Natural approaches to epilepsy

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

The prevalence of celiac disease has been found to be higher in patients with epilepsy than in controls (1/44 versus 1/244, respectively). (9) Seizures have improved in patients with celiac disease who consumed a gluten-free diet, (10) but only when the diet was started soon after the onset of epilepsy. (11) Most epileptic patients with celiac disease did not have gastrointestinal symptoms at the time of presentation, so testing for celiac disease should be considered even in the absence of such symptoms. Some patients with epilepsy and celiac disease have also been found to have cerebral calcifications, (12-14) the significance of which is not clear.

Dietary Inciting Factors

In some cases, epileptic seizures have been triggered by excessive alcohol intake. (15)

Two case reports indicate ingestion of monosodium glutamate appeared to trigger or exacerbate seizures in children. (16)

Grand real seizures have occurred after consumption of aspartame by people who had no prior history of epilepsy. (17,18) Ingestion of a drink containing aspartame (40 mg/kg body weight) also exacerbated EEG spike-wave discharges in children with a history of absence seizures. (19)

However, in trials funded by the NutraSweet Company (the manufacturer of aspartame), administration of aspartame (34 mg/kg/day for two weeks or a single dose of 50 mg/kg) did not provoke seizures in patients with epilepsy or in people who reported a history of aspartame-induced seizures. (20,21) A potential limitation of these trials is that aspartame was administered in capsules, rather than in soft drinks or other aspartame-containing foods or beverages. As aspartame in commercial products is said to undergo chemical changes on exposure to high temperatures or after storage for more than two months, these degradation products may be partly responsible for the reported adverse effects of aspartame. (22 Therefore, symptoms that occur after ingestion of aspartame-containing commercial products or hot drinks to which aspartame has been added may not be reproducible by challenging with aspartame in capsules. Based on the available evidence, aspartame should be considered a potential trigger for seizures and should be excluded during an elimination diet.

Ketogenic Diet

The ketogenic diet has been used since 1921 to control seizures in children who do not respond to anticonvulsant medications. (23-31) The diet is calorie-restricted and provides a ratio of fat to (carbohydrate protein) ranging from 2:1 to 5:1. The proportion of total energy derived from fat ranges from 82-92 percent. Consuming a ketogenic diet produces a state of ketosis, which helps control seizures through an unknown mechanism. Fluid intake is restricted to maintain urine specific gravity at 1.020-1.025, since fluid intake dilutes blood ketones.

In different studies, 40-70 percent of patients following the diet experienced at least a 50-percent reduction in seizure frequency, and 10-33 percent became seizure-free. In many cases, medications could be discontinued or the dosages decreased. Two children with acquired epileptic aphasia were also successfully treated with this diet. (32) According to some research, myoclonic epilepsy responds best to the ketogenic diet. (26) However, another study found that the response to the diet did not vary significantly according to seizure type. (25) The diet is most effective in children ages 2-5 years, although patients of other ages have also benefited. (26)