Epilepsy treatment by Ray Sahelian, M.D. Alternative treatment for epilepsy

Epilepsy is a disorder of the brain. In people with epilepsy, brain cells create abnormal electricity that causes seizures. A seizure may cause "jerking" movements. In some cases, seizures cause only a loss of consciousness, a period of confusion, a staring spell or muscle spasms. Epilepsy is a common neurological disorder that manifests in diverse ways. There are numerous seizure types and numerous mechanisms by which the brain generates seizures. The two hallmarks of seizure generation are excessive excitability of neurons and hypersynchrony of neural circuits. A large variety of mechanisms alters the balance between excitation and inhibition to predispose a local or widespread region of the brain to hyperexcitability and hypersynchrony. A single seizure is not considered epilepsy. People with epilepsy have repeated episodes of seizures.

Natural supplements for epilepsy
I am still studying the role of a natural supplements in epilepsy treatment or prevention. I am certain that there are a number of supplements or herbs that could reduce the severity of this conditions.
   Antidepressant drugs such as selective serotonin re-uptake inhibitors, i.e., Prozac, may be useful in seizure control. SSRI drugs increase serotonin levels in the brain. Since tryptophan and 5-HTP also increase brain serotonin levels, one wonders if these natural supplements could reduce the severity of epilepsy or reduce the number of seizures.
   The ketogenic diet is helpful in reducing the risk of epilepsy.

Vitamin D supplement for those on epilepsy drugs
Taken for long periods, anti- epilepsy drugs can lead to brittle bones. High-dose vitamin D therapy significantly improves bone mineral density in this situation. Dr. Ghada El-Hajj Fuleihan from American University of Beirut Medical Center, and colleagues compared the effects of low-dose and high-dose vitamin D on bone mineral density in 72 adults and 78 children and adolescents taking anti epilepsy medications. The low dose consisted of 400 IU (international units) per day, and the high dose was 2000 IU per day for children and 4000 IU daily for adults. At the start of the study, 34 percent of the adults were in the deficient range of vitamin D levels and 46 percent were in the insufficient range. Among children, the corresponding figures were 18 percent and 44 percent. Bone mineral density was below normal in the adults, but in the children and adolescents it was still in the normal range. After treatment, none of the adults and only a few of the children in the high-dose group still had vitamin D deficiency, and relatively few had vitamin D insufficiency. Bone density in adults assigned to high-dose vitamin D increased significantly, but it didn't change much in the low-dose vitamin D group. For children, bone density increased with both low and high doses of vitamin D, with no differences between the dose groups. Neurology, December 2006.

Epilepsy Drug Tolerance
Over time, some patients being treated for epilepsy show signs of tolerance to antiepileptic drugs. Tolerance is the reduction in response to a drug after repeated administration. Almost all first-, second-, and third-generation epilepsy drugs lose their antiepileptic activity during prolonged treatment. This tolerance may lead to a reoccurrence of the epilepsy. Tolerance is reversible with discontinuation of the drug or drugs. There are two types of tolerance: Pharmacokinetic (metabolic) tolerance due to induction of epilepsy drug -metabolizing enzyme has been demonstrated for most first-generation epilepsy drugs and may be easi to overcome by increasing the dosage of the drug. However, if the drug tolerance is not overcome by dose increments, the epilepsy may be considered drug resistant. Pharmacodynamic (functional) tolerance due to "adaptation of epilepsy drug targets (e.g., loss of receptor sensitivity) has been shown experimentally for all epilepsy medications that lose activity during prolonged treatment. Perhaps alternating different epilepsy medications may be an option for some people who have epilepsy. Epilepsia 2006.

Suicide risk from epilepsy drugs
Patients receiving drugs commonly used to treat epilepsy are more likely to experience suicidal behavior compared to those receiving placebo. The increased risk, observed as early as the first week of treatment, is consistent among 11 commonly used epilepsy drugs.
   Epilepsy drugs are associated with a higher risk of suicidal thoughts and behavior. Epilepsy drugs include Pfizer Inc's Lyrica, GlaxoSmithKline's Lamictal, Johnson and Johnson's Topamax, and Abbott Laboratories Inc's Depakote.

Epilepsy Surgery
Severe epilepsy that can't be controlled with anti-seizure medication may require a brain operation, but in such cases there's apparently a trade-off. Surgery, especially on the left temporal lobe, can results in long-term loss of verbal memory.

Epilepsy and ketogenic diet
Long-term use of the ketogenic diet in the treatment of epilepsy.
Dev Med Child Neurol. 2006 Dec;48(12):978-981. Groesbeck DK, Bluml RM, Kossoff EH. The Johns Hopkins University School of Medicine, USA.
Long-term outcomes of the ketogenic diet in the treatment of epilepsy have not previously been reported. A retrospective chart review of children treated with the ketogenic diet for more than 6 years at the Johns Hopkins Hospital was performed. In all, 28 patients (15 males, 13 females), currently aged 7 to 23 years, were identified. The median baseline seizure frequency per week at diet onset was 630 (range 1-1400). Diet duration ranged from 6 to 12 years; 19 remain on the diet currently. After 6 years or more, 24 children experienced a more than 90% decrease in seizures, and 22 parents reported satisfaction with the diet's efficacy. Ten children were at less than the 10th centile for height at diet initiation; this number increased to 23 at the most recent follow-up (p=0.001). Kidney stones occurred in seven children and skeletal fractures in six. After 6 years or more the mean cholesterol level was 201mg/dl, high-density lipoprotein was 54mg/dl, low-density lipoprotein was 129mg/dl, and triglycerides were 97mg/dl. Efficacy and overall tolerability for children are maintained after prolonged use of the ketogenic diet. However, side effects, such as slowed growth, kidney stones, and fractures, should be monitored closely.

Children with epilepsy may have nutritional deficits
The nutrient levels in young children with poorly controlled epilepsy disorders is often below the recommended levels. Dr. Stella L. Volpe, at the University of Pennsylvania in Philadelphia did a nutritional analysis comparing 43 children with intractable epilepsy with 1,718 healthy children between 1 and 8 years of age. Intractable epilepsy was defined as one or more seizures every month, despite treatment with at least three antiepileptic drugs. The average age of the children was 5 years. Children with epilepsy ate statistically significant lower levels of total calories, protein, carbohydrates, fat, dietary fiber, and multiple vitamins and minerals, compared with healthy children. Thirty percent of the children with epilepsy had lower-than-recommended intakes of vitamins D, E and K, folic acid, calcium, linoleic acid and alpha-linoleic acid. The younger children had lower levels of micronutrients than the older children. Journal of the American Dietetic Association, June 2007.

Newly diagnosed epilepsy
People newly diagnosed with epilepsy have an especially high risk of suicide and doctors should monitor them.

Epilepsy questions
Q.  This is my second e-mail in regards to advising me on the suggested natural medications for my 10 year-old Autistic & Epileptic child. I want to give him carnosine (or Mind Power Rx), fish oils a multivitamins but i don't know the dosage and frequency to give it to him. I want to inform you that he is on Topamax and Klonopin (both anticonvulsants) twice a day. He is now seizure free for a year.
   A. Thank you for your email, but as we state on the website where the email address is located, we are not in a position to offer individual advice. We suggest having your doctor read the info and then give his or her opinion. One has to be very careful with epilepsy and epilepsy meds.

Q. My name is John B. Symes, D.V.M. I am a veterinarian who has been studying the effects of gluten-free/casein-free/soy-free/corn-free diets on canine (and now human) epilepsy for the past 7 years. I have witnessed phenomenal results in my canine patients and am now getting more and more testimonials from people who have successfully used the diet I outline (now called "The G.A.R.D.") on themselves or their epileptic children. I believe this will all make perfectly good sense to you, especially if you are already familiar with the link between celiac disease and epilepsy.
I found your site by doing a search for "epilepsy diet". I know that your main interest is in the publication of medical information that is derived from peer-reviewed research but I thought that you might be interested in my work, which is currently under review by contacts I have made at Johns Hopkins, the Mayo Clinic, and the Cleveland Clinic. The results of "The G.A.R.D." (the glutamate-aspartate restricted diet) have been astounding for epilepsy, chronic pain syndromes, peripheral neuropathies, and much more. You will find my work at www.dogtorj.net. Seven years ago I found out that I suffered from celiac disease. I quickly experienced a miraculous recovery from numerous long-term ailments, especially once I eliminated the others of what I call "the big 4"...gluten (wheat, barley, rye), dairy, soy and corn...the four "foods" capable of inducing the villous atrophy commonly associated with gluten intolerance. In the very first week of my study, I read that celiac children with epilepsy who were placed on gluten-free (GF) diets often had dramatic improvements in the severity and frequency of their seizures. This really grabbed my interest, as epilepsy in veterinary medicine was also considered "idiopathic". I began placing my epileptic canine patients on GF diets and the results were astounding. I then set out to understand WHY this was happening. That is what my Website is all about. Rather than going into great detail here, I will refer you to the Epilepsy and Diet section of my site (http://dogtorj.tripod.com/id2.html ). In that section, I explain how I developed The G.A.R.D. (the glutamate-aspartate restricted diet; also known as the gut absorption recovery diet). It dives into the role of the "excitotoxins" (glutamate and aspartate), the lectins of the "big 4", viruses, environmental issues (pollution) and even the seasonal influences (lack of sunlight->low serotonin->increased seizures) in the pathogenesis of epilepsy. I hope that you will find this interesting and helpful. I lecture at veterinary conferences and have even spoken at a human medical conference on this topic. In my mind, the research behind the G.A.R.D. helps to explain the successes (and failures) that your profession is seeing with the use of the ketogenic and now "modified Atkin's" diets in epileptic people, neither of which eliminate all of the dietary culprits we have now identified as factors in canine epilepsy. The connections between celiac disease and epilepsy are well-established but gluten is clearly not the only culprit. By eliminating all of the "big 4", I believe both professions will realize the huge gains that I have seen in these patients. John B. Symes, D.V.M. (aka "Dogtor J") Beltline Animal Hospital, Mobile, AL 36609
 

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