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Epilepsy

Also indexed as: Convulsions, Falling Sickness, Seizure Disorders

Epilepsy is a brain disorder in which abnormal bursts of electrical activity occur in cells of the brain, resulting in seizures. There are many types of epilepsy, usually categorized by the symptoms that occur during seizures. The cause of many types of epilepsy is unknown, and frequently no cure is available. Rather, treatment focuses on reducing the frequency and severity of seizures.

Checklist for Epilepsy

Rating Nutritional Supplements Herbs
3Stars Vitamin E (for children)  
2Stars   Bupleurum in combination with peony root, pinellia root, cassia bark, ginger root, jujube fruit, Asian ginseng root, Asian scullcap root, and licorice root
1Star Folic acid
Melatonin
Taurine
Vitamin B6
Vitamin E (for adults)		  
3Stars Reliable and relatively consistent scientific data showing a substantial health benefit.
2Stars Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.
1Star An herb is primarily supported by traditional use, or the herb or supplement has little scientific support and/or minimal health benefit.

What are the symptoms of epilepsy? There are many types of seizures in epilepsy. They are categorized as either partial or generalized, depending on how much of the brain is involved. Some types of epilepsy involve seizures characterized by convulsive muscle contractions of all or some parts of the body. Other types can involve momentary loss of consciousness, amnesia, unusual sensations or emotions, and other symptoms. Symptoms that indicate an imminent seizure (called auras) may occur. Similarly, non-convulsive symptoms, including deep sleep, headache, confusion, and muscle soreness (called a postictal state), may follow a generalized seizure.

How is it treated? Treatment focuses on reducing the frequency and severity of seizures. People with epilepsy may take several different drugs to control seizures, as no single drug controls all types. For partial seizures, carbamazepine (Tegretol®), phenytoin (Dilantin®), and valproic acid (Depacon™, Depakene®, Depakote®) are commonly given. For absence seizures, ethosuximide (Zarontin®) is preferred. Benzodiazepines (e.g., diazepam [Valium®], lorazepam [Ativan®]) are sometimes added to a drug regimen in order to help control seizures. About 10 to 20% of epilepsy patients do not respond to treatment and may require surgery.

Dietary changes that may be helpful: The ketogenic diet was developed in the early twentieth century when few drug treatments for epilepsy were available; until recently, it had been used only when drug therapy was ineffective. The dietary approach was based on the observation that ketosis (increased blood levels of chemicals called ketones) is associated with reduction of seizures.1 Ketosis can be produced by a diet high in fat and very low in carbohydrate and protein. The ketogenic diet has been evaluated in several preliminary and a few controlled trials. According to a 1996 review, the ketogenic diet appears to be very effective in one-third to one-half of epilepsy cases in children, and partially effective in another one-third of cases.2

Recent trials continue to support this success rate;3 4 5 one preliminary trial demonstrated a 50% reduction in seizure activity in 71% of children in a group after 45 days on the diet. There is little research on the effects of the ketogenic diet in adults, but it may be effective in those who are able to comply with the strict dietary guidelines.6 7 The diet is usually initiated by fasting under close medical supervision, often in a hospital, followed by introduction of the diet and training of the family to ensure successful maintenance.

Possible side effects of the ketogenic diet include gastrointestinal upset, dehydration, anemia, low blood protein levels, high blood levels of fat and acidity, kidney stones, and signs of liver toxicity.8 9 Vitamin and mineral supplementation is necessary due to the many deficiencies of this unusual diet.10 The ketogenic diet should not be attempted without the supervision of a qualified healthcare professional. Practical information about the ketogenic diet is available in recent texts 11 and articles,12 as well as on the Internet.13

Allergic reactions to food have been reported to trigger epileptic seizures in individual cases,14 15 some of which were proven with double-blind testing.16 One report found people with epilepsy to have significantly more biochemical evidence of allergy than do non-epileptics.17 A study of children who suffered from both epilepsy and migraine headaches found that a diet low in potential food allergens reduced seizures in the majority of cases; however, children who had epilepsy alone without migraines did not respond to the diet.18 Another report confirmed that children who have epilepsy without migraines do not improve on a low-allergen diet.19 Some doctors recommend that people with epilepsy and other allergic symptoms, such as asthma or hay fever, should be checked for food allergies that may be causing seizures.20

Nutritional supplements that may be helpful: Vitamin E has been studied as a possible add-on to conventional drug treatment for epilepsy. A double-blind trial found that adding 400 IU per day of vitamin E reduced seizure frequency in children without side effects.21 Other preliminary trials22 23 have reported similar results, and, while some preliminary research suggested this effect might also be achieved in adults,24 a double-blind trial found no effect of vitamin E supplementation on adults with epilepsy.25

Folic acid supplementation (5 mg per day) was reported to reduce epileptic seizure frequency, though the effect was not significantly better than with placebo.26 Folic acid supplementation of as little as 800 mcg per day has also been reported to interfere with the action of anticonvulsant medications, resulting in an increase in the frequency and/or severity of seizures;27 28 29 30 this effect occurs only in a small number of cases.31 32 People taking anticonvulsant medications should consult with the prescribing physician before deciding whether to use folic acid.

Vitamin B6 has been used to treat infants and small children who have seizures related to a genetic enzyme defect.33 34 35 36 However, this condition is not considered true epilepsy, and whether people with epilepsy would benefit from taking vitamin B6 supplements is unknown.

Taurine is an amino acid that is thought to play a role in the electrical activity of the brain; deficits of taurine in the brain have been associated with some types of epilepsy. However, while some short-term studies have suggested that taurine supplementation may reduce epileptic seizures in some people, the effect appears to be only temporary.37

Case reports have suggested that evening primrose oil may worsen symptoms in people with temporal lobe epilepsy.38 Until more is known, people with this type of epilepsy should avoid using evening primrose oil supplements, except perhaps under the supervision of a qualified physician.

A small, preliminary trial found that 5 to 10 mg per day of melatonin improved sleep and provided “clear improvement of the seizure situation” among children with one of two rare seizure disorders.39 More research is needed to determine whether or not melatonin could benefit other people with epilepsy.

Two elderly individuals with well-controlled epilepsy reportedly developed recurrent seizures within two weeks of starting Ginkgo biloba extract.40 Individuals with epilepsy should not, therefore, take Ginkgo biloba without medical supervision.

Are there any side effects or interactions? Refer to the individual supplement for information about any side effects or interactions.

Herbs that may be helpful: The Chinese herb bupleurum is included in two similar Chinese herbal formulae known as sho-saiko-to and saiko-keishi-to; these combinations contain the same herbs but in different proportions. The other ingredients are peony root, pinellia root, cassia bark, ginger root, jujube fruit, Asian ginseng root, Asian scullcap root, and licorice root. Both formulas have been shown in preliminary trials to be helpful for people with epilepsy.41 42 43 No negative interactions with a variety of anticonvulsant drugs were noted in these trials. The usual amount taken of these formulas is 2.5 grams three times per day as capsules or tea. People with epilepsy should not use either formula without first consulting with a healthcare professional.

Are there any side effects or interactions? Refer to the individual herb for information about any side effects or interactions.

References:

1. Wilder RM. The effects of ketonemia on the course of epilepsy. Mayo Clinic Proc 1921;2:307–8.

2. Prasad AN, Stafstrom CF, Holmes GL. Alternative epilepsy therapies: the ketogenic diet, immunoglobulins, and steroids. Epilepsia 1996;37:S81–S95 [review].

3. Vining EP, Freemen JM, Ballaban-Gil K, et al. A multicenter study of the efficacy of the ketogenic diet. Arch Neurol 1998;55:1433–7.

4. Freeman JM, Vining EP, Pillas DJ, et al. The efficacy of the ketogenic diet-1998: a prospective evaluation of intervention in 150 children. Pediatrics 1998;102:1358–63.

5. Neelam GK, Koehler AN, McGhee B, et al. The ketogenic diet in refractory epilepsy: the experience of Children’s Hospital of Pittsburgh. Clinical Pediatrics 2000;39:153–9.

6. Barborka CJ. Results of treatment by ketogenic diet in one hundred cases of epilepsy in adults. Assoc Res Nerv Ment Dis 1929;7:638–58.

7. Ballaban-Gil K, Callahan CM, O’Dell C, et al. The ketogenic diet in the treatment of intractable epilepsy in adults. Epilepsy 1996;37:92 [abstract].

8. Ballaban-Gil K, Callahan CM, O’Dell C, et al. Complications of the ketogenic diet. Epilepsia 1998;39:744–8.

9. Prasad AN, Stafstrom CF, Holmes GL. Alternative epilepsy therapies: the ketogenic diet, immunoglobulins, and steroids. Epilepsia 1996;37:S81–95 [review].

10. Barron TF, Hunt SL. A review of the newer antiepileptic drugs and the ketogenic diet. Clin Pediatr (Phila) 1997;36:513–21.

11. Freeman JM, Kelly MT, Freeman JB. The epilepsy diet treatment. New York, NY: Demos, 1994.

12. Carroll J, Koenigsberger D. The ketogenic diet: a practical guide for caregivers. J Am Diet Assoc 1998;98:316–21.

13. http://www-leland.stanford.edu/group/ketodiet

14. Stevens H. Allergy and epilepsy. Epilepsia 1965;6:205–16 [review].

15. Campbell M. Neurologic manifestations of allergic disease. Ann Allergy 1973;31:485–98 [review].

16. Crayton JW, Stone T, Stein G. Epilepsy precipitated by food sensitivity: report of a case with double-blind placebo-controlled assessment. Clin Electroencephalogr 1981;12:192–8.

17. Cunningham AS. Allergy, immunodeficiency and epilepsy. Lancet 1975;11:975 [letter].

18. Egger J, Carter CM, Soothill JF, Wilson J. Oligoantigenic diet treatment of children with epilepsy and migraine. J Pediatr 1989;114:51–8.

19. Van Someren V, Robinson RO, McArdle B, Sturgeon N. Restricted diets for treatment of migraine. J Pediatr 1990;117:509–10 [letter].

20. Crayton JW, Stone T, Stein G. Epilepsy precipitated by food sensitivity: report of a case with double-blind placebo-controlled assessment. Clin Electroencephalogr 1981;12:192–8.

21. Ogunmekan AO, Hwang PA. A randomized, double-blind, placebo-controlled, clinical trial of D-alpha-tocopheryl acetate (vitamin E), as add-on therapy, for epilepsy in children. Epilepsia 1989;30:84–9.

22. Hom AC, Weaver RC, Aldersen JJ. Efficacy of D-alpha tocopherol acetate as adjunctive antiepileptic agent in patients with refractory epilepsy and profound developmental disability. A prospective, randomized, double-blind, placebo-controlled trial. Epilepsia 1991;32(suppl 3):63 [abstract].

23. Sullivan C, Capaldi N, Mack G, Buchanan N. Seizures and natural vitamin E. Med J Aust 1990;152:613–4 [letter].

24. Tupeev IR, Kryzhanovskii GN, Nikushkin EV, et al. The antioxidant system in the dynamic combined treatment of epilepsy patients with traditional anticonvulsant preparations and an antioxidant—alpha-tocopherol. Biull Eksp Biol Med 1993;116:362–4 [in Russian].

25. Raju GB, Behari M, Prasad K, Ahuja GK. Randomized, double-blind, placebo-controlled, clinical trial of D-alpha-tocopherol (vitamin E) as add-on therapy in uncontrolled epilepsy. Epilepsia 1994;35:368–72.

26. Gibberd FB, Nicholls A, Wright MG. The influence of folic acid on the frequency of epileptic attacks. Eur J Clin Pharmacol 1981;19:57–60.

27. Guidolin L, Vignoli A, Canger R. Worsening in seizure frequency and severity in relation to folic acid administration. Eur J Neurol 1998;5:301–3.

28. Lewis DP, Van Dyke DC, Willhite LA. Phenytoin-folic acid interaction. Ann Pharmacother 1995;29:726–35 [review].

29. Berg MJ, Rivey MP, Vern BA, et al. Phenytoin and folic acid: individualized drug-drug interaction. Ther Drug Monit 1983;5:395–9.

30. Reynolds EH. Effects of folic acid on the mental state and fit frequency of drug treated epileptic patients. Lancet 1967;1:1086.

31. Eros E, Geher P, Gomor B, et al. Epileptogenic activity of folic acid after drug induces SLE (folic acid and epilepsy). Eur J Obstet Gynecol Reprod Biol 1998;80:75–8.

32. Ueda S, Shirakawa T, Nakazawa Y, et al. Epilepsy and folic acid. Folia Psychiatr Neurol Jpn 1977;31:327–37.

33. Bankier A, Turner M, Hopkins IJ. Pyridoxine dependent seizures—a wider clinical spectrum. Arch Dis Child 1983;58:415–8.

34. Baxter P, Griffiths P, Kelly T, et al. Pyridoxine-dependent seizures: demographic, clinical, MRI and psychometric features, and effect of dose on intelligence quotient. Develop Med Child Neurol 1996;38:998–1006.

35. Jiao FY, Gao DY, Takuma Y, et al. Randomized, controlled trial of high-dose intravenous pyridoxine in the treatment of recurrent seizures in children. Pediatr Neurol 1997;17:54–7.

36. Goutieres F, Aicardi J. Atypical presentation of pyridoxine-dependent seizures: a treatable cause of intractable epilepsy in infants. Ann Neurol 1985;17:117–20.

37. Durelli L, Mutani R. The current status of taurine in epilepsy. Clin Neuropharmacol 1983;6:37–48.

38. Vaddadi KS. The use of gamma-linolenic acid and linoleic acid to differentiate between temporal lobe epilepsy and schizophrenia. Prostaglandins Med 1981;6:375–9.

39. Fauteck J, Schmidt H, Lerchl A, et al. Melatonin in epilepsy: first results of replacement therapy and first clinical results. Biol Signals Recept 1999;8:105–10.

40. Granger AS. Ginkgo biloba precipitating epileptic seizures. Age Ageing 2001;30:523–5.

41. Yarnell EY, Abascal K. An herbal formula for treating intractable epilepsy: a review of the literature. Alt Compl Ther 2000;6:203–6 [review].

42. Narita Y, Satowa H, Kokubu T, et al. Treatment of epileptic patients with the Chinese herbal medicine “saiko-keishi-to” (SK). IRCS Med Sci 1982;10:88–9.

43. Nagakubo S, Niwa S-I, Kumagai N, et al. Effects of TJ-960 on Sternberg’s paradigm results in epileptic patients. Jpn J Psych Neur 1993;47:609–19.