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

2. 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

3. 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

4. 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!

5. 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

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

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

8. 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

9. 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

10. 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

11. 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

12. 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

13. Another “herb” often in the news

14. 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

15. 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)

16. 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

17. 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

18. 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

19. 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

20. 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!

21. 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!

22. Thank you!
Evan Fertig, MD
Munazza Malik, MD