Epilepsy: Natural Treatments. What do you need to know? Evan Fertig, MD Co-Director Epilepsy Center of Excellence LibertyHealth Jersey City Medical Center

Case Study A 3 year old girl is treated by her pediatrician for her seizures. She was born in a Central American country and lives with her parents in Jersey City Grandma from the home country comes to visit An uncle had epilepsy during childhood but no longer has seizures after treatment with traditional herbal therapy Grandma is horrified that she still has seizures and wants her to stop the anti-seizure medication and start herbal therapy

What Should Mom do? Stop the anti-seizure medication and start the herbal therapy since the uncle got better as a kid Continue the anti-seizure medication and start the herbal therapy Do nothing Speak to the pediatrician about the herbal therapy, other treatments for epilepsy, and/or a referral to epilepsy center

Complementary and Alternative Medicine (CAM) for Epilepsy Western Medicine has made great progress in treating epilepsy No magic bullet to instantly eliminate all seizures without side effects CAM therapies are not usually taught in medical school Many patients use CAM without discussing with their MD!

CAM use is common for Epilepsy Surveys indicate 24 to 44% use CAM Treatments include Herbal and botanical medicine Acupuncture Magnets Chiropractic medicine Yoga Marijuana Others

Why is CAM use common? Standard treatments might not work right away Other concerns Fatigue, energy Headaches Depression Anxiety Side effects from medicine

Herbal treatments for Epilepsy Most common form of CAM Used for centuries to treat epilepsy Valerian Piper nigrum Kava withania Eastern Systems of Medicine

Herbal Treatments Many patients praise herbal treatments, however there has been little scientific study Randomized controlled trials (RCT) are a comparison test: some take active medicine and some take placebo (sugar pill) without knowing which they are taking. RCT are required for FDA approval We don’t know yet if they work or not

Herbal Therapy Purity is not overseen by the FDA Purity between batches may vary considerably An herb processed by one company may not be as safe or effective as an herb processed by another company Some herbs may actually worsen seizures

Case Report 2 A 52 year woman with epilepsy has successfully controlled her epilepsy for years with Tegretol. She is very depressed though and can’t find a psychiatrist who will take her insurance. She reads online about St. John’s wort for depression and decides to take it without telling her neurologist. A month later, she has a seizure while driving through New Jersey on her way to visit relatives

What’s the most likely reason for the seizure? New Jersey St. John’s Wort causes tegretol levels to drop, so she did not have enough seizure medication in her bloodstream Tegretol is the wrong medicine for her Traffic

Other CAM Therapies Biofeedback, yoga, massage, acupuncture Little scientific study has been performed Overall risks if used in association with standard epilepsy treatment is low Tell your MD about it to be sure

Another “herb” often in the news

Marijuana Approved for medical use in 16 states and DC Approved for many different conditions including epilepsy in many states (NJ) Can Marijuana help? Many patients report better seizure control One small RCT reported a benefit Some animal studies show benefit with main ingredient THC Other studies show that THC can cause seizures, depression, and psychosis

Marijuana Potential Risks Mood effects Memory effects May lead to missed anti-seizure medication doses and seizures Effect on blood levels of anti-seizure medications is unknown Smoking it may have effects on lung health Legal implication (still against federal law)

The bottom line…. The Epilepsy Foundation of America did not come out for or against medical marijuana but recommended further scientific study Would discuss with your MD before use Despite state laws, Federal law still prohibits marijuana use

What Should Mom do? Stop the anti-seizure medication and start the herbal therapy since the uncle got better as a kid Continue the anti-seizure medication and start the herbal therapy Do nothing Speak to the pediatrician about the herbal therapy, other treatments for epilepsy, and/or a referral to epilepsy center

Wrap up on CAM therapies Seizures are just the tip of the iceberg. Epilepsy is associated with many other problems! It is understable why so many seek alternative treatments Experimenting with CAM without discussing with your MD can cause major problems Even “natural” treatments can alter body chemistry lowering anti-seizure medication levels or cause seizures

Recommendations Always speak to your MD before starting CAM For uncontrolled seizures, consider seeing an epilepsy specialist Other options may be available: surgery, diet, meds, clinical trials If you have fatigue Discuss with your MD Get more regular sleep, get better sleep/exercise Depression and other mood symptoms Get more help from a medical health specialist

What is your doctor’s job? To keep an open mind Many databases exist now of different CAM treatments (I have one on my smartphone!) Finding a physician who will work with you, and help address of your concerns is very important!

More Research is Needed The NIH has an institute to study CAM treatments You can play an important part! Consider enrolling in an epilepsy clinical trial!

Thank you! Evan Fertig, MD Munazza Malik, MD 201 343 6686