Mindfulness meditation increases interictal epileptiform discharges in meditation-naïve surgical epilepsy patients

Meditation has widely recognized psychological and neuromodulatory benefits, yet its effects on epileptiform activity remain unclear. This study examined whether novice meditation modulates interictal epileptiform discharges (IEDs) in patients with drug-resistant epilepsy using intracranial electroencephalography (iEEG).

Twenty-seven meditation-naïve patients undergoing iEEG monitoring performed two meditation conditions, focused attention meditation (FAM) and open monitoring meditation (OMM), as well as two control conditions, story listening (STL) and classical music listening (CMM). IEDs were visually identified across the brain and manually labeled by an experienced neurologist. Linear mixed-effects models were applied to assess the effect of meditation on IED density (IEDs/min). Subjective meditative depth was evaluated using the Meditation Depth Questionnaire (MEDEQ), and associations between IED density and subjective experiences were examined.

Both focused attention (p = .027) and open monitoring (p = .041) meditation increased IED density relative to the non-meditative STL control condition, whereas no differences were observed relative to the CMM control condition. Although both meditation conditions produced numerically comparable IED increases relative to STL control at the individual level, there was notable inter-individual variability depending on type of meditation. Subjects overall reported higher meditation depth scores during meditation than the STL control, and perceived depth increased with progressive meditative levels. Crucially, the relationship between IED density and perceived meditation depth changed across levels (p < .01), suggesting a dynamic interplay between neural excitability in the context of epilepsy and the subjective ease of meditative engagement.

This exploratory study provides direct intracranial evidence that meditation modulates interictal epileptiform activity in meditation-naïve epilepsy patients. Increased IED density during meditation suggests that these internally directed cognitive states can transiently influence epileptic network dynamics. These preliminary findings indicate a functional coupling between meditative states and cortical excitability in epilepsy, offering crucial insights into the clinical relevance of meditation in epilepsy.