• Ketogenic Diet, Nutritional Support
• Acupuncture, Electromagnetic Therapy (rTMS), Fish Oil, Food Allergen Identification and Avoidance, Manganese, Melatonin, Nigella sativa, Taurine, Traditional Chinese Herbal Remedies (Saiko-Keishi-To and Sho-Saiko-To)
• 5-HTP, 2-Dimethylaminoethanol (DMAE), Ginkgo, Glutamine, Hyssop, Ipriflavone, Japanese Star Anise, Nicotinamide, White Willow
Epilepsy is a disorder of the brain that causes recurrent episodes called seizures. A seizure is sometimes described as an electrical storm in the brain leading to abnormal movements, sensations, and states of consciousness. In reality, however, it is more orderly than a storm. During a seizure, nerves function in an abnormally synchronized manner, a kind of lockstep that can continue for seconds or minutes. The results range from mild changes in awareness to violent convulsions.
Isolated seizures can occur for many reasons. The term epilepsy is applied when a person has recurrent seizures with no known treatable cause. If the seizure occurs in a localized part of the brain, it is called a partial seizure . If it affects much of brain, it is called a generalized seizure.
The most common forms of generalized seizures are absence seizures (petit mal) and tonic-clonic seizures (grand mal). Petit mal seizures involve a brief lapse of consciousness that occurs suddenly and lasts for a brief time before disappearing; there are usually no symptoms afterward. A grand mal seizure involves: loss of consciousness, convulsions of the body, tongue biting, and often urination. A state of confusion follows the seizure.
Partial seizures come in three main varieties. They can be simple (involving just an arm, for example) or complex (involving more complicated movements and loss of consciousness). Finally, some may turn into generalized seizures. There are several medications used to treat epilepsy, generally with considerable success. Most of these drugs can cause significant side effects, though. Fortunately, some of these side effects may be partially correctable through nutrient supplementation (see the Nutritional Support section).
Principal Proposed Natural Treatments
There are no well-established herbs or supplements for the treatment of epilepsy. However, a number of supplements may be useful for treating nutritional deficiencies caused by anticonvulsant drugs. Besides herbs and supplements, the ketogenic diet might be helpful for controlling seizures in children.
Note: Epilepsy is far too serious a condition for self-treatment. For this reason, none of the treatments listed below should be used without the advice and supervision of a doctor.
Before drug treatments for epilepsy were invented, scientists noticed that fasting tends to reduce seizure frequency. Subsequent investigation pinned down a metabolic state called ketosis as the causative factor. Ketosis occurs during fasting and also while consuming a diet high in fat and very low in carbohydrates (the ketogenic diet).
When effective anticonvulsant drugs were developed, the ketogenic diet fell into disfavor, but in recent years medical interest has returned. Today, the diet is seeing increased use in the treatment of people who do not respond fully to standard medications. Most studies have involved children because they tend to be more agreeable than adults to the diet.
Evidence suggests that the ketogenic diet may almost completely stop seizures in about half of all children with epilepsy and reduce seizure frequency less dramatically in another third. 1-6 Unfortunately, the ketogenic diet can cause side effects, such as fatigue, nausea, reduced immunity, mental confusion, dehydration, constipation, and increased tendency to bruise. 2,3,7-13 Major side effects seen occasionally with certain forms of the ketogenic diet include kidney stones, gallstones, impaired liver function, severe hypoproteinemia (dangerously low levels of protein in the blood), and kidney injury. 14 Vitamin and mineral deficiency may also occur with some ketogenic diets, but the use of a multivitamin/multimineral supplement can easily prevent this. 15
Many drugs can impair the body’s ability to absorb or metabolize certain nutrients; however, anticonvulsants are particular offenders. Meaningful evidence indicates that common anticonvulsants interfere with the body’s handling of folate , biotin , calcium , vitamin D , and vitamin K . In addition, one anticonvulsant, valproic acid, affects the nutrient-like substance carnitine . For these reasons, it is often recommended that people using anticonvulsants take supplements that provide these nutrients.
However, there’s a potential catch to correcting such “nutrient depletions.” In some cases, taking the nutrient can impair the absorption or alter the metabolism of anticonvulsant drugs. In other cases, it is possible that nutrient depletion is part of how the anticonvulsant operates! For this reason, physician supervision is essential when taking any supplements.
Folate (also known as folic acid) is a B vitamin that plays an important role in many vital aspects of health. Unfortunately, most drugs used for preventing seizures can reduce levels of folate in the body. 16-21 In turn, low serum folate levels can cause elevated levels of homocysteine, possibly increasing the risk of heart disease. 22
Low folate levels are also linked to increased risk of a variety of birth defects. Because anticonvulsant drugs deplete folate, babies born to women taking anticonvulsants are at increased risk for such birth defects.
However, the case for taking extra folate is complicated by the fact that high folate levels may speed up the normal breakdown of phenytoin 19,21 and possibly other anticonvulsants. This could lead to breakthrough seizures. For this reason, folate supplementation during anticonvulsant therapy should always be supervised by a physician.
Numerous anticonvulsants can reduce body levels of the essential vitamin biotin , probably by interfering with its absorption. 23,24 Valproic acid may affect biotin to a lesser extent than other anticonvulsants.
It is not clear whether this biotin deficiency actually causes any problems. Nonetheless, it is not good to be short on any essential nutrient, and for this reason biotin supplementation has been recommended during long-term anticonvulsant therapy. Keep in mind, though, that the action of anticonvulsant drugs may be at least partly related to their effect on biotin levels. For this reason, physician supervision is strongly advised before adding biotin to an anticonvulsant regimen.
Many anticonvulsant drugs increase the risk of osteoporosis and other bone disorders. 25,26 This is believed to be due in part to the fact that they impair calcium metabolism (see also the sections on vitamin D and vitamin K below). Effects on calcium may also increase the tendency toward seizures by lowering blood levels of calcium. 26
Calcium supplementation may thus be beneficial for people taking anticonvulsant drugs. However, some studies indicate that antacids containing calcium carbonate interfere with the absorption of phenytoin and perhaps other anticonvulsants. 27,28 For this reason, calcium supplements and anticonvulsant drugs should be taken several hours apart.
Phenytoin, carbamazepine, phenobarbital, and primidone speed up the normal breakdown of vitamin K into inactive byproducts, thus depriving the body of active vitamin K. Use of these anticonvulsants by pregnant mothers can lead to vitamin K deficiencies in their unborn babies, resulting in bleeding disorders or facial-bone abnormalities in the newborns. 33,34 For this reason, mothers who take these anticonvulsants may need vitamin K supplementation during pregnancy.
In other circumstances, anticonvulsants seldom deplete vitamin K enough to cause bleeding problems. However, vitamin K deficiency may contribute to anticonvulsant-induced osteoporosis.
Valproic acid (Depakene) and possibly other anticonvulsants may reduce the body’s levels of the substance carnitine . 35-44 For this reason it has been suggested that people using these drugs should take supplemental carnitine. However, there is no evidence as yet that taking carnitine will provide any noticeable benefit; the one study that did attempt to evaluate this possibility failed to discern any meaningful effect. 45
Other Proposed Treatments for Epilepsy
Herbs and Supplements
The traditional Chinese herbal remedies known by the Japanese names saiko-keishi-to and sho-saiko-to have also been suggested for epilepsy, but the supporting evidence for their use remains highly preliminary. 46-48 Both of these combination treatments consist of bupleurum, peony root, pinellia root, cassia bark, ginger root , jujube fruit, Asian ginseng root , Asian skullcap root, and licorice root , but the proportions vary.
A double-blind study performed in Iran reportedly found that use of an extract of the seed of the Nigella sativa plant helped control seizures in children.80
Other supplements sometimes suggested for epilepsy (but with no meaningful supporting evidence) include vitamin B 1 , vitamin B 6 , beta-carotene , and glycine . Herbs traditionally regarded as “nervines” or nerve-relaxants are also sometimes proposed, such as the following:
However, there is no meaningful evidence that they can help, and some of these herbs present significant safety concerns.
Note: Most herbs used for epilepsy are sedatives, as are many anticonvulsant drugs. Combination treatment could lead to dangerous over-sedation. People with epilepsy should, therefore, seek medical supervision before using any herbs or supplements.
A special form of electromagnetic therapy called rTMS has shown promise for epilepsy. In a double-blind, placebo-controlled trial, 24 participants with epilepsy localized to a specific part of the brain and not fully responsive to drug treatment were given twice daily treatment with rTMS or sham rTMS for a week. 54 The results showed a mild reduction in seizures among the participants given real rTMS. However, the benefits rapidly disappeared when treatment was stopped.
Herbs and Supplements to Avoid in Epilepsy
Numerous herbs and supplements have been associated with unexpected or unexpectedly severe seizures. 67 In most cases, however, the evidence linking any particular natural product to increased seizure activity remains circumstantial. Some of the more worrisome potential “pro-seizure” agents are discussed here. In addition, we discuss herbs and supplements that may interact with medications used for seizures. See also the discussion of folate and biotin above.
Ginkgo seeds contain a seizure-promoting substance called 4-methoxypyridoxine (MPN). 57 Although ginkgo seeds are seldom used today, seizures have also been reported with the use of the more normal form of the herb: ginkgo leaf extract. 58,59,73 One possible explanation is that ginkgo-leaf products may have been contaminated ginkgo seeds. Another possibility has been proposed as well: ginkgo may affect the brain in ways similar to tacrine, a drug also used to improve memory and which has been associated with seizures. Finally, it has been suggested that ginkgo might impair the effectiveness of dilantin and depakote. Regardless of the explanation, people with epilepsy should probably avoid ginkgo.
Many anti-epilepsy drugs work by blocking the effects of a substance called glutamate; for this reason, high dosages of the closely-related amino acid glutamine could conceivably overwhelm these drugs and pose a risk to people with epilepsy.
Manufacturers of the supplement DMAE warn that it might increase seizure risk.
Tea made from the herb hyssop is thought to be safe, but hyssop essential oil, like most essential oils , is toxic in excessive doses. Some of the constituents of hyssop oil are thought to increase risk of seizures. 74,75 For this reason, hyssop essential oil should not be used by people with epilepsy.
Japanese star-anise contains substances that can trigger seizure activity. 76-78
Grapefruit juice slows the body's normal breakdown of several drugs, including the anticonvulsant carbamazepine , allowing it to build up to potentially dangerous levels in the blood; this effect can last for 3 days or more following the last glass of juice. 62
The herb white willow , also known as willow bark, is used to treat pain and fever. White willow contains a substance closely related to aspirin known as salicin. Aspirin is known to increase phenytoin levels and toxicity during long-term use of both drugs. 64 This raises the concern that white willow might have similar effects on phenytoin, though this has not been proven.
21. Lewis DP, Van Dyke DC, Stumbo PJ, et al. Drug and environmental factors associated with adverse pregnancy outcomes. Part I: Antiepileptic drugs, contraceptives, smoking, and folate. Ann Pharmacother. 1998;32:802-817.
26. Weinstein RS, Bryce GF, Sappington LJ, et al. Decreased serum ionized calcium and normal vitamin D metabolite levels with anticonvulsant drug treatment. J Clin Endocrinol Metab. 1984;58:1003-1009.
28. McElnay JC, Uprichard G, Collier PS. The effect of activated dimethicone and a proprietary antacid preparation containing this agent on the absorption of phenytoin. Br J Clin Pharmacol. 1982;13:501-505.
34. Cornelissen M, Steegers-Theunissen R, Kollee L, et al. Supplementation of vitamin K in pregnant women receiving anticonvulsant therapy prevents neonatal vitamin K deficiency. Am J Obstet Gynecol. 1993;168:884-888.
35. Hug C, McGraw CA, Bates SR, et al. Reduction of serum carnitine concentrations during anticonvulsant therapy with phenobarbital, valproic acid, phenytoin, and carbamazepine in children. J Pediatr. 1991;119:799-802.
43. Camina MF, Rozas I, Gomez M, et al. Short-term effects of administration of anticonvulsant drugs on free carnitine and acylcarnitine in mouse serum and tissues. Br J Pharmacol. 1991;103:1179-1183.
45. Freeman JM, Vining EP, Cost S, et al. Does carnitine administration improve the symptoms attributed to anticonvulsant medications?: a double-blinded, crossover study. Pediatrics. 1994;93(6 pt 1):893-895.
50. Marchesi GF, Quattrini A, Scarpino O, et al. Therapeutic effects of taurine in epilepsy: a clinical and polyphysiographic study [in Italian; English abstract]. Riv Patol Nerv Ment. 1975;96:166-184.
69. Gupta M, Aneja S, Kohli K. Add-on melatonin improves quality of life in epileptic children on valproate monotherapy: a randomized, double-blind, placebo-controlled trial. Epilepsy Behav . 2004;5:316-321.
71. Gupta M, Gupta YK, Agarwal S, et al. A randomized, double-blind, placebo controlled trial of melatonin add-on therapy in epileptic children on valproate monotherapy: effect on glutathione peroxidase and glutathione reductase enzymes. Br J Clin Pharmacol. 2004;58:542-547.
72. Gupta M, Gupta YK, Agarwal S, et al. Effects of Add-on Melatonin Administration on Antioxidant Enzymes in Children with Epilepsy Taking Carbamazepine Monotherapy: A Randomized, Double-blind, Placebo-controlled Trial. Epilepsia . 2004;45:1636-1639.
75. Millet Y, Tognetti P, Lavaire-Perlovisi M, et al. [Experimental study of the toxic convulsant properties of commercial preparations of essences of sage and hyssop]. Rev Electroencephalogr Neurophysiol Clin . 1979;9:12-18.
77. Nakamura T, Okuyama E, Yamazaki M. Neurotropic components from star anise (Illicium verum Hook. fil.) Chem Pharm Bull (Tokyo). 1996;44:1908-1914. Erratum in: Chem Pharm Bull (Tokyo). 1996 ;44:2344.
Last reviewed January 2008 by EBSCO CAM Review Board
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
Copyright © 2011 EBSCO Publishing All rights reserved.