Alternative treatments for epilepsy.
Q Our 12 year old has hid seizures since she was two-years old. Her doctors do not know why she developed epilepsy. Over the years, she has had a number of EEGs, all abnormal. She has taken many medications. First phenobarbital phenobarbital /phe·no·bar·bi·tal/ (fe?no-bahr´bi-tal) a long-acting barbiturate, used as the base or sodium salt as a sedative, hypnotic, and anticonvulsant.
n. when she was two, but it seemed to make her "hyper" and irritable. Her doctor changed her to Mebaral [TM] to decrease the irritability. This worked for a short period of time, then her seizures increased. We tried Mysoline [TM], then Tegretol [TM] which seemed to decrease the seizures for a while. Then Depakene [TM] was added to the Tegretol [TM] and this also worked for a while. CAT scans, lab tests and an MRI 1. (application) MRI - Magnetic Resonance Imaging.
2. MRI - Measurement Requirements and Interface. haven't shown anything wrong. Her pediatric pediatric /pe·di·at·ric/ (pe?de-at´rik) pertaining to the health of children.
Of or relating to pediatrics. neurologist says she has complex partial seizures which turn into generalized seizures. We changed to Felbatol [TM] which seemed to eliminate most of her seizures but I wanted it stopped due to a possible severe side effect. Her neurologist felt it was acceptable to continue it with close monitoring.
I am tired of all these medication changes and side effects Side effects
Effects of a proposed project on other parts of the firm. . What other options are there? Are there newer medications that are more effective and have fewer possible side effects? I have also heard about some alternative treatments such as the ketogenic diet ketogenic diet
A high-fat, low-carbohydrate diet that includes normal amounts of protein. and surgery.
A I understand your concerns as I have seen it happen with some of my own patients. It is very upsetting to use a medication with good results for a while and then see control stop. It is a difficult choice to stop using an effective medication because of an adverse side effect or because of a severe, potential side effect. It is also frustrating not to know the reason for your child's particular medical problem. There are some newer anticonvulsants Anticonvulsants
Drugs used to control seizures, such as in epilepsy.
Mentioned in: Antipsychotic Drugs, Osteoporosis that you may wish to discuss with your daughter's neurologist. I have a few patients using gabapentin (Neurontin [TM], approved for use in 1993) in combination with other anticonvulsants. We've had fairly good results so far. I have less experience with lamotrigine (Lamictal [TM], approved in 1994), but my colleagues in pediatric neurology are using it more frequently. No doubt, more anticonvulsants will be available in the future. Nevertheless, it is always important to discuss the use and potential side effects of any medication with your daughter's neurologist
The National Institutes of Health define alternative medicine, or nontraditional therapy, (also referred to as complimentary, non-drug, unconventional, and unorthodox as an unrelated group of non-orthodox therapeutic practices, often with explanatory systems that do not follow conventional biomedical bi·o·med·i·cal
1. Of or relating to biomedicine.
2. Of, relating to, or involving biological, medical, and physical sciences. explanations. By that definition, I do not believe that the ketogenic diet or surgical procedures should be considered "alternative" therapies for epilepsy. There is a definite resurgence in the use of the ketogenic diet Any individual with epilepsy, especially if reasonable trials of anticonvulsants have failed to control frequent seizures, may want to try the ketogenic diet The current version of the diet is easier to start and maintain but still must be administered under the direction of an experienced physician with good dietary support services support services Psychology Non-health care-related ancillary services–eg, transportation, financial aid, support groups, homemaker services, respite services, and other services . The diet consists of high fat foods with limited amounts of protein. Sugars and starches are extremely restricted.
Once started, barring any major complications, it is essential that the child follow the diet strictly. Any cheating, whether intentional or unintentional, can result in restarting or increasing seizures. The ketogenic diet has controlled seizures in almost 50 percent of my patients who followed it and caused a significant decrease in about 20 percent more. Many of these patients were able to discontinue or limit the amount of medications they are taking. Potential side effects of the ketogenic diet include hunger, thirst, constipation, kidney stones Kidney Stones Definition
Kidney stones are solid accumulations of material that form in the tubal system of the kidney. Kidney stones cause problems when they block the flow of urine through or out of the kidney. and an alteration in how the body handles medications, causing a buildup. For more about the ketogenic diet, see my July 1995 Ask the Doctor column and "The Ketogenic Diet" (Exceptional Parent, July 1997).
Surgical intervention for epilepsy applies to only a small fraction of individuals with epilepsy, and probably does not apply to your daughter. This is only for individuals who have intractable, or refractory, epilepsy, that is, the seizures have not been brought under adequate control with medications or any other modality of treatment. This is definitely not a first line therapy for epilepsy and must be very carefully considered by a team consisting of professionals, the patient, and parents.
One form of alternative therapy is biofeedback biofeedback, method for learning to increase one's ability to control biological responses, such as blood pressure, muscle tension, and heart rate. Sophisticated instruments are often used to measure physiological responses and make them apparent to the patient, who I have no personal experience with it. Monitoring instruments "feed back" physiologic information, usually brain waves brain waves Neurology Oscillations/sec that correspond to various types of cerebral activity, as measured on an EEG. See Electroencephalogram. , to patients as they adjust their breathing or other physiologic or thought processes. The goal is to prevent the seizure from developing The instrument gives the patient immediate feedback that tells the patient how successfully they are changing their brain waves, usually through a sound or visual signaL Given your daughter's age and the type of epilepsy she has, I doubt this would be a worthwhile approach.
Vagus nerve stimulation vagus nerve stimulation Psychiatry Electroconvulsive therapy
in which a pacemaker-like device stimulates the vagus nerve. See Electroconvulsive therapy. is reportedly successful in some children with refractory epilepsy, though none of my patients use it. The vagus nerve vagus nerve
Either of the tenth pair cranial nerves that originate from the medulla oblongata and supply multiple vital organs, including the lungs, heart, and gastrointestinal viscera. is one of 12 cranial nerves Cranial nerves
The set of twelve nerves found on each side of the head and neck that control the sensory and muscle functions of a number of organs such as the eyes, nose, tongue face and throat. which emerge from the base of the brain and facilitate functions such as smell, vision, eye movement, glandular glandular /glan·du·lar/ (glan´du-ler)
1. pertaining to or of the nature of a gland.
1. secretion, chewing, facial expressions, swallowing, taste, phonation pho·na·tion
The utterance of sounds through the use of the vocal cords; vocalization.
phona·to (vocalization vocalization
to make a vocal sound; a form of communication. Studies of feline vocalization have identified murmur, vowel and strained intensity patterns.
excessive vocalization ), tongue movement, and head and shoulder movement The vagus nerve is essential for speech swallowing, and the function of many parts of the body, most important, the heart and stomach
The vagus nerve stimulator is surgically implanted under the collar bone, much like a peacemaker. A wire connects it to the vagus nerve in the neck. The stimulator periodically sends electrical impulses through the wire to the vagus nerve. The frequency of this stimulation can be changed by a physician using an external controller. Some researchers have reported a 20 to 50 percent decrease in seizures in certain individuals. Increases in seizures in a few patients have also been reported, however.
The other forms of alternative therapy my patients have used for epilepsy as well as other chronic conditions include traditional, folk and herbal medicine herbal medicine, use of natural plant substances (botanicals) to treat and prevent illness. The practice has existed since prehistoric times and flourishes today as the primary form of medicine for perhaps as much as 80% of the world's population. (these often have strong cultural connections), diets (other than the ketogenic ketogenic
forming or capable of being converted into ketone bodies.
one containing large amounts of fat, with minimal amounts of protein and carbohydrate. The object of such a diet is to produce ketosis. ), aromatherapy (more commonly used in Europe), chiropractic, naturopathy naturopathy /na·tur·op·a·thy/ (na?cher-op´ah-the) a drugless system of health care, using a wide variety of therapies, including hydrotherapy, heat, massage, and herbal medicine, whose purpose is to treat the whole person to stimulate , massage, relaxation therapy, music therapy, brain stimulation techniques, and of course, prayer. I never recommend reliance on any of these therapies as the "sole" treatment for epilepsy because there are not adequate studies showing their efficacy. However, the use of these and other alternative therapies as adjuncts to more conventional therapies for epilepsy is probably helpful.
I commend you for continuing to search for ways to better control your daughter's epilepsy and improve the quality of her life. Alternative and nontraditional therapies are becoming more popular these days, partly because many physicians do not listen carefully enough to their patients or the parents of their patients. It is not surprising that many patients and parents believe their doctor, and today's medical system in general, is too technical and impersonal, or worse yet, uncaring. These individuals then seek treatments where they have more control.
Although not traditionally considered a medical concern, the overall treatment of epilepsy in adolescents should be balanced by an understanding of the issues and concerns that are unique to this age group. A smooth transition of care from pediatric to adult services is important, not only for epilepsy but for all chronic conditions as well. It is essential that you have a clear understanding of the benefits and risks of any treatment option which is proposed for your daughter. Alternative and nontraditional therapies, when appropriately used, may play an integral part in the treatment of your daughter's epilepsy.
In this column, David Hirsch, M.D., a pediatrician and member of Exceptional Parent's Editorial Advisory Board, answers questions from readers. Dr. Hirsch is a partner in Phoenix Pediatrics, Ltd., in Phoenix, Arizona. He specializes in treating children with developmental disabilities developmental disabilities (DD),
n.pl the pathologic conditions that have their origin in the embryology and growth and development of an individual. DDs usually appear clinically before 18 years of age. and chronic illnesses.
Since Dr. Hirsch has not examined the child in question, parents need to review his suggestions with appropriate professionals. Mention of specific products or medications illustrate suggestions; he is not endorsing any specific products.
Send questions to: Ask the Doctor, Exceptional Parent, 555 Kinderkamack Road, Oradell, NJ 07649-1517, (201) 634-6598 (fax).