Search and Seizure

Matthew Robinson, of Denver was just 20 months old when he had his first seizure. “He fell on the floor and shook for about three or four minutes,” his dad, Doug, recalls. “And then two weeks later he did it again.” A local neurologist scheduled an EEG (electroencephalogram); it revealed irregular activity in the brain of this otherwise healthy toddler, who, turns out, had suffered grand mal seizures. The frightening reality stunned Robinson and his wife Diane: Their son had epilepsy.

Epilepsy is a neurological condition that causes seizures—sudden surges of electrical activity in the brain affecting how a person feels or acts. Seizures can relate to a brain injury or family history, but in a majority of cases, the cause is unknown. In the US, 2.7 million people have been treated with epilepsy in the past five years. Children, especially those in their first year of life, make up most of the new cases, but epilepsy can develop at any age.

The standard method of treatment—anti-seizure medications—come with side effects, including fatigue, abdominal discomfort, dizziness, blurred vision, rashes, and bone loss, and unfortunately, these conventional drugs don’t always work. Matthew’s medications actually exacerbated his seizures—from one or two a day to a staggering 100 a day.

Unfortunately, Matthew’s experience isn’t out of the norm. “One-third of those with epilepsy in the US, that’s around a million people, do not respond to treatment with any of the existing therapies,” says Warren Lammert, the Boston-based chairman and co-founder of the Epilepsy Therapy Development Project (ETDP), which seeks to advance new treatments for people living with epilepsy. Luckily, the following seven natural strategies—which including dietary and lifestyle changes—hold promise for those who don’t respond to conventional drugs.

Fatten up
The ketogenic diet is the most ubiquitous of all epilepsy nutritional therapies. So much so, in fact, that Eric H.W. Kossoff, MD, associate director of the Pediatric Neurology Residency Program and assistant professor of Pediatrics and Neurology at Johns Hopkins in Baltimore, Maryland, considers it mainstream. “The diet was exclusively developed for epilepsy back in the 1920s when doctors learned fasting improved seizures,” he says, “so they created this diet to mimic starvation.” Kossoff says that from the 1930s to the mid ’90s, drugs took over, “but now the ketogenic diet is back and very popular around the world.”

It begins with a 24-hour fasting period to cleanse the system. After that you restrict carbohydrates and instead get most of your calories from fats. People on the diet usually eat 3 to 4 grams of fat for every 1 gram of carbohydrate and protein. Nutritionists and neurologists tweak meals to induce ketosis, a state in which the body burns stored fat for fuel. Doctors don’t know why ketosis reduces seizures, but it produces positive results for lots of people. According to Kossoff, one-half to two-thirds of those who try the ketogenic diet get some degree of relief, and about 55 percent of those who respond positively experience a greater than 50 percent reduction in their seizures.

Happily, Matthew tried the ketogenic diet and it worked very quickly. “Just one day into the diet Matthew was seizure free,” says Robinson, “and after about four months, Matthew was completely off all medications.” Most of Matthew’s fat grams come from olive and canola oils. He eats things like hot dogs, peanut butter, and chocolate milk, and snacks on olives and lettuce.

A high-fat diet may seem like an easy fix, but lots of people have a tough time sticking to the ketogenic diet—most medical experts believe strict compliance is mandatory. That’s probably why success rates are better for young children, whose parents can exercise complete control over what goes into their mouths. Teens and adults, on the other hand, have the freedom (and often the strong desire) to eat out and indulge in treats. “It’s very, very difficult—there’s no cheating—and Matthew has to eat every bite of every meal,” says Robinson.

Loosen up to low-carb
To the relief of many a food-cop mom, the latest research indicates that perhaps an anti-epilepsy diet needn’t be so rigid. Kossoff, along with a team of neurologists at Johns Hopkins, is pioneering what he calls the modified Atkins diet. “I was working with families who were on the ketogenic diet for a long time and they were no longer weighing and measuring their food—they were just winging it,” he says. “They were eating more carbs and less fat than the ketogenic diet would allow, but it was still working.” That’s when he figured this less-intense alternative—a one-to-one ratio of fats to carbs and proteins—was worth further investigation. “Children and adults can be on this looser diet and still make ketones and have seizure control,” says Kossoff. “It’s the carb restriction that really makes it work.”

He found success rates for the modified Atkins similar to those of the ketogenic diet; however, because the diet is new to the field of epilepsy, he doesn’t know yet whether it will have side effects similar to those of the ketogenic diet, which include constipation, acidosis, kidney stones, heightened cholesterol, and decreased growth rates.

Regardless of which plan you subscribe to, both focus on certain food types. “With any neurological condition, it is critical to nourish the brain with high-quality fats,” says Jennifer Means, ND, LAc, a naturopath in Tigard, Oregon, who works with many epilepsy patients, including her 10-year-old daughter who was diagnosed with severe epilepsy after birth trauma. Means suggests incorporating lots of nut and seed oils into your meals, as well as fish, avocadoes, and coconut oil. Stay away from sugar, food colors (especially yellow and red), MSG, and NutraSweet, as they have a tendency to trigger seizures.

Get moving
In addition to nutrition, physical activities that lowers stress levels may help reduce seizures, too. Steven Pacia, MD, associate professor in the Department of Neurology at the New York University School of Medicine as well as a neurologist and director of Clinical Neurophysiology at the NYU Medical Center’s Comprehensive Epilepsy Center, advocates yoga. “I believe yoga is a fantastic resource to reduce your stress levels,” he says, “and because stress clearly plays a role in seizures, I think that seizure reduction is an indirect effect of the practice.” He prescribes yoga to his patients and suggests a Hatha practice, at least three times a week, that focuses on gentle postures and slow deep breathing.

Pacia recommends aerobic exercise (anything that gets your heart pumping), as well—a minimum of three times a week, for 20 minutes a session—and similarly credits its positive effects to stress reduction. “Many neurologists discourage exercise because they’re afraid patients will have seizures,” he says. “However, just 10 percent of patients actually have exercise-induced seizures.” If you’re in that minority, monitor your activity level by not doing too much too quickly, and exercise with supervision in case you have a seizure. Also, check with your doctor before beginning any exercise program.

And if you don’t have control of your seizures, proceed with caution when choosing a piece of equipment or activity. For example, avoid a treadmill or the swimming pool, which can cause serious harm if you become unconscious, and opt instead for a stationary bike.

Calm down with botanicals
Supplementing with herbs and other minerals can complement conventional epilepsy care, especially when you choose stress-busting and sedative botanicals. A 2001 study found that kava, valerian, chamomile, and passionflower may improve the effects of anti-epileptic medications, increasing their sedative and cognitive effects. The study also offered some anecdotal observations that discourage the use of ephedra, caffeine, ginkgo, and ginseng because they may exacerbate seizures.

Means advises against kava, however, because of its possible ill effects on the liver, but says she often prescribes passionflower in her practice, especially for children, and additionally suggests supplementing with the amino acid taurine. “It’s a neuro-modulator and can quiet electrical activity in the brain,” she says. Kids tolerate this supplement—found naturally in meat and eggs—especially well.

Means also recommends taking magnesium, explaining, “It can calm the mind and the nervous system.” Foods high in magnesium include mushrooms, whole grains, and nuts.
Dosages for herbs and supplements vary according to size of the patient and severity of the symptoms, so it’s best to work with someone trained in their use for epilepsy.

Only time will tell what role herbs and supplements will play in the treatment of epilepsy, as more significant studies are under way. Steven Schachter, MD, professor of neurology at Harvard Medical School (HMS) and associate director of clinical research at the HMS Division of Clinical Research and Education in Complementary and Integrative Medical Therapies, recently received a grant from the ETDP to lead a study on Asian herbs. And the National Center for Complementary and Alternative Medicine currently funds Siegward Elsas, MD, assistant professor of neurology at Oregon Health and Sciences University in Portland, Oregon, so that he can further study passionflower.

Adopt a dog detective
Specially trained canine companions can recognize the onset of a seizure, especially in children, and alert the parents. “We can’t guarantee every dog will be able to do this, but it is our hope,” says Karen Shirk, founder of Xenia, Ohio-based 4 Paws for Ability, a nonprofit organization that trains seizure dogs. But even if the dog can’t predict a seizure, the child still benefits. “Kids naturally feel at ease when the dogs are around, and the animals foster an increase in independence,” says Shirk. This stress reduction may be why, anecdotally, these dogs act as a form of treatment. Shirk’s organization has placed about 30 seizure dogs to date and all of the parents have reported a reduction in their child’s medications as well as in their number of seizures.

Accept helpful feedback
In an attempt to diminish abnormal brain-wave activity and elevate the seizure threshold, biofeedback (sometimes referred to as neurofeedback) uses conditioning to help epilepsy patients. Although the practice has been around for many years, recent research indicates it’s still a viable treatment to reduce seizures.
Biofeedback for epilepsy uses EEG technology to look for abnormal brain waves and then teaches patients various techniques—using a game or puzzle perhaps—that will help them morph them back into a normal pattern. Over time, these exercises may reduce the number of seizures. Before starting, however, find a practitioner with relevant experience. The Biofeedback Certification Institute of America (www.bcia.org) certifies practitioners and offers advice on how to find a credentialed one in your area.

Master your destiny
A recent development in the alternative treatment of epilepsy includes examining the condition in terms of emotions, especially anger and fear. “Our goal is to discover where the problem is coming from in the brain and then find compensatory measures to treat it,” says Donna J. Andrews, PhD, director of the Andrews-Reiter Epilepsy Research Program in Santa Rosa, California.

According to her research, emotional overload triggered 65 percent of the seizures she studied. Andrews therefore uses counseling and relaxation techniques to help her patients recognize early signs of seizures (called auras) and change their behavior to modify the outcome.

Although each case is unique, therapists urge patients to focus on what triggers the seizure—or what they feel just prior to a seizure—because behavioral therapists believe the same type of emotional overload causes seizures to recur. So, for example, if the therapist and patient determine that anger triggers that particular patient’s seizures, they work on learning to recognize early signs of anger and how to head off that behavior before it causes a seizure.

Kelli Rosen is a freelance writer who lives in Monkton, Maryland.

Before You Stop Taking Your Meds, Ask Your Doc
What should you do before going off anti-seizure medications? “When I work with patients, I try to wean them down to just one or two of the drugs,” says Means. “But I don’t recommend completely going off seizure medication unless you haven’t had a seizure in a very, very long time.” And even then, the experts urge, only do so under the strict supervision of your health care practitioners.

Seizure-Free and Successful
When doctors diagnosed Sally Fletcher of San Rafael, California, with epilepsy back in the late 1960s, they pointed to a concussion years earlier as the cause. She tried conventional drugs for years but continued to have seizures, upwards of 10 to 15 a month, and she suffered side effects, including drowsiness and depression. So she decided to take the alternative route. “I tried EEG biofeedback to retrain the part of my brain that was acting abnormally,” says Fletcher. “I noticed improvements within five to six months and my seizures were completely gone after about three years.”Fletcher also practices yoga to reduce stress and meditates on a daily basis to slow brain-wave activity. Today, this 67-year-old has been seizure-free for more than 20 years and takes great pleasure in being a motivational speaker as well as a performing harpist. She wrote The Challenge of Epilepsy: Complementary and Alternative Solutions (Aura, 2004), which chronicles her experience with epilepsy and the alternative methods she used to combat the condition. “I realized that taking good care of myself, especially reducing my stress and eating healthy, was the key to managing my epilepsy,” she says.

Resources

Epilepsy Therapy Development Project
Reston, Virginia
703.437.4250
www.epilepsytdp.org
www.epilepsy.com

Epilepsy Foundation
Landover, Maryland
800.332.1000
www.epilepsyfoundation.org

Atkins for Seizures
Carbondale, Colorado
970.704.1716
www.atkinsforseizures.com

4 Paws for Ability
Xenia, Ohio
937.374.0385
www.4pawsforability.org

Complementary and Alternative Therapies for Epilepsy, edited by Orrin Devinsky, MD, Steven Schachter, MD, Steven Pacia, MD (Demos, 2005).