Complementary medicine for Epilepsy

The large percentage of patients whose seizures are refractory to AEDs and who undergo resective surgery or medical device implantation may perhaps explain why patients with epilepsy turn to complementary medicine as a last resort. Complementary and alternative medical therapies include chiropractic, acupuncture, yoga, diet, homeopathy, acupuncture, biofeedback, traditional Oriental medicine, aromatherapy (with or without hypnosis), massage therapy, herbal remedies, mind–body therapies (such as meditative practices and visualization, Reiki-like healing practices), and folk practices and religious healing. Of these, modalities based on spiritual healing create a number of conundrums for the clinician, including legal, regulatory,
and ethical issues. Magnets, electric currents, and artificial electromagnetic fields have also been used to treat patients with epilepsy. Psychological interventions such as relaxation therapy, cognitive-behavioral therapy, electroencephalography, biofeedback, and educational interventions
have been used alone or in combination in the treatment of epilepsy, to reduce seizure frequency and improve quality of life. Anecdotal accounts suggest that some herbal substances may have anticonvulsant effect, but randomized double-blind controlled trials are lacking. Alternatively, many herbals and dietary supplements may predispose to seizures in individuals without epilepsy and worsen seizure control in those with epilepsy. It remains
to be seen whether perceived positive outcomes of complementary medicine could be explained by enhancement of the placebo effect or specific action, if any. In view of methodological deficiencies and limited number of individuals studied, there seems to be no reliable evidence to support the use of any of these treatments; randomized controlled trials are needed.

Recommendation.

Complementary medicine is often sought when and if AEDs have failed to control seizures despit  toxicity from high doses, and surgery is not possible or declined. AED treatment should be continued when complementary medicine is used. The toxicity of unproven complementary medicine is often underestimated.