*2.1.6 Tapping*

*Epilepsy - Advances in Diagnosis and Therapy*

*2.1.4 Physical activity*

are relaxed or sleeping.

*2.1.5 Ketogenic diet*

In Asia-Pacific region, they actively use acupuncture as a nonpharmacological method of epilepsy treatment. There is data on the use of acupuncture for patients with stroke in order to avoid poststroke epilepsy. Weng et al. showed that patients with stroke receiving acupuncture had significantly less probability of poststroke epilepsy compared to those who did not receive such treatment (p < 0.0001). However, defensive effects, associated with acupuncture, need further exploration [29]. Some authors report neuroprotective, anti-inflammatory, and neurotrophic effects of acupuncture and electroacupuncture. These effects are explained by the amplification of recurrent inhibition of the brain cortex and hippocampus with the liberation of different neurotransmitters, including gamma-aminobutyric acid (GABA) and serotonin. However, due to the lack of controlled clinical trials, those methods cannot be recommended as reliably effective and safe in epileptology [30].

Patients with epilepsy experience a range of social restrictions, leading to their external and internal stigmatization. These limitations include the employment problem, driving prohibition, and restriction of *physical activity*. However, it is a well-known fact that physical exercises lead to better functional adaptation [31]. Patients with epilepsy, involved in sport, can receive the same benefits of physical activity as healthy people, including increase in performance efficiency and tolerance, weight loss, and cardiovascular system functioning normalization. Physical activity is also a critical factor in reducing the risks of diabetes mellitus, arterial hypertension, coronary heart disease, obesity, and osteoarthritis. As for psychological advantages, the research in this field found out that physically active patients have better mental health than those leading a sedentary lifestyle [32–34].

Physical activity in early age can cause neuronal reserve's formation, which then will be used during the life course. Consequently, physically active patients have lower risk of developing cognitive impairments associated with epilepsy [35, 36]. Preventive and curative effect of the physical activity in case of epilepsy can be achieved in accordance with several principles, including the principles of consistency, regularity, duration, monitoring, and personalization of the training load. Despite this, it is believed that enhanced muscular activity is accompanied with

However, some authors claim that physical activity can reduce the likelihood of seizures. Usually, seizures do not occur while running, swimming, ice skating, skiing, crossing the crowded street, as well as during sport events, although this issue is disputable. On the other side, it is reported that seizures often start when patients

The described fact accounts for the development of new dominant excitation areas in the central nervous system (CNS) during vigorous exercises. Due to the negative induction, these areas slow down or inhibit the epileptic area activity, therefore preventing seizure occurrence. It is reported that during physical exercises seizures occur much more rare than during relaxation [31]. The disappearance of epileptiform activity in many patients' EEG during the physical activity proves this theory **[**37–40].

Ketogenic diet (KD) is a high-fat and low-carbohydrate diet that induces ketosis.

Ketosis is a metabolic state where the body uses ketone bodies, made from the breakdown of fatty acids in the liver, rather than carbohydrates as primary source of energy. The classical KD has a fat to carbohydrate plus protein ratio of 3–4:1. Additionally, classical KD can be supplemented with either long- or medium-chain

tachypnea (hyperventilation), which can initiate the seizures.

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Tapping is a psychomotor test that can be used to assess the psychophysiological brain functions, in particular the time perception**.** Tapping without any external influence reflects the speed of nervous processes and endogenous rhythmic processes of the central nervous system since tapping with the preferred test speed represents a "biological constant" [43, 44].

However, in case of exogenously defined long-term reproduction of the rhythmic intervals, the frequency of stimulation is of importance. A number of studies revealed association between the frequency of exogenous stimulation in case of tapping and body response. Specifically, if stimulation is more than 1 Hz, the leading value is the reaction to time, and at a stimulation frequency less than 1 Hz, the reaction to the stimulus prevails. Therefore, at the frequency of exogenous stimulation of 1 Hz, both reactions acquire an equivalent value.

Despite the long-standing interest in tapping, new developments in this area constantly appear. This is due to the fundamental principles of this technique. In this case we are talking about the doctrine of dominants.

Therefore, tеmpo-rhythm correction methods hold a specific place in neurorehabilitation. Prototypical techniques of such therapy include movement therapy, music therapy, and logopedic rhythmics [43].

One of the methods of studying the typological features of the nervous system is the "tapping test." The essence of the classical tapping test technique is the application of pencil points on an A4 sheet of paper, pre-drawn into six squares, with the maximum allowable speed. The movement from square to square is carried out by command every 5 seconds, from left to right clockwise [45].

Tapping test is widely used to study the effect of sleep duration on the level of anxiety of different groups of patients [46, 47].

The technique of meridian tapping [or the emotional freedom technique (EFT)] is used as a clinical procedure to alleviate the psychological and physical suffering of the patient. This method is described as "tapping" and is often combined with other nondrug techniques aimed at relieving patient's emotional stress. Such techniques may include acupuncture and aromatherapy. The EFT includes finger tapping on certain points on the face and hands. More than 60 research articles in various journals report 98% of the effectiveness of this technique in various patients with psychological disorders (such as post-traumatic stress disorder, phobias, anxiety, depression), as well as in patients with various somatic diseases (asthma, fibromyalgia, pain, epilepsy). The advantages of this method are its simplicity and safety. Patients can easily learn this technique and use it as a self-help in various pathological conditions. Also, this technique is used by nurses for patients undergoing inpatient treatment [48].

To study neural mechanisms, lying in foundation of rhythm reproduction, authors conducted an EEG during the tapping test. All subjects were divided into two groups of those who were previously trained and those who were not. EEG analysis showed that beta-rhythm in temporal and hippocampal areas in those who were trained beforehand was higher than in those who were not trained. More than that synchronization between frontal and temporal and hippocampal areas on later training stages was higher than on earlier stage. These results show that frontal,

temporal, and hippocampal beta-neuron schemes can be studied with auditory motor rhythm [49].

In other studies, it was concluded that the decrease in beta-rhythm in temporal areas is connected with rhythmic movements (in this case, rhythmic hand movements) [50]. It is also supposed that temporal areas play an important role in rhythm reproduction, correlating with frontal areas and basal ganglia, forming a link between auditory stimulus and motor response [51]. It is proven that the hippocampus is connected with the processing of rhythmic information. Moreover, EEG showed the beta-fluctuation in the cerebellum during the processing of sensorimotor information [52].

## *2.1.7 Transcranial magnetic stimulation*

Low-frequency rhythmic transcranial magnetic stimulation (rTMS) leads to a decrease in the cerebral cortex neuronal excitability, while high-frequency rTMS increases their excitability [2]. The mechanisms of rTMS are related to its ability to cause long-term effects of postsynaptic inhibition in excitatory neurotransmitter systems and neuronal excitability reduction through inactivation of the voltagedependent ion channels [53].

### **2.2 Nonpharmacological invasive therapy**

## *2.2.1 Percutaneous stimulation of trigeminal nerve*

Percutaneous stimulation of trigeminal nerve is a minimally invasive method which is based on exposure of the first trigeminal nerve's branches to electricity. To implement this method in practice, a special system is used which consists of external electric impulse generator and electroconductive plasters. There are few studies which report the use of this method, but most of them consider this method to have a positive clinical effect. During preliminary clinical trials, 57% of patients noticed a 50% or more reduction in the number of seizures [54].

### *2.2.2 Vagus nerve neurostimulation*

Vagus nerve neurostimulation (VNS) is one of the nondrug epileptic treatment methods. The principle of this method is in the chronic electrical stimulation of the left vagus nerve, using an implantable stimulator [55]. The primary candidates for the application of this method are patients with drug-refractory epilepsy (DRE), who cannot get resection surgery.

The main contraindications for this method are pregnancy and lactation, cardiac arrhythmia, bronchial asthma, chronic obstructive pulmonary disease, acute peptic and duodenal ulcer, vasovagal syncope, and type 1 diabetes [56]. Against the background of VNS therapy during the period from 3 months to 3 years, a complete cessation of seizures was revealed in 4.8–17.6% of patients. The decrease in the number of seizures by 50% or more was detected in 27.3–47% of patients, while the decrease in the number of seizures by less than 50% was detected in 23.5% of patients [57–59].

### *2.2.3 Deep brain stimulation*

Deep brain stimulation is an effective therapeutic method for DRE treatment, especially for temporal lobe epilepsy. Thus, according to a randomized study, assessing the effectiveness of hippocampal stimulation in patients with temporal lobe DRE, positive effect in the form of complete disappearance of seizures was found in 50% of patients [60]. According to other studies, it was shown that after

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*The Role of Nondrug Treatment Methods in the Management of Epilepsy*

11 years of deep brain stimulation, the attacks were not registered for at least

The principle of this method is in electrode implantation into certain brain structures (target structures), these electrodes being supplied with low-voltage and high-frequency electric current. Due to the impulses, generated by the neurostimulator, the selected brain structures change their functions. Thus, this highfrequency stimulation of the target structures allows reducing the severity of the symptoms and the amount of AEDs taken by the patients as well as bringing the

Based on the conducted literature review results, it can be stated that an adequate number of Russian and foreign studies of the analyzed period are dedicated to nonpharmacological epilepsy treatment. Both methods with proven clinical effectiveness and low-reliable treatment options were found in the studied literature. Most of the authors emphasize a positive influence of physical activity on epileptic patients, including prevention of epileptic seizures. Besides, physical activity is reported to have a positive influence on patients' psychic function, preventing cognitive disorders. However, up until now, physical exercises as an additional therapy are not included in any treatment program for patients with epilepsy. The analysis of the literature showed that it is due to the current concern of neurologists and epileptologists over the occurrence of epileptic seizures in state

Those concerns are not unfounded, because hyperventilation can provoke epileptic seizures in a certain group of patients with epilepsy. As a result, it is reasonable not to ban physical activity for all epileptic patients but to limit its intensity for the group of patients, in whom hyperventilation can provoke epileptic seizures. Meanwhile, the fact is reported that during physical exercising the reduction of epileptiform activity occurs on the epileptic patients' EEG. There are also works that prove a positive effect of music therapy, but the issue is still underinvestigated. All the options for nonpharmacological epilepsy treatment, represented in the present review, are based on the classical theory of Kryzhanovskii about creation and destruction of pathological systems [62]. The author noted that on early stages of the disease the elimination of pathological determinant leads to liquidation of

On late stages the fixation of pathological system leads to chronization of pathological process and corresponding neural disorders. The battle with pathological systems, especially with those with complicated and matured forms, is hard and is not always effective. It requires a complex pathogenetic therapy, focused on elimination of pathological determinant (e.g., the elimination of epileptic focus) and normalization of other links of the pathological system. Activation of antiepileptic system, amplification of overall control, and other genetic mechanisms are important as well. It is also known that there is a constant countdown in living system, on

According to the theory of Rudnev [14], the so-called internal time is a genetic core of any motor activity, having both populations' and individual characteristics. Internal time is expressed as an individual rhythm. A lot of studies explore individual rhythm, its "maturation" in late ontogenesis, as well as its breaking in different cases of neural disorders [64]. Individual rhythm is a reflection of harmony of brains' work, and its breaking is a sign of disintegration in brain's work. Since there is an established fact that in case of epilepsy a pathological activation of

*DOI: http://dx.doi.org/10.5772/intechopen.81912*

patient back into the society [56].

**3. Conclusion**

of hyperventilation.

pathological (and, as a result, epileptic) system.

which homeostasis is based [63].

12 months in only 13.8% of the patients [61].

### *The Role of Nondrug Treatment Methods in the Management of Epilepsy DOI: http://dx.doi.org/10.5772/intechopen.81912*

11 years of deep brain stimulation, the attacks were not registered for at least 12 months in only 13.8% of the patients [61].

The principle of this method is in electrode implantation into certain brain structures (target structures), these electrodes being supplied with low-voltage and high-frequency electric current. Due to the impulses, generated by the neurostimulator, the selected brain structures change their functions. Thus, this highfrequency stimulation of the target structures allows reducing the severity of the symptoms and the amount of AEDs taken by the patients as well as bringing the patient back into the society [56].
