People with epilepsy whose seizures are not fully controlled by antiepileptic drugs or who experience troublesome adverse effects may consider looking into the emerging field of complementary and alternative therapies (CAM). Options in the alternative health care arena include treatments such as herbal medicine, relaxation and biofeedback, acupuncture and even chiropractic therapy.
So what are the pros and cons of complementary and alternative therapies and just how effective are they in treating epilepsy? Alternative therapies are rarely subjected to careful scrutiny through rigorous double-blind controlled studies (that is, a study in which neither the doctor nor the patient knows which patients are receiving the "active" and which are receiving the "inactive" treatment.) Without carefully controlled clinical studies of alternative treatments, we do not know the extent of how helpful, harmful or ineffective they are.
What we do know is that more and more people with epilepsy are using alternative therapies in conjunction with the prescribed treatment of their neurologist. In light of the increasing popularity and utilization of alternative therapies by people with epilepsy, we will explore the most common available treatments used.
Acupuncture is used in China and by some practitioners in the West to treat seizures. Although its mechanisms are not understood, acupuncture can act to alter brain activity. Many surgical procedures can be performed using acupuncture instead of anesthetic drugs. As with other alternative therapies, the usefulness in the treatment of epilepsy is unconfirmed.
Some chiropractic teachings suggest that specific nutrients or forms of spinal manipulation can improve seizure control. There is no evidence to support these claims.
Many epilepsy patients have warnings of their seizures and have learned techniques to "fight off a seizure." The warnings may take the form of certain symptoms that occur 20 minutes to several days before a seizure. Such symptoms may include irritability, depression, fatigue, "not feeling right," or a headache. Patients who have well-defined symptoms of this kind potentially can help prevent a seizure from occurring by getting more sleep or taking additional medication (either their usual medicines or a “rescue” medicine such as lorazepam) under a doctor’s supervision.
Some patients have a simple partial seizure that occurs seconds before a complex partial or tonic-clonic seizure. They may be able to "block" the seizure from progressing, but the individual’s technique to stop seizure progression is often hard to describe. It is a real but idiosyncratic phenomenon. Some patients report that they need to "focus on a difficult problem," "get up and walk," "relax," or keep repeating to themselves "no, no, no." Some patients who experience a tingling sensation or jerking movement in an arm or leg can prevent a tonic-clonic seizure by vigorously rubbing or scratching the arm or leg. Similarly, some patients with seizures beginning with a smell (olfactory aura) can stop their seizure from progressing by smelling an unrelated strong odor.
More examples of self-control of seizures appear in a book, Epilepsy: A New Approach, by Adrienne Richard and Joel Reiter.
Nearly 20% of patients who take prescription drugs also take herbal supplements. Unlike drugs, herbal therapies are classified by the FDA as dietary supplements and are not subject to regulations concerning their preparation, safety, or effectiveness.
Herbal therapies are prepared from the flowers, leaves, stems, bark, or roots of plants. Some of these can be taken directly, but others undergo various forms of processing, such as drying of bark. Herbal therapy is ancient, dating back to prehistoric times. Many modern drugs are derived from plants of herbal therapy. Texts from the 18th and 19th centuries describe many herbal therapies for epilepsy, including mistletoe, foxglove (digitalis), and Cannabis sativa (marijuana), but few were found to be of much help.
A common misconception is that if a substance is synthetic it is unsafe, but if it is natural, it is safe. Hemlock and poisonous mushrooms illustrate that plants can be deadly.
Do some herbal treatments work better than others to treat epilepsy?
Herbal preparations are most often recommended to treat epilepsy in Asian or African folk medicine practices. The herbal medicines that are alleged, but not proven, to have a beneficial effect on seizures include:
Are herbal therapies safe?
Most of them are relatively safe in recommended doses, but adverse effects include rash, digestive disturbances, and headache. However, overdoses can be dangerous.
In isolated cases, some herbal products were reported to cause seizures: ephedra, gingko, ginseng, evening primrose, borage, and essential oils such as eucalyptus, fennel, hyssop, pennyroyal, rosemary, sage, savin, tansy, thuja, turpentine, and wormwood. The exact mechanism of how these drugs may induce seizures is not known. Gingko may reduce the effectiveness of antiepileptic drugs.
Can they be taken with antiepileptic drugs?
Herbal therapies can interact with antiepileptic drugs. For example, St John’s Wort can lower levels of certain antiepileptic drugs, including phenobarbital and phenytoin. Garlic may increase the levels of some antiepileptic drugs. Chamomile may intensify or prolong the effects of phenobarbital. Sedating herbs such as kava, valerian and passionflower can increase sedation produced by phenobarbital, benzodiazepines, and other drugs.