven HS. Changes in other areas have also been documented. Amygdaloid changes were assessed in a study of 29 patients with newly diagnosed and 54 patients with chronic temporal lobe epilepsy. In the newly diagnosed patients, the mean amygdaloid volume did not differ from that in controls. The mean T2 relaxation time in newly diagnosed or chronic patients did not differ from each other or from control values. However, unilateral T2 time of the amygdala was prolonged in 12 (171). T2-weighted signal abnormalities have also been observed in the anterior temporal lobe of TLE patients (252, 330), although their etiology and relevance is not known. We have recently observed T2 relaxometry changes outside the ipsilateral hippocampus of patients with HS, affecting the subcortical structures. These observations suggest that the structural signal abnormality in HS is...

Diagnostic Evaluation And Differential Diagnosis

Daydreaming is associated with boredom, can be broken with stimulation, and is not associated with motor activity. Absence seizures, however, may sometimes be terminated with stimulation and tend to increase during periods of relaxation and tiredness. Tics and pseu-doseizures may need to be considered as well. A normal EEG that includes several trials of 3 to 5 minutes of hyperventilation, however, virtually rules out absence seizures. Repeated studies or prolonged monitoring occasionally are necessary when diagnostic confusion persists (85).

Psychotherapeutic Interventions

Despite awareness of the efficacy of psychotherapeutic interventions for depression and anxiety, they have rarely been studied in epilepsy. In a recent Cochrane review of psychological treatments in epilepsy, Ramaratnam e t al. (2005) concluded that due to the limited number of studies and methodological concerns there is not enough evidence to endorse psychological treatments in epilepsy. The authors conducted a focused review of randomized controlled trials of psychological treatments in epilepsy. There were three studies that identified anxiety as measured outcome (Sultana, 1987 Helgeson et al, 1990 Olley et al, 2001) . The results of the studies were mixed one study found no change (Helgeson et al, 1990), and the other two studies found significant reductions in symptoms of anxiety (Sultana, 1987 Olley t al, 2001 . The interventions used were psycho-educational programs and relaxation plus behavioral therapy. Depression was the outcome measure in six studies with three studies...

Observing Hippocampal Sclerosis Development

Hippocampal Sclerosis

Whereas the studies reported above consist of case reports or small series, one recent report assessed a series of 35 children (298). All had MR investigations within 5 days of a generalized status epilepticus. Quantitative assessments included T2 relaxometry and hippocampal volumetry. T2 relaxation time was elevated in patients with prolonged febrile convulsions compared with control subjects when they were scanned within 2 days of the acute event, whereas no difference in the T2-values were found in patients examined 3-5 days after the event. These findings are consistent with another series in children, scanned within 14 days of the event (299). In this series, T2 relaxometry findings showed no abnormalities.

Intermittent explosive disorder in epilepsy

Margerison and Corsellis, 1966 Wieser, 1983). A radiological in vivo diagnosis of mesial temporal lobe sclerosis is possible by demonstrating atrophy of the mesial temporal lobe structures on Tl-weighted anatomical MRI images and increased signal on conventional spin echo T2 MRI sequences (Duncan et al., 1996 Jackson et al., 1990 Woermann et al., 1998). Since HS seems to be diffuse rather than focal in most of the cases (Kim et al., 1995) an involvement of the amygdala by the pathological process underlying hippocampal sclerosis might be expected, and indeed is reported in the literature (Hudson et al., 1993 Miller et al., 1994). In vivo identification of amygdala sclerosis by measuring the amygdala T2 relaxation time has been reported in patients with TLE (Kalviainen et al., 1997 Van Paesschen et al., 1996). Furthermore amygdala volumetry has been validated as a reliable method (Cendes et al., 1993 Kalviainen et al., 1997 Soininen et al., 1994 Watson et al., 1992). There was no...

Stage One Active Phase

The active phase of stage one labor can last up to 6 hours, or more, although it can be shorter, especially if you have previously had a vaginal delivery. Now the real work of labor begins, and you will no longer be able to talk during contractions. Breathing exercises, relaxation techniques, and a good labor coach can be helpful during this phase. Massage and gentle encouragement can also be helpful. By now, you have probably arrived at the hospital or birth center. If you have no medical or obstetric complications, you should be able to move around. You may find that it feels good to walk, but you will probably want to stop and lean against someone or something during contractions. If you feel exhausted, sit in a rocking chair or lie in bed on your left side. This might be a good time to take a warm shower or bath if you have access to these facilities. Warm water can help ease the pain of labor, and women sometimes progress quite rapidly with the relaxation that water provides.

Signal Changes In Epilepsy

Temporal Lobe Abnormalities

In the patients with HS, there is an association between AT signal abnormality and the severity of HS as determined by a higher T2-relaxation time within the hippocampus. Severity of insult as a cause of this change is supported by the significant twofold increase in the incidence of febrile convulsions in the patients with AT changes.

Sclerosis of the Amygdala

The majority of quantitative MR studies using T2 relaxometry are focused on the hippocampus in patients with pathologically proven HS. Changes in other areas, particularly the amygdala, have also been documented (165-167, 171, 172, 178, 236, 334). Amygdaloid changes were assessed in a study of 29 patients with newly diagnosed and 54 patients with chronic temporal lobe epilepsy. In the newly diagnosed patients, the mean amygdaloid volume did not differ from that in controls. The mean T2 relaxation time in newly diagnosed or chronic patients did not differ from each other or from control values. However, unilateral T2 time of the amygdala was prolonged in 12 (171).

Treatment and outcome

The patient agreed to try this approach and chose a relaxing oil (ylang ylang). After several massages with the diluted oil I taught her an autohypnotic technique so that she could immediately associate the smell of the gently inhaled oil (vigorous sniffing might trigger a seizure) with the intense relaxation induced by massage with the oil. Once relaxation seemed to occur automatically when she smelt the oil (which she carried round with her in a small bottle), she was instructed to inhale the oil gently as soon as she either felt a seizure starting (she had about 1 minute of warning with retained awareness) or if she heard the tune. When in a situation where she could not reach her bottle of oil she used a tactile memory of the masseur's thumb pressing on a particular relaxing acupressure point on her back as a counter-measure but this was more difficult to concentrate on.

Biochemical pathophysiology

As yet, no specific defect in GABA functioning has been identified in patients with PD. However, GABA is indirectly implicated in PD through benzodiazepines. Benzodiazepine receptor agonists produce neuronal inhibition via benzodiazepine receptor modulation of GABAa receptor mechanisms, leading to, amongst other effects, anxiolysis, muscle relaxation and sedation. Benzodiazepine antagonists occupy the benzodiazepine receptor site without producing pharmacological effects, while inverse agonists, such as beta-carboline, are anxiogenic and procon-vulsant (Katz et al., 1993). Clinical data show that high potency benzodiazepine agonists, such as alprazolam and clonazepam, have marked antipanic effects. Moreover, other studies have suggested subsensitivity of benzodiazepine receptors in these patients (Eison, 1990). Possibly in relation to this, flumazenil, a benzodi-azepine antagonist, has been reported to be panicogenic in patients with PD but not in healthy controls.


The aim of clinical imaging is to distinguish the structures of the object with such sharpness and accuracy that there is no doubt as to the visualization of the object in the image. A high degree of contrast is therefore a necessity for efficacious imaging. The contrast in MRI is a direct consequence of the relative signal intensities from different tissue types. The aim will always still be to obtain the optimal SNR and therefore, for example, moving to a higher field strength should improve the contrast. The magnetic field strength is an example of an 'extrinsic' contrast parameter and other such parameters determined by the pulse sequence parameters have been discussed in previous sections. The relative levels of signal intensity also depend on several 'intrinsic' factors. The common, and possibly the most important, ones from a medical imaging viewpoint are proton density contrast and contrast as a result of the NMR relaxation time, T2 and T1. The other intrinsic components of...

Autonomic Seizures

Contralateral to a frontal source or spread pattern and can occur in isolation (47,48). Urinary incontinence is also common in generalized seizures, where it occurs due to the relaxation of the external sphincter (49). In absence seizures, it occurs (albeit infrequently) due to increased bladder pressure (50). Urinary incontinence is exceedingly rare in isolation, but one case is described in the text.

Sleep Starts

For patients with vigorous jerks at sleep onset, diagnostic considerations may include periodic leg movements, myoclonic seizures, and excessive startle responses. An EEG is indicated if myoclonic seizures are suspected. Sleep starts generally do not require treatment other than reassurance. Relaxation therapy or other treatments for anxiety are usually successful for the rare patient with sleep-onset insomnia as a result of sleep starts.

What Is CAM

Complementary and alternative therapies are used in an effort to prevent illness, reduce stress, prevent or reduce side effects and symptoms, or control or cure disease. Some commonly used methods of complementary or alternative therapy include mind body control interventions such as visualization and relaxation, manual healing including acupressure and massage, homeopathy, vitamins or herbal products, and acupuncture.

Postictal Sleep

Postictal sleep is a common phenomenon after a generalized tonic-clonic seizure. The patient may pass through several stages from sleep to delirium to drowsiness before awakening. During the late postictal state, the heart rate begins to normalize from the typical ictal tachycardia. There is a decrease in muscle tone with bladder sphincter relaxation and incontinence that typically occurs in the early postictal phase. In the immediate postictal phase, there is partial obstruction of the airway resulting in stertorous respirations. Deep tendon reflexes are diminished and the plantar responses are sometimes extensor. The patient then may pass into sleep. If the seizure occurs during the night, the patient may sleep through the postictal period and awaken with complaints of tongue soreness, muscle aches, or nocturnal enuresis. Patients may often experience postictal morning headaches or unexplained bruises.

Imaging Modalities

Any interpretation of magnetic resonance imaging of the developing brain must take into account the dynamic process of myelination and changes in water content, with corresponding signal intensity changes on T1- and T2-weighted imaging. In most basic terms, T1 and T2 relaxation

Risks to the Woman

Pregnant women with epilepsy who want to have a home birth need to consider the complications that could arise if a seizure occurs during labor. Water births also need to be carefully considered, because consciousness may be impaired during seizures. A water birth can be performed at home or at a birthing center. The warm water relaxes the mother's back and pelvic muscles, and takes the weight of the baby off the mother's back and hips. Relaxation, combined with the buoyancy of water, helps the baby descend through the birth canal. A water birth can provide a relaxing transition for the baby from the womb into the world.

Staying Relaxed

Staying Relaxed

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