Epilepsy and Alternative Medicine

I have asked several friends/colleagues and mentors to help me with blog content this year. So, we'll be having some "guest posters". Today's guest blogger will provide a naturopathic perspective to the treatment of epilepsy.

Dr.Sara-Jane White is a Graduate of the Canadian College of Naturopathic Medicine. She has also received an Honors English Degree from Brescia College at the University of Western Ontario and she has completed her medical school prerequisites at the University of Toronto.

For more information on the naturopathic treatment of epilepsy, or if you have questions on Rett Syndrome please see Dr.White's webpage: http://www.natdoc.com

Epilepsy and Alternative Medicine

This list is not inclusive but provides information on the more commonly used herbs.

Approximately 2-5% of the population will suffer from epilepsy during their lifetime. As there is more patient awareness of complementary and alternative medicine, patients with epilepsy are increasingly turning to herbs and supplements to avoid the side-effects of anti-epileptic pharmaceuticals.

One can class alternative treatments into four categories: 1. those with excellent efficacy and tolerability i.e. Vitamin B6 used to treat a rare neonatal seizure and some infantile spasms; 2. those with excellent efficacy but poor tolerability i.e. ACTH (adrenocorticotropic hormone) used for infantile spasms and Lennox-Gastaut syndrome; 3. those with promise but without proof of efficacy; 4. those with unproven efficacy but also little evidence of side effects.

At this point in time, however, very little is known about epilepsy and herbal medicine. The most used herbs on the market are typically: ginkgo, St. John’s wort, ginseng, garlic, Echinacea/goldenseal, saw palmettos, kava, pycnogenol/grapeseed, cranberry, valerian root, evening primrose oil, bilberry and milk thistle.

Those herbs primarily considered for a possible treatment of seizures are: American hellebore, betony, blue cohosh, kava, mistletoe, mugwort, pipsissewa and skullcap.

Interactions
Reviews are mixed but ginkgo, evening primrose oil and mistletoe can be considered pro-convulsants in a number of seizure disorders. Anecdotal observations suggest that herbal stimulants containing ephedrine (ephedra or ma huang) and caffeine (cocoa, coffee, tea, mate, guarana, cola or kola) can exacerbate seizures in people with epilepsy especially when taken in combination.

Kava, valerian, chamomile, passionflower may increase the effects of antiepileptic medications by increasing their sedative and cognitive effects.

Theoretical interactions include those herbs that can affect the enzymes within the liver that are responsible for metabolizing seizure medications. Drugs commonly prescribed for the treatment of epilepsy that are metabolized via the cytochrome P450 enzyme system within the liver are: carbamazepine, clonazepam, ethosuximide, felbamate, lamotrigine, oxcarbazepine, phenobarbital, phenytoin, primidone, tiagabine, topiramate, valproic acid and zonisamide (gabapentin and levetiracetam are not).

Anecdotal evidence suggests St. John’s wort, garlic, Echinacea, pyconogenol, milk thistle, mugwort and pipsissewa all inhibit the liver metabolic enzyme system. Actual proof of an interaction is yet to be discovered so at this time the above herbs are not typically seen in herb/drug interaction lists and St. John’s wort is currently considered the most likely to cause a reaction.

Herbs can also affect a ‘pump’ that moves chemicals out of cells. Overrepresentation of a gene (MDR1) responsible for controlling this pump has been seen in tissue samples from patients with intractable epilepsy. Four herbs that potentially affect this pump system are St. John’s wort, garlic, pycnogenol and American hellebore, therefore, they too can be considered a possible interaction.
People with seizures may be advised to avoid ginseng, because the ginsenosides in ginseng may increase the levels of hormones such as ACTH and corticosteroids in the blood, and corticosteroids can raise the likelihood of seizures. As mentioned above, LGS has a low tolerance to ACTH and would want to avoid ginseng and those products containing ginseng, this would include the new Cold FX treatment for cold and flu prevention.

Some essential oils may contain plants containing compounds that increase epilepsy.

References:
http://www.epilepsy.com/epilepsy/alternative_ginseng.html
http://www.neurologyreviews.com/aug02/nr_aug02_epilepsyalt.html