Natural approaches to epilepsy

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

Long-term problems include moderate growth retardation, renal stones (5-8% of cases), gallstones, acidosis or metabolic problems (particularly during illness), recurrent infections, hypercholesterolemia, hyperuricemia, vitamin deficiency, and feeding problems. Prolonged ketosis may raise the serum level of phenobarbitone, which can result in alopecia, renal stones, and growth retardation. (36)

The ketogenic diet and anticonvulsant drugs both have an adverse effect on bone density, which can be partially reversed with vitamin D supplementation. Carnitine deficiency may also occur with the ketogenic diet, particularly in patients taking valproic acid. L-carnitine supplementation is recommended for patients who have low serum carnitine levels. (41)

Patients on the ketogenic diet must be monitored closely by a practitioner experienced in its use.

Atkins Diet

The Atkins diet is a low-carbohydrate, high-fat diet used by millions of people for weight reduction. Like the ketogenic diet, the Atkins diet can induce a state of ketosis, but it has fewer restrictions on calories and protein. In addition, the Atkins diet does not require fluid restriction and does not need to be started in the hospital.

According to one study, the Atkins diet may be an effective alternative to the ketogenic diet in some children with intractable epilepsy. Twenty children (ages 3-18 years) with intractable epilepsy, with at least three seizures per week, who had been treated with at least two anticonvulsants, followed a modified Atkins diet (nature of the modification not specified) over a six-month period. Carbohydrates were limited to 10 g/day for the first month and consumption of fats was encouraged. All children received vitamin and calcium supplements. At six months, 13 patients (65%) had more than 50-percent improvement and seven patients (35%) had more than 90-percent improvement (four were seizure-free). Small increases were seen in serum cholesterol and blood urea nitrogen levels during the study. (42)

In another study, two adults (ages 42 and 52) with epilepsy showed no improvement on the Atkins diet. (43) Table 1 weighs the evidence for various dietary/ metabolic interventions.

Nutritional Supplements

Vitamin B6

Experimentally-induced vitamin B6 deficiency resulted in seizures in rats (44) and swine. (45) In the early 1950s, numerous infants in the United States developed convulsions traced to the use of a formula that was deficient in pyridoxine. (46,47) Seizures also occurred in an infant fed exclusively on powdered goat's milk, which had undetectable levels of the vitamin. The seizures resolved after supplementation with vitamin B6. (48)

Vitamin B6 deficiency has been found in a high proportion of patients with epilepsy. Of 62 drug-treated epileptic patients, 55 percent had a subnormal blood level of pyridoxal phosphate (PLP). (49) In a study of 68 institutionalized patients with severe epilepsy, 37 percent had a reduced serum concentration of pyridoxal. (50) Low levels of vitamin B6 may be due in part to treatment with phenytoin, which has been associated with laboratory evidence of reduced vitamin B6 status (i.e., increased xanthurenic acid excretion following a tryptophan load). (51) However, other factors may be involved as well, since there does not appear to be a strong relationship between low vitamin B6 levels and use of any specific anticonvulsant medication.