Natural approaches to epilepsy

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

Vitamin B6 supplementation is clearly beneficial in cases of vitamin B6-dependent seizures. Some studies have demonstrated improvements in patients with non-vitamin B6-dependent epilepsy as well, although the research has produced conflicting results.

Vitamin B6-dependent Seizures

Vitamin B6-dependent epilepsy is a rare inherited disorder that usually presents with intractable seizures in the first six months of life. The seizures can be completely controlled by administration of large doses of vitamin B6, (52,53) but if the condition is not treated promptly irreversible neurological damage may occur.

The diagnosis of vitamin B6 dependency can be established by intravenous administration of pyridoxine, which results in cessation of seizures within minutes. Intravenous administration of vitamin B6 to infants after a long period of convulsions has been followed in some cases by acute hypotonia; in one case assisted ventilation was required. (54) For that reason, resuscitation equipment should be available during a trial of intravenous vitamin B6.

Most patients can subsequently be maintained on 25-50 mg/day oral pyridoxine, although one child required 200 mg/day. (55) Long-term supplementation is necessary; discontinuation of pyridoxine after several years of good seizure control has resulted in death from status epilepticus.

Some patients with vitamin B6-dependent seizures present with an atypical picture, including later onset (up to 19 months of age), (56,57) a seizure-free period before administration of pyridoxine, a long remission after withdrawal of pyridoxine, and an atypical seizure type. Because the spectrum of vitamin B6-dependent seizures is broader than initially thought, it has been recommended that a trial of vitamin B6 be considered in all infants and young children with intractable epilepsy. (58)

It is also recommended that women who have a child with vitamin B6 dependency receive vitamin B6 supplements during subsequent pregnancies.

Vitamin B6 for Non-vitamin B6-dependent Epilepsy

Vitamin B6 supplementation has been reported to be beneficial in some, but not all, studies of patients with non-vitamin B6-dependent epilepsy.

Twenty-six children with epilepsy received 160 mg/day pyridoxine. Of the 19 patients with laboratory evidence of vitamin B6 deficiency (i.e., increased urinary excretion of xanthurenic acid following a tryptophan load), nine had complete or partial amelioration of seizures, and some of these patients were able to discontinue anticonvulsant medication. Of the seven patients with a normal tryptophan load test, none responded to pyridoxine. (59)

Of three children (ages 3-8 years) with epilepsy associated with impaired intellectual development, progressive emotional disturbances, and abnormal EEGs, all excreted elevated amounts of xanthurenic acid after a tryptophan load. After administration of 60-160 mg pyridoxine daily, tryptophan metabolism became normal and substantial clinical improvement occurred. (60)

Pyridoxine (20 mg, 3-6 times daily) was given for an unspecified length of time to 14 epileptic patients, ages 2-17 years. All patients had petit mal and one also had grand mal epilepsy. Seizures ceased in five patients and became less frequent in three others. (61)