Natural treatments for epilepsy

Definition: Treatment of the brain disorder that causes recurrent seizures.

Principal proposed natural treatments: Ketogenic diet, nutritional support

Other proposed natural treatments: Acupuncture, electromagnetic therapy, fish oil, food allergen identification and avoidance, manganese, melatonin, Nigella sativa, taurine, traditional Chinese herbal remedies (saiko-keishi-to and sho-saiko-to)

Herbs and supplements to avoid: 5-hydroxytryptophan, ginkgo, glutamine, hyssop, ipriflavone, Japanese star anise, nicotinamide, 2-dimethylaminoethanol, white willow

Introduction

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, the seizure 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 complex seizure. If it affects much of the 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, some of which may be partially correctable through nutrient supplementation.

Principal Proposed Natural Treatments

There are no well-established herbs or supplements for the treatment of epilepsy. However, several 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.

Epilepsy is far too serious a condition for self-treatment. For this reason, none of the treatments listed here should be used without the advice and supervision of a doctor.

Ketogenic diet. 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 medical interest has returned. 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 accept the diet more readily than adults.

Evidence suggests that the ketogenic diet may almost completely stop seizures in about one-half of all children with epilepsy and reduce seizure frequency less dramatically in another one-third. The ketogenic diet can cause side effects, such as fatigue, nausea, reduced immunity, mental confusion, dehydration, constipation, and an increased tendency to bruise. 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. Vitamin and mineral deficiency may also occur with some ketogenic diets, but the use of a multivitamin-multimineral supplement can easily prevent this.

Nutritional support. 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 is 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. Folate (also known as folic acid) is a B vitamin that plays an important role in many vital aspects of health. However, most drugs used for preventing seizures can reduce levels of folate in the body. In turn, low serum folate levels can cause elevated levels of homocysteine, possibly increasing the risk of heart disease. Low folate levels are also linked to an 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 high folate levels, which may speed up the normal breakdown of phenytoin 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.

Biotin. Numerous anticonvulsants can reduce body levels of the essential vitamin biotin, probably by interfering with its absorption. Valproic acid may affect biotin to a lesser extent than other anticonvulsants.

It is not clear whether this biotin deficiency 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. 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.

Calcium. Many anticonvulsant drugs increase the risk of osteoporosis and other bone disorders. This is believed to be caused, in part, by their impairment of calcium metabolism. Effects on calcium may also increase the tendency toward seizures by lowering blood levels of calcium.

Calcium supplementation may 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. For this reason, calcium supplements and anticonvulsant drugs should be taken several hours apart.

Vitamin D. Anticonvulsant drugs may interfere with the activity of vitamin D; this may be another factor contributing to anticonvulsant-induced bone problems. Vitamin D supplementation may help prevent bone loss. Adequate sunlight exposure may also help because sunlight aids the body in manufacturing vitamin D.

Vitamin K. Phenytoin, carbamazepine, phenobarbital, and primidone speed up the normal breakdown of vitamin K into inactive by-products, depriving the body of active vitamin K. The use of these anticonvulsants by pregnant women can lead to vitamin K deficiencies in their fetuses, resulting in bleeding disorders or facial bone abnormalities in the newborns. 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.

Carnitine. Valproic acid (Depakene) and possibly other anticonvulsants may reduce the body’s levels of the substance carnitine. For this reason, it has been suggested that people using these drugs should take supplemental carnitine. However, there is no evidence that taking carnitine will provide any noticeable benefit; the one study that did attempt to evaluate this possibility failed to discern any meaningful effect.

Other Proposed Treatments

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 preliminary. 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 the use of an extract of the seed of the Nigella sativa plant helped control seizures in children. Weak evidence suggests that the amino acid taurine might offer modest, short-term benefits in epilepsy. Results are inconsistent regarding whether the use of fish oil can decrease seizure frequency in people with epilepsy. Several studies by a single research group hint that the supplement melatonin may improve quality of life in children with epilepsy. People with epilepsy have lower-than-normal levels of the mineral manganese in their blood. This suggests (but does not prove) that manganese supplements might be helpful for epilepsy.

Other supplements sometimes suggested for epilepsy (but with no meaningful supporting evidence) include vitamin B₁, vitamin B₆, beta-carotene, and glycine. Herbs traditionally regarded as nervines or nerve-relaxants are also sometimes proposed. These include skullcap, lobelia, lady’s slipper, valerian, kava, passionflower, and lemon balm. However, there is no meaningful evidence that they can help, and some of these herbs present significant safety concerns.

Most herbs used for epilepsy are sedatives, as are many anticonvulsant drugs. Combination treatment could lead to dangerous oversedation. People with epilepsy should seek medical supervision before using any herbs or supplements.

Alternative therapies. A form of electromagnetic therapy called rTMS (repetitive transcranial magnetic stimulation) has shown promise for epilepsy. In a double-blind, placebo-controlled trial, twenty-four 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 one week. The results showed a mild reduction in seizures among the participants given real rTMS. However, the benefits rapidly disappeared when treatment was stopped. Despite this, many practitioners and researchers pursue this therapy for their patients.

Weak evidence hints that food allergen identification and avoidance may be helpful for people with both migraine headaches and epilepsy. Acupuncture has been proposed for the treatment of epilepsy, but there is no convincing evidence for its effectiveness. A single-blind, controlled trial of individualized acupuncture for thirty-four people with severe epilepsy found no benefit. Also, in a comprehensive review involving ten Chinese trials and one Norwegian trial, acupuncture was largely found to be ineffective. While research is mixed, the majority of the evidence finds no benefit.

Herbs and Supplements to Avoid

Numerous herbs and supplements have been associated with unexpected or unexpectedly severe seizures. 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. Also discussed are herbs and supplements that may interact with medications used for seizures.

Ginkgo seeds contain a seizure-promoting substance called 4-methoxypyridoxine. Although ginkgo seeds are seldom used in modern medicine, seizures have also been reported with the use of the more common form of the herb: ginkgo leaf extract. One possible explanation is that ginkgo leaf products may have been contaminated with ginkgo seeds. Another possibility has been proposed: 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 2-dimethylaminoethanol 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 the risk of seizures. For this reason, hyssop essential oil should not be used by people with epilepsy.

Japanese star anise contains substances that can trigger seizure activity. Also, some evidence hints that the supplement 5-hydroxytryptophan could potentially exacerbate or initiate a seizure-related illness called myoclonic seizure disorder. The supplement ipriflavone might increase levels of carbamazepine and phenytoin, potentially raising the risk of side effects.

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 continue for three days or more following the last glass of grapefruit juice.

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. This raises the concern that white willow might have similar effects on phenytoin, though this has not been proven.

Nicotinamide may increase blood levels of carbamazepine and primidone, possibly requiring a reduction in drug dosage to prevent toxic effects. Some reports suggested that the supplement gamma-linolenic acid might worsen temporal lobe epilepsy. However, there has been no confirmation of this.

Bibliography

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Walton, Dean, et al. “Transcranial Magnetic Stimulation for the Treatment of Epilepsy.” The Cochrane Database of Systematic Reviews, vol. 4, no. 4, Apr. 2021, p. CD011025. doi:10.1002/14651858.CD011025.pub3.

Yuen, A. W., et al. “Omega-3 Fatty Acid Supplementation in Patients with Chronic Epilepsy.” Epilepsy and Behavior, vol. 7, 2005, pp. 253-258.