Natural approaches to epilepsy

Alternative Medicine Review, March, 2007 by Alan R. Gaby

Abstract

This article reviews research on the use of diet, nutritional supplements, and hormones in the treatment of epilepsy. Potentially beneficial dietary interventions include identifying and treating blood glucose dysregulation, identifying and avoiding allergenic foods, and avoiding suspected triggering agents such as alcohol, aspartame, and monosodium glutamate. The ketogenic diet may be considered for severe, treatment-resistant cases. The Atkins diet (very low in carbohydrates) is a less restrictive type of ketogenic diet that may be effective in some cases. Nutrients that may reduce seizure frequency include vitamin B6, magnesium, vitamin E, manganese, taurine, dimethylglycine, and omega-3 fatty acids. Administration of thiamine may improve cognitive function in patients with epilepsy. Supplementation with folic acid, vitamin B6, biotin, vitamin D, and L-carnitine may be needed to prevent or treat deficiencies resulting from the use of anticonvulsant drugs. Vitamin K1 has been recommended near the end of pregnancy for women taking anticonvulsants. Melatonin may reduce seizure frequency in some cases, and progesterone may be useful for women with cyclic exacerbations of seizures. In most cases, nutritional therapy is not a substitute for anticonvulsant medications. However, in selected cases, depending on the effectiveness of the interventions, dosage reductions or discontinuation of medications may be possible.

Introduction

Epilepsy is a disorder of brain electrical activity that results in recurrent seizures. The type of seizure depends on the portion of the brain affected. While there are many different causes of seizures, including brain tumor, head injury, stroke, and alcohol withdrawal, the discussion in this article is limited mainly to cases in which the cause is idiopathic (primary epilepsy).

Conventional treatment of epilepsy consists primarily of anticonvulsant medications. Although these drugs often control or reduce the frequency of seizures, some patients show little or no improvement.

A number of dietary modifications, nutritional supplements, and hormones have been found to be beneficial for some patients with epilepsy.

Potentially useful dietary interventions include measures to stabilize blood glucose levels, identification and avoidance of allergenic foods, and avoidance of potential inciting agents (such as ethanol and aspartame). The ketogenic diet has been successful for many patients, but because of its highly restrictive nature and potential to cause significant adverse effects, its use is restricted to severe cases that fail to respond to other treatments. A less restrictive version of the ketogenic diet, the Atkins diet, has shown promise and deserves further study.

Several different nutrients (and two hormones) may also be beneficial in selected patients with epilepsy. The fact that nutritional factors are involved in the regulation of electrical activity in the brain is indicated by the fact that severe deficiency of thiamine, magnesium, or vitamin B6 can cause seizures. A subnormal concentration of each of these nutrients has been found to be common in patients with epilepsy. While the severity of these deficiencies is probably not great enough in most cases to cause seizures in otherwise healthy people, marginal status with respect to any of these nutrients could conceivably exacerbate a seizure disorder due to another cause.

In addition, some patients with epilepsy might have a higher-than-normal requirement for one or more nutrients that play a role in brain electrical activity. That phenomenon has been clearly demonstrated in the case of vitamin B6-dependent epilepsy, a condition in which intractable seizures can be completely controlled by administration of large doses of vitamin B6. The existence of this relatively rare syndrome raises the possibility that more subtle forms of nutrient dependency occur more commonly. While mildly or moderately increased requirements for vitamin B6 or other nutrients may not by themselves be sufficient to cause seizures, a failure to meet these increased requirements could aggravate an existing seizure disorder.

Some studies have found that supplementation with individual nutrients reduced seizure frequency or improved other aspects of health in patients with epilepsy, but other studies have failed to confirm those findings. Administration of combinations of nutrients might be more effective than supplementing with a single nutrient, but that possibility has largely been unexplored. Nutrient supplementation may also be necessary to prevent or reverse the effects of certain deficiencies that frequently result from the use of anticonvulsant drugs. The potential benefits of nutrient supplementation in patients with epilepsy must be weighed against reports that large doses of certain nutrients (such as vitamin B6 and folic acid) can interfere with the effects of anticonvulsants.

Because there are many different types of epilepsy, a nutritional intervention that is helpful for one patient may not be beneficial for another. Some studies did not specify the types of epilepsy being treated, so it is difficult to generalize results. Nevertheless, natural approaches to the treatment of epilepsy show promise and should be considered as part of the overall treatment of epilepsy.