Natural approaches to epilepsy

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

Fifty-six epileptic children received 160-200 mg pyridoxine daily for at least six weeks. Significant clinical improvement was seen in five cases. (62)

A 23-year-old man with recurrent seizures presented with status epilepticus, which resolved immediately following intravenous administration of 60 mg PLP. Prior to treatment, his serum pyridoxine concentration was markedly decreased (80% below the lower limit of normal). (63)

Pyridoxine was given intravenously to infants and children with acute, recurrent seizures due primarily to acute infections. A dose of 30 or 50 mg/kg/day was administered in 100-250 mL of 10-percent glucose over 2-4 hours and given for a few days. Anti-epileptic drugs were used as appropriate. The treatment was rated "very effective" (i.e., duration and frequency of seizures decreased by more than 75 percent after 24 hours) in 62.5 percent of patients receiving pyridoxine compared with 26 percent of control patients (p<0.001); both doses of pyridoxine were equally effective. Aside from transient flushing, no adverse effects were seen. (64)

In other studies, pyridoxine in doses of 20-100 mg/day orally (65,66) or 300 mg/day parenterally (67) produced no clinical improvement in patients with various types of epilepsy.

Pyridoxine versus Pyridoxal Phosphate

While most patients with vitamin B6-dependent seizures can be effectively treated with pyridoxine, some patients have only responded to PLP, the biologically active form of vitamin B6. (68,69) The average effective oral dose in six patients with PLP-responsive seizures was 30 mg/kg/day (range, 7-38 mg/kg/day), which was significantly higher than the average effective pyridoxine dose (18 mg/kg/day) in pyridoxine responders. (70)

Because of superior efficacy in certain cases, PLP should be considered for first-line treatment of patients in whom a clinical trial of vitamin B6 is indicated. PLP should also be considered for patients with suspected vitamin B6-responsive seizures that are unresponsive to pyridoxine.

Vitamin B6 in Clinical Practice

Vitamin B6 should be tried in all infants and young children with intractable epilepsy. For children and adults whose seizures are well controlled on medication, moderate doses of vitamin B6 (such as 10-50 mg/day) may be considered to prevent possible drug-induced vitamin B6 deficiency. Although larger doses might be appropriate in selected cases, high-dose vitamin B6 appears to interfere with some anticonvulsant medications. In one study, supplementation with 80-200 mg/day pyridoxine reduced serum phenytoin and phenobarbitone levels in epileptic children. (71) In addition, long-term administration of 500 mg/day or more of pyridoxine has resulted in neurotoxicity in some adults, (72) which could presumably occur at lower doses in children.

One practitioner found that supplementation with 600 mg/day vitamin B6 reversed phenytoin-induced gingival hyperplasia in several patients; however, such high doses are probably excessive for most patients with epilepsy. (73) Lower doses might be effective for phenytoin-induced gingival hyperplasia, particularly when used in combination with a folic acid mouth rinse (see below).