Patients with epilepsy often seek CAM therapies-with or without the recommendations or explicit approval of their neurologist.
Ann Marie Collier, MD
The use of complementary and alternative medicine (CAM) in epilepsy was highlighted at a presentation at the 2019 American Academy of Neurology Annual Meeting in Philadelphia, PA. The speaker, Ann Marie Collier, MD, an epileptologist and medical director of the epilepsy program at SCL Health Colorado, discussed the impact of lifestyle factors on seizure control. Several patient-controlled factors include diet, exercise, sleep, and supplements. She also discussed the potential benefits of adjunctive medically directed treatments, such as counseling and biofeedback.
Impact of sleep
Dr Collier emphasized that all patients have a seizure threshold and that, while antiepileptic drugs (AEDs) are the cornerstone of epilepsy management, CAM therapies and strategies can lower or raise that threshold. Sleep deprivation is a powerful seizure trigger. Dr Collier recommends educating patients about the impact of sleep on their seizure control. She pointed to studies that showed a high incidence of obstructive sleep apnea among patients who have epilepsy, which suggests that many of those with epilepsy may have undiagnosed-and potentially treatable-sleep disorders.
The ketogenic diet, a modified Atkins diet, a low glycemic index diet, and a medium chain triglyceride (MCT) diet have all been shown to have a moderately positive impact on epilepsy control, with some variation in their efficacy. Of course, adherence to strict diets can be challenging for patients, and this can affect their efficacy.
Regular physical exercise may improve seizure control in some patients who have epilepsy. The presentation cited results of a 2017 Cochrane review, which suggests a possible beneficial effect of yoga on seizure control.
Dr Collier spoke about the strong relationship between mood disorders and epilepsy, particularly depression. She explained that depression in epilepsy may not fall within the traditional DSM criteria and is not always recognized and treated. In fact, not only does depression emerge when patients experience the helplessness and unpredictability of living with epilepsy-often seen as a comorbid condition-depression can also be an inherent part of epilepsy itself.
Counseling and therapy can have a substantial impact on the lives of patients who experience symptoms of depression with their epilepsy. And patients who have psychogenic seizures, which are almost always accompanied by a comorbid diagnosis of epilepsy, may also experience a sense of reassurance, an improved quality of life, and possibly improved seizure control with counseling. The value of directing patients to therapists who are familiar with epilepsy was emphasized as well.
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Biofeedback is a therapeutic modality that requires substantial patient engagement and dedication. This method, which many neurologists are not familiar with, has been shown to improve quality of life in patients who have epilepsy.
Supplements and CBD
Over-the-counter supplements were also discussed. There are numerous supplements sold through countless vendors, and their composition and ingredients vary. Dr Collier pointed out the importance of making patients aware that supplements can interact with epilepsy medications, potentially diminishing the efficacy of AEDs or producing adverse effects.
The discussion of supplements often is intertwined with patient inquiries about cannabidiol (CBD) oil. Dr Collier emphasized that CBD oil is approved for only two conditions at this time-Lennox-Gastaut syndrome and Dravet syndrome-and has not been proven effective for other epilepsy types.
The bottom line
Patients who have epilepsy often seek CAM therapies, with or without the recommendations or explicit approval of their neurologists. Some lifestyle strategies can have a positive impact on seizure control for patients with epilepsy. Other CAM approaches may have no effect-or may even produce harmful effects. It is important for neurologists who treat patients with epilepsy to be aware of the non-pharmacological tools that can help achieve optimal seizure control and to become ready to discuss positive and negative aspects of CAM approaches.
Dr Collier has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with GW Pharmaceuticals, UCB Pharmaceuticals, LivaNova.