Epilepsy

Nutritional Therapy for Epileptics

Epilepsy is a highly variable disease, and its ideal management requires close supervision and cooperation with a physician. For some individuals, however, nutrient supplementation can reduce the number of seizures or minimize the amount of prescription medication they require. The dosages given at the end of this chapter are designed for adults. Parents should not initiate antiepilepsy nutrient supplementation on their own. Please consult a physician before adding supplements to a child’s epilepsy program.

The B vitamins are essential for many functions in the central nervous system. Vitamin B6 and folate are critical cofactors in the production of many neurotransmitters. Of particular relevance in epilepsy, B6 is required to convert the principal excitatory neurotransmitter, glutamate, into the primary inhibitor neurotransmitter, gamma-aminobutyric acid. Vitamins B1, B3, B12, and carnitine are required in the maintenance of the myelin sheath that surrounds neurons and affects their ability to conduct coherent impulses.

Oxidative stress has also been identified as a major factor in epileptic seizures. It appears that the brains of people with epilepsy are under considerable oxidative stress from free radicals. Studies have shown that epileptics are low in many antioxidants, including intrinsic antioxidants such as glutathione and superoxide dismutase and extrinsic antioxidants including vitamin E, vitamin C, and vitamin A (Liao KH et al 2004). Although large human studies have not yet been conducted on the use of antioxidants in people with epilepsy, it is already known that vitamins A, C, and E are vital to brain function (Almeida SS et al 2002; Frederickson CJ et al 2000; Savaskan NE et al 2003). Studies have found that the combination of vitamin E and vitamin C protects nerve cell membranes from oxidation in people with posttraumatic seizures (Yamamoto N et al 2002).

Levels of vitamin E are reportedly lower in children with epilepsy than in controls (Ogunmekan AO 1979). In one small study of children not responding to standard drug treatment, the addition of vitamin E to the treatment regimen produced a significant reduction in seizures (Ogunmekan AO et al 1989).

Polyunsaturated fatty acids, including linolenic acid and the omega-3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), have also been shown to protect the brain from seizure activity. In an animal study, linolenic acid protected animals from seizures after treatment with a seizure-producing drug (Lauritzen I et al 2000). This study was duplicated two years later with similar results. The animals in this study experienced significant protective benefits from linolenic acid (Blondeau N et al 2002). Other animal studies have found that omega-3 fatty acids can increase seizure thresholds and lower markers of inflammation. In a recent human study, 57 epileptic patients were given 1 g EPA and 0.7 g DHA daily. Seizure activity was reduced over the first six weeks, although the effect was temporary. The researchers called for more in-depth studies, with larger doses and larger observational groups (Yuen AW et al 2005).

In many cultures, including African and Asian cultures, epilepsy is commonly treated with herbal preparations from a wide variety of plants. While some of these herbs have anticonvulsive properties, many are hard to locate in the United States. Ginkgo biloba, however, has been identified as a possible anticonvulsant and is widely available. People should be aware, however, that Ginkgo biloba may prevent or cause seizures, and the doses of different brands of ginkgo vary significantly. People should approach this herbal remedy with caution (Harms SL et al 2006). Other herbal remedies have been shown to interact with AEDs. St. John’s wort, for example, has been suggested to lower blood pressure in conjunction with carbamazepine.

In Western medicine, some people also self-treat their epileptic seizures with cannabis, or marijuana. In one Canadian survey, 24 percent of patients in an epilepsy care center reported using marijuana or cannabinoids to treat their disease (Gross DW et al 2004). Researchers are investigating active ingredients in marijuana to see if novel drugs can be isolated that may aid in seizure therapy. However, because of psychoactive side effects associated with marijuana, and possible legal repercussions, it is not practical or recommended for the treatment of epilepsy (Wallace MJ et al 2003).

Seizure Triggers

Many factors can affect the excitability of brain neurons and increase the possibility of seizure activity. In susceptible individuals, seizures can be precipitated by the presence of certain factors referred to as triggers. Seizure triggers include low blood sugar, dehydration, fatigue, lack of sleep, stress, extreme heat or cold, depression, and flashing or flickering lights. Potentially sensitive individuals can have additional triggers consisting of food and environmental sensitivities.

• Diet. Nutritional deficiencies and electrolyte imbalances can cause seizures.
• Aspartame. Aspartame has been implicated as a possible cause of seizures; its metabolite phenylalanine can be neurotoxic at high levels, and it interferes with the production of inhibitory neurotransmitters, providing a logical mechanism for its effect. Clinical studies, however, are conflicting. In a study of people with an apparent history of seizures after exposure to aspartame, no seizures were produced under controlled conditions of aspartame exposure (Rowan AJ et al 1995). Another study of children with petit mal seizures, however, did demonstrate EEG changes (but not seizures) after oral doses of aspartame (Camfield PR et al 1992).
• Caffeine and herbal stimulants. Caffeine is a global stimulant; there is one reported case of a patient’s seizure frequency decreasing with the elimination of caffeine from the diet, but little other evidence exists to support such a role (Kaufman KR et al 2003).
• Environmental toxins. Many environmental toxins, including certain pesticides and heavy metals, are known to trigger seizures. For instance, mercury and lead, which are present in drinking water and certain foods, are well known neurotoxins that are associated with seizures. Also, insecticides known as organophosphates are known to increase brain activity.
• Stress. Stress adversely affects neurons and induces neurotoxic damage in humans, probably through generation of free radicals. It decreases antioxidant enzyme levels and activities (Zaidi SM et al 2004). Stress often functions as a trigger for patients with seizures. The high correlation of stress, sleep deprivation, and fatigue with seizures suggests that they act through common mechanisms to worsen seizure control (Frucht MM et al 2000).

Seizure Interruptions

Although auras do not occur in all individuals with seizure disorder, some individuals are aware of a change in their sensory perception (whether auditory, olfactory, sensory, visual, or gustatory, sometimes involving malaise, vertigo, or the sense of deja vu) that signals the onset of a seizure. Auras can last for several seconds to a few minutes before progressing to the next stage. However, sometimes auras end without evolving into a seizure. The nature of the aura varies for each individual and is dependent on the area of the brain where the seizure originates (Kotagal et al 2003). For example, a person who generally experiences partial seizures that begin in the temporal lobe (where auditory signals are processed) might hear sounds that do not exist. Other individuals might perceive odors (usually unpleasant) or experience visual aberrations.

Anecdotal reports indicate that some people have learned to interrupt their seizure process by replacing the aura-induced perception with another. In these individuals, the aura is a known signal of seizure onset. For example, if the aura is a smell or unpleasant odor, these individuals can often interrupt the seizure by immediately smelling something else (in general, something with a more pleasing smell than the aura). Some are able to take this interruption technique a step further. By simply relying on mental imagery (e.g., remembering a pleasant, positive smell), they can arrest a seizure. Some find that anger can be a positive force to interrupt a seizure. They are able to arrest their seizures by yelling at the seizures. Other individuals who have seizures with an observable onset pattern enlist a support person to shout at them or give them a quick shake when the pattern commences.

Lifestyle Changes

Lifestyle changes will also reduce the likelihood of seizure activity. Getting a good night’s sleep on a regular basis is a very important component of seizure prevention. Some scientists hypothesize that one major function of REM sleep is to reduce the brain’s susceptibility to epileptogenic influences (Jaseja H 2004). Stress reduction and relaxation techniques such as meditation may also aid in reducing seizures.

A variety of activities can help people deal with stress and improve the quality of sleep as well (Richard A 1995). Daily exercise is an obvious means of decreasing stress. However, individuals with epilepsy should exercise at a moderate level, focusing on relaxation and muscle tone rather than bodybuilding or strenuous, competition-level exercise. Yoga, low-impact aerobics, moderate weight lifting, dancing, jogging, biking, and swimming are also suitable activities (Ramaratnam S et al 2000).

In addition to exercise, several relaxation techniques are appropriate: progressive relaxation, autogenic training, guided imagery, hypnotherapy (Puskarich CA et al 1992; Noeker M et al 2000; Ramaratnam S et al 2001). Some involve conscious breathing. Deep, full, slow breaths can stimulate the parasympathetic nervous system and block anxiety. Relaxation techniques can facilitate accurate recognition of disease-related symptoms, leading to empowerment to handle acute crises and strengthen self-esteem (Noeker M et al 2000). Progressive muscle relaxation has been successful in reducing seizure frequency. Progressive muscle relaxation techniques are taught in a few sessions. The method is inexpensive and noninvasive. In one study in a neurology clinic (24 participants with epilepsy, 13 receiving relaxation training, 11 using quiet sitting), 11 of the 13 participants using relaxation techniques reported decreased seizure frequency; 7 of the 11 participants in the quiet group reported a decrease (Puskarich CA et al 1992).

Biofeedback, another relaxation technique, can also be helpful. When the autonomic nervous system (or the involuntary nervous system) is in a state of overarousal, the likelihood of seizure activity can increase. When overaroused, the body is in what is called a beta state. Using biofeedback, participants can learn to shift the body to an alpha state—a state of relaxation. Stress is reduced. In some cases, the ability to recognize auras is enhanced. While researchers are divided on its uses for epilepsy, some studies have shown biofeedback to be successful in reducing seizure frequency (Tozzo CA et al 1988; Andrews DJ et al 1992; Ramaratnam S et al 2001).

Acupuncture may also be helpful in seizure prevention. Two acupuncture studies have found that acupuncture at specific sites produces anticonvulsant effects by increasing inhibitory neurotransmitters and other natural substances that may prevent seizures (Wu Y et al 1992).