Alternative and Complementary therapy in Epilepsy
What are complementary and alternative therapies?
The term “conventional medicine” refers to the methods and treatments most widely practised by Western health professionals today to diagnose and treat health conditions. These methods and treatments are based on scientific research. Their effectiveness is proven and their side effects are well known.
The term “complementary and alternative medicine” (CAM) refers to the use of treatment methods that are not yet approved by conventional Western medicine or proven by scientific research techniques. These may include physical treatments or procedures; herbal therapies, vitamins, and other substances; and even complete systems of medical theory and practice, such as traditional Chinese medicine and Ayurveda.
Strictly speaking, “alternative medicine” refers to using only the non-conventional treatment, whereas “complementary medicine” means using the non-conventional treatment in conjunction with conventional ones. However, the terms “complementary medicine” and “alternative medicine” are often used interchangeably. The terms “holistic” and “integrative” medicine can also be used to refer to patient-centred care that combines mainstream and complementary therapies.
CAM for epilepsy may be used for lessening seizures, for alleviating related symptoms, and for reducing side effects. Some complementary and alternative therapies for epilepsy are based on the principle that relaxation may reduce seizures. Others are based on the idea that the person with epilepsy has less of some vitamin or mineral in his body than is normal. Still others focus on avoiding certain types of food.
Currently there is mixed scientific evidence on CAM. Studies have been done on various treatments over the years, with some results supporting their use, some indicating adverse reactions, and some no impact at all. Most studies have been done in adults, so we have limited information about the use of CAM for children with epilepsy.
If a treatment has been studied enough to show that it is both effective and safe, it is moved into the realm of conventional therapies. For example, the ketogenic diet was once considered an alternative therapy, but after various research studies showed that it was effective, it became a conventional treatment for epilepsy. Thanks to the same research, we also know what side effects and challenges to expect from this treatment and how best to implement it.
What are your responsibilities as a parent considering CAM?
In cases of epilepsy, people may investigate CAM for various reasons:
- Conventional drugs, such as anti-epileptic drugs, may not be effective in controlling their child’s seizures or if they are effective, the side effects may be intolerable.
- Parents may want to supplement the conventional treatment and improve the overall well-being of their child.
- Surgery may be too risky, not an option, or tried and failed.
- Their cultural beliefs may make the CAM a viable option.
- Parents may have heard of the CAM helping another child with a similar condition.
If you are a parent exploring CAM options for your child with epilepsy, it is important for you to educate yourself fully on the pros and cons and discuss the options thoroughly with your child’s doctor before you take any action.
Practitioners of CAM are often not as strictly regulated as doctors of conventional medicine. Ensure that the practitioner you consult is properly qualified, reputable, and has experience treating similar cases. Ask the CAM practitioner many of the same questions you would your regular doctor before beginning a therapy, to make sure you understand:
- the treatment
- how it works
- its possible side effects
- what to do in case of a seizure
- how to begin the treatment
- how to best administer it
- when and how often to give it
CAM should only be used with great care and under the guidance of a professional. Registered and licensed practitioners of CAM exist and both they and your child’s doctor should be consulted before starting a treatment. Like conventional Western medicine, complementary or alternative therapies may be potent, may interact with each other and with conventional anti-epileptic drugs, and may have side effects. Like AEDs, prescription of CAM should be done on an individual basis. What works on one type of seizure or one child may not work in another similar case.
Some alternative “therapies” may be actively harmful. A popular treatment in the 1960s and 1970s involved “aversive therapy,” a technique based on the belief that seizures were a learned behaviour that could be modified by giving an unpleasant stimulus (such as a skin shock) at the start or end of a seizure. Effectively, this technique punished children for something they could not help – their seizures. Always keep your child’s wellbeing in mind when investigating any treatment.
CAM should be used along with conventional medicines, not instead of. Do not suddenly stop your child’s anti-epileptic medication, because this can result in very serious withdrawal seizures. Decide upon a schedule for your CAM together with your CAM practitioner and with the full knowledge and approval of your child’s doctor.
Because CAM should be used in conjunction with AEDs, it is necessary to consider any interaction between the two. Ask both your CAM practitioner and your child’s doctor about this.
CAM for epilepsy can be categorized into vitamins and supplements, herbs, homeopathy, diets, mind-body techniques, and physical therapies.
Vitamins and other supplements
Some children have seizures because of a vitamin deficiency caused by an inherited metabolic disorder. Giving a supplement to replace the missing vitamin stops the seizures and normalizes the child’s EEG. Disorders in this category include pyridoxine dependent seizures, biotinidase deficiency, and folinic acid responsive seizures. In this situation, daily vitamin supplements are an approved, conventional treatment.
In other cases, certain anti-epileptic drugs may reduce levels of certain vitamins in the body. For example, valproate can reduce the body’s supply of carnitine, so your child’s doctor may recommend carnitine supplementation if your child is taking valproate.
Some vitamins and supplements are also thought to have a seizure-reducing effect. The evidence for these supplements is still not strong. A few are discussed here.
Melatonin is a natural hormone that regulates the biological clock and sleep. It is produced by the pineal gland, located in the brain. One theory on how it may help people with epilepsy is that it enables better sleep and thereby reduces the risk of seizures brought on by fatigue.
One study of children with epilepsy found melatonin helpful when taken together with the anti-epileptic drug valproate. Another study, though, found that melatonin increased the rate of seizures. Melatonin is still being studied.
The major side effect of melatonin is it can affect the production and use of other hormones in the body, such as the growth hormone. Other side effects include tiredness, dizziness, depression, confusion, irritability, headaches, low blood pressure, nausea, stomach cramps, and vomiting.
Omega-3 fatty acids
Omega-3 fatty acids have been studied in patients with epilepsy, but the results have been poor. One study found that polyunsaturated fatty acids had no effect on seizures; another found that omega-3 fatty acids reduced seizure frequency at first, but the effect wore off.
Vitamin E is thought to have an effect on neurotransmitter systems in the brain. Some studies have shown vitamin E to be helpful in reducing seizures, while other studies have not shown an effect. Further study is needed.
Herbal therapies are a part of many non-Western medical systems, including traditional Chinese medicine and Ayurveda. A variety of herbal therapies are sometimes suggested to reduce the frequency and severity of seizures. So far, there have been few high-quality studies of herbal medicines or their components for seizure control in humans, although there have been some promising animal studies. Research in this area is continuing.
Herbal remedies are often perceived as safer than conventional medicines because they are made from plants and are therefore “natural.” However, like conventional prescription and over-the-counter drugs, herbal remedies contain pharmacologically active ingredients that may have side effects or interactions with other drugs. Some may trigger or worsen seizures. In addition, some herbal remedies may be contaminated with other drugs or even heavy metals, and the dosage may vary from batch to batch. Use herbal therapies with caution and in consultation with your child’s doctor and your pharmacist.
Homeopathy is based on giving tiny amounts of active substances, diluted many times. Homeopathic remedies are popular, but there is little scientific evidence to support their use in people with epilepsy.
The ketogenic diet has been present for many years, is well established, and is now considered a conventional treatment for epilepsy. Recently, other diet therapies for epilepsy have been studied, including a modified version of the Atkins diet and a low glycemic index diet. Since these diets allow a wider range of foods, they may be easier to follow. Diet therapies are often recommended for children who are not eligible for surgery and who have tried two or more anti-epileptic drugs without success. They do not work for all children, but they can be very effective.
Occasionally, seizures may be triggered by food allergies. If you notice that a particular food seems to trigger your child’s seizures, by all means avoid that food. Some doctors may work with your child to slowly remove and reintroduce foods to their diet to determine the effect of certain foods on seizures. These results are usually very specific to each child.
Mind-body techniques and psychological therapy
Mind-body techniques are often difficult to evaluate in high-quality, double-blinded, randomized controlled trials, so the evidence for their use is often weak. However, unblinded trials or trials comparing the techniques to “sham” treatments sometimes show benefit from these techniques.
Biofeedback and neurofeedback
Biofeedback is a treatment technique in which people are trained to improve their health by using information and signals from their own bodies. This technique is used for a variety of diseases and by different kinds of specialists to help patients relax, reduce pain, and regain normal functioning.
In epilepsy, a form of biofeedback known as neurofeedback may be used to teach patients to consciously control their brain activity and thereby avoid seizures. The technique may require many sessions to learn and is unlikely to control seizures completely.
A number of studies have looked at the use of biofeedback to treat epilepsy; these studies have shown a reduction in seizures in some people. However, most of these studies were small and give limited information.
There are many different forms of meditation, but in general, meditation is a way of focusing the mind in the present moment. Meditation is being studied in many different conditions, including chronic pain and attention-deficit/hyperactivity disorder.
One small study of adults with epilepsy who practiced meditation for 20 minutes per day for a year found that they had fewer, shorter seizures and a change in EEG patterns. The patients in the control group did not show significant changes.
A few small studies have looked at relaxation techniques for epilepsy. One study taught children to recognize the signs of an approaching seizure and then apply relaxation techniques. Compared with the control group, children in the treatment group had fewer seizures after 10 weeks and at 1 year after the treatment ended. The study is small and it is hard to draw conclusions from it. However, other small studies in adults have also shown positive effects from relaxation techniques. Interestingly, one such study compared a group using relaxation techniques with a group who received therapy in which they discussed public attitudes towards epilepsy, what epilepsy meant to them, how they experienced seizures, and so forth. Compared to a control group, the relaxation group had fewer seizures, while the epilepsy-discussion group had more seizures.
Yoga is an ancient Hindu system of meditation and low-impact exercise to promote control of the body and mind.
Yoga has been explored as a way to reduce seizures because of its aim to reduce stress and promote relaxation. A few studies have found that yoga reduced seizure frequency and changed patients’ EEGs compared to control groups; however, the studies were small and give limited information. Yoga is still being studied.
Acupuncture is a part of traditional Chinese medicine. It involves inserting thin needles at specific points on the body. There have been a few good-quality randomized controlled trials of acupuncture for people with epilepsy, which have not shown any anti-seizure effect from the treatment. Since many children are afraid of needles, acupuncture is probably not a good option for them.