Epilepsy

NOTE: THESE SUMMARIES ARE OF HISTORICAL INTEREST ONLY AS THE COCHRANE REVIEWS ARE OUTDATED
Studies:

Epilepsy is a fairly common nervous system (neurological) condition which causes recurrent seizures. How often the seizures occur and their severity can wax and wane and many people with epilepsy find that the condition goes into remission over time. Seizures are where muscles in the body contract and relax erratically. The seizures are caused by abnormal electrical activity in the brain. Around three quarters of people with epilepsy find that medication successfully stops any seizures but these medications frequently have serious adverse side-effects and may not be suitable for taking during pregnancy.

Adverse effects with medication include drowsiness, memory problems, nausea, unsteadiness, headache, visual problems, weight gain, visual problems and depression. Because medication isn’t effective for everyone and because even when effective it can present problems, there is interest in alternative treatments for epilepsy, and acupuncture is one possibility.

We present some of the evidence from Cochrane systematic reviews about complementary and alternative treatments related to epilepsy. This evidence comes from carefully researched reviews of information about clinical trials done to evaluate medical treatments. Studies are only included in these reviews if they meet pre-defined criteria.

ACUPUNCTURE FOR EPILEPSY

Acupuncture is a widely used therapy with increasing popularity in Western countries. It involves the insertion of very fine needles into specific points of the body, and has been in use for over 2000 years in China. 

Antiepileptic drugs are effective in controlling seizures for many people with epilepsy but not everyone. Some people experience adverse effects with medication (for instance drowsiness, memory problems, nausea, unsteadiness, headache, visual problems, weight gain, visual problems, depression, and others). Because medicine isn’t effective for everyone and because even when effective it can present problems, there is interest in alternative treatments for epilepsy, and acupuncture is one possibility.

What the synthesised research says

The current, limited evidence does not support use of acupuncture as a treatment for epilepsy.  

Three small studies of low methodological quality, involving 184 people, were located and analyzed. Comparability of baseline conditions of groups assigned to different interventions was questionable, and follow-up periods were rather short (12 weeks to 6 months). The trial with the highest quality involved adults and concluded that acupuncture did not make any difference in seizure frequency or quality of life; however, sample size was so small that the trial might not have detected a small positive difference. The other two trials (in children) reported a mildly positive effect on reducing seizure intensity and duration. No overall conclusions can be drawn.

How it was tested

The researchers made a thorough search of the medical literature to identify controlled trials that a) assigned patients with epilepsy to either acupuncture or a non-active treatment -- placebo, sham acupuncture or no treatment -- or else b) assigned patients with epilepsy to either acupuncture plus another treatment regimen or to non-active treatment plus the same treatment regimen.

Ten trials were found but only three, involving a total of 184 patients, met predetermined criteria. Two studied children in China and one studied adults in Norway. The Chinese trials compared groups who received acupuncture and Chinese herbs (in addition to any anti-epileptic drugs they were already taking) against groups of children receiving Chinese herbs.

Side effects and general cautions

No adverse effects were reported in the trials included, but the small trial sizes limit the ability to detect adverse effects. Based on other trials and observational studies that observe changes over time, adverse effects of acupuncture are generally mild and uncommon. Serious side effects of infections or organ damage are possible if the proper procedure is not used, so choosing a qualified practitioner who will follow precautions is important.

Because epileptic seizures typically wax and wane in frequency with or without treatment, long follow-up times are highly desirable for trials.

Source

Cheuk DKL, Wong V. Acupuncture for epilepsy. Cochrane Database of Systematic Reviews 2006, Issue 2. Art. No.: CD005062. DOI: 10.1002/14651858.CD005062.pub2.

YOGA FOR EPILEPSY

Yoga comprises a variety of practices – devotional practices, meditation, breathing exercises, and physical postures – that are traditional in India. It is believed to correct physical and mental disorders.

Yoga is believed to reduce stress and increase relaxation. Because stress is a well-recognized risk factor for seizures in people with epilepsy, reducing stress could potentially have a beneficial effect on seizure occurrence. Yoga would be an attractive therapeutic option for epilepsy, if proven to be effective, especially since yoga has minimal adverse effects. 

What the synthesised research says

No reliable conclusions can be drawn about yoga as a treatment for epilepsy. Yoga should only be tried as an add-on treatment at this time. Future clinical trials should also use yoga as an add-on treatment. It should not be substituted for use of medications, which are known to be effective.  

One small trial of low methodological quality involved 32 people with epilepsy and assigned them to three groups: yoga, sham yoga (other exercises), and no treatment. Antiepileptic drugs were continued in all three groups. The yoga used in the study was sahaja yoga. This involves a person’s sitting in meditation and directing attention to a picture placed before him with a candle burning in front of it, then closing one’s eyes and directing attention to the area around the top of the head.

Results were reported as positive, with four individuals in the yoga group becoming seizure-free for a six-month period but none in the other groups. However, it appears that baseline conditions of the groups were not comparable. And, the groups are so small that results do not provide solid evidence of an effect because sampling error can naturally produce huge variations in results. Definitive conclusions cannot be drawn.

How it was tested

The researchers made a thorough search of the medical literature to identify controlled trials that assigned people with epilepsy randomly to yoga versus routine care or other interventions. Trials where participants were using anti-seizure medications as well as doing yoga were acceptable. Five studies were located, but only one met pre-set criteria for inclusion.

Side effects and general cautions

The review does not state whether adverse effects were looked for in the one trial included. The review mentions in general that yoga is believed to have few adverse effects.

Source

S Ramaratnam, K Sridharan. Yoga for epilepsy. The Cochrane Database of Systematic Reviews 2002, Issue 1. Art. No.: CD001524. DOI: 10.1002/14651858.CD001524.

VITAMINS FOR EPILEPSY AND FOR THE SIDE-EFFECTS OF EPILEPTIC TREATMENT

Epilepsy is a fairly common nervous system (neurological) condition where those affected have recurrent seizures. The course of these seizures can wax or wane and many people with epilepsy find that the condition goes into remission over time (around 70% who take anti-seizure medications). However, up to 30% will continue to have seizures despite treatment, so there is a constant interest in a variety of long-term anti-epileptic treatments.

Moreover, although anti-seizure medications are very useful, they can have adverse side effects, such as swelling of gums; adverse effects on bone and bone marrow; nausea and vomiting; dizziness; cognitive and mood effects; disruption of hormone levels; liver or kidney damage; birth defects in pregnant women, etc.

Do vitamins help control seizures, counter harmful effects of anti-epileptic drugs, or improve the quality of life for diabetic patients? It has been thought that they may, and it is important to examine the evidence for thinking this.

Pyridoxine (vitamin B6) dependent epilepsy is a seizure disorder that begins in the first week of life, or even before. Traditional anti-seizure medications are not effective, but giving pyridoxine is effective in relieving the seizures. Vitamin B6 is also effective in relieving seizures caused by a bad reaction to one of the medications for tuberculosis. 

Because of this, vitamin B6 has also been tried for recurrent seizures. Other vitamins – vitamin D, folic acid and vitamin E have also been tried as add-ons to anti-epileptic drugs in an attempt to further reduce seizure frequency.

Women who are epileptic are more likely than others to have babies with birth defects, including neural tube defects. Because folic acid supplementation is very useful to reduce neural tube defects in the general population of pregnant women, it is believed that folic acid is also likely to be an effective preventative for women with epilepsy on anti-seizure drugs.

Folic acid has also been recommended to prevent swelling of gums common among those who take phenytoin (Dilantin) as an anti-epileptic. Folic acid has also been investigated for prevention of pins and needles or numbness in the extremities (peripheral neuropathy) and for improving the intelligence and behavior of people with epilepsy.

Because bone side effects (depression of blood production in the marrow) can occur with anti-epileptic drugs, Vitamin D has been recommended. However, long-term vitamin D supplementation may have adverse effects, so caution is needed.

Another review addresses the specific issue of anti-epileptic drugs and their effect on the baby during pregnancy (see below, Adab 2004), the review authors did not look at this here in the present review.

What the synthesised research says

No reliable evidence was found to support routine use of vitamins in patients with epilepsy. Trials were small and likely to be biased.  

One small study with 24 participants found a significant decrease in seizure frequency among those given vitamin E compared with placebo.

Nine studies with a total of 331 participants investigated the effect of folic acid on seizure rates and found no effect. In various studies, folic acid did not improve gum health, intelligence, mental health, peripheral neuropathy, or blood composition either. 

One study with 72 participants found an improvement with thiamine on mental abilities.

One study with 226 participants found a beneficial higher bone mineral content among patients on anti-epileptic drugs who also took vitamin D.

As noted, evidence from these trials is extremely weak.

How it was tested

The researchers made a thorough search of the medical literature to identify randomised controlled trials that investigated the effects of vitamins given to people with epilepsy. One or more vitamin could be given alone or in addition to anti-seizure medications. Fifteen studies were located that met the pre-set inclusion criteria.

The studies involved 808 participants:  thiamine (75 participants), vitamin D (274), folic acid (435), and vitamin E (24).

Side effects and general cautions

Possible side-effects of vitamin consumption were not mentioned in the review, with the exception that it was mentioned that too much vitamin D might cause excess calcium in the blood with deposits in the kidneys, weakened bones, fatigue, nausea and vomiting, high blood pressure as some of the adverse effects (hypervitaminosis D). This can be serious but requires extremely high doses of vitamin D over several months and is rare.

Many of the trials were performed and reported on 20 to 30 years ago. All trials were of poor methodological quality (with results therefore considered unreliable), and most had only small numbers of participants. Some studies involved participants with learning or physical disabilities in addition to epilepsy. Adults and children were involved in the studies, and all studies used vitamins as an add-on to anti-seizure medications.

Source

Ranganathan LN, Ramaratnam S. Vitamins for epilepsy. Cochrane Database of Systematic Reviews 2005, Issue 2. Art. No.: CD004304. DOI: 10.1002/14651858.CD004304.pub2.

Adab N, Tudur Smith C, Vinten J, Williamson PR, Winterbottom JB. Common antiepileptic drugs in pregnancy in women with epilepsy.Cochrane Database of Systematic Reviews 2004, Issue 3. Art. No.: CD004848. DOI: 10.1002/14651858.CD004848.

A DIET THAT CAUSES AN INCREASE IN KETONES FOR EPILEPSY

Epilepsy is a common neurological disorder that modern anticonvulsant medications have had much success in treating. Ketones (chemical substances made when the body breaks down fat for energy) are raised after fasting, and these might account for fasting possibly stopping seizures. A diet high in fat and low in carbohydrate could also increase ketones. This diet was one of the strategies used before the advent of modern antiepileptic medications, and there are numerous observational studies that indicate it is quite effective in reducing seizures in some people. However, the diet is generally disagreeable and hard to keep to. Modern dieticians are also often not experienced with ketogenic diets since these are now less used than in the past. However, increased media coverage (including a TV movie) about benefits of a ketogenic diet for epilepsy has led to some increased public interest in recent years.

A ketogenic diet is an option to try for people who cannot get adequate relief from their seizures with anticonvulsant medication. The primary variants are the ‘classic’ ketogenic diet and the medium chain triglyceride diet. (Although the popular Atkins diet is also a ketogenic diet, it is not the same as the ketogenic diets used for epilepsy.)

What the synthesised research says

Although numerous observational studies suggest that a ketogenic diet may have benefit for epilepsy, and is worth a try when seizures cannot be adequately controlled by medication, no evidence from randomised controlled trials is available.  

Twenty observational studies were located that had at least a three-month follow up. They had from 10 to 150 participants and took place in the years 1927 to 2001. The studies are difficult to evaluate because of their methodological limitations, but all indicate that the diet is efficacious in reducing or stopping seizures in a significant proportion of participants despite side-effects.

How it was tested

The researchers made a thorough search of the medical literature to identify trials randomly assigning people with epilepsy to a ketogenic diet or to a placebo or active treatment. Unfortunately, no randomised controlled trials were found.

Side effects and general cautions

There are a number of recognised short-term adverse side effects of ketogenic diets, including gastrointestinal disturbances (such as nausea and vomiting, diarrhea, and constipation), dehydration and electrolyte imbalances. Long-term adverse effects are also possible but have not been studied.

Because the diet is generally unpalatable, it has been modified in various ways and diets may not be comparable between the different observational studies.

Source

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R Levy, P Cooper. Ketogenic diet for epilepsy. The Cochrane Database of Systematic Reviews 2003, Issue 3. Art. No.: CD001903. DOI: 10.1002/14651858.CD001903.