Effectiveness of Yoga Intervention in Reducing Felt Stigma in Adults With Epilepsy: A Randomized Controlled Trial

Persons with epilepsy are afflicted with co-morbidities such as stigma, anxiety and depression which have a significant impact on their quality of life. These co-morbidities remain largely unaddressed in resource limited countries. This randomized controlled trial (RCT) aimed to investigate if yoga and psychoeducation were effective in reducing felt stigma (primary outcome), neuropsychiatric outcomes and seizure frequency, as compared to sham yoga and psychoeducation in persons with epilepsy.This was an assessor blinded, sham-yoga controlled RCT. Patients clinically diagnosed with epilepsy, aged 18-60 years and scoring higher than the cut-off score for felt stigma as measured by the Kilifi Stigma Scale in our population were randomly assigned to receive either yoga therapy plus psychoeducation (intervention) or sham yoga therapy plus psychoeducation (comparator) for a duration of three months. The primary outcome was a significant decrease in felt stigma as compared to the comparator arm as measured by the Kilifi Stigma Scale. Primary and secondary outcomes (seizure frequency, quality of life, anxiety, depression, mindfulness, trait rumination, cognitive impairment, emotion regulation) were assessed at baseline, 3 months and 6 months. Parametric/non-parametric ANCOVA and chi-square test were used to compare the two arms.160 patients were enrolled in the trial. At the end of the follow-up period (6 months) the intervention arm reported significant reduction in felt stigma as compared to the control arm (p-value = 0.006, Cohen's d = 0.23 95% CI [-0.08, 0.55]. Significantly higher odds of >50% seizure reduction (OR 4.11 95% CI [1.34, 14.69], p =0.01) and complete seizure remission (OR 7.4 95% CI [1.75, 55.89], p=0.005) were also observed in the intervention group. The intervention group showed significant improvement in symptoms of anxiety, cognitive impairment, mindfulness and quality of life relative to the control group at the end of follow-up period (p<0.05).Yoga can alleviate the burden of epilepsy and improve the overall quality of life in epilepsy by reducing perceived stigma.