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Alternative Treatments in Epilepsy Shannon Brophy, RN, MSN, ANP-BC October 2, 2010 Objectives Define Complementary and Alternative Medical (CAM) treatments Understand the role CAM can have in management of epilepsy Understand the different treatment options

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Alternative treatments in epilepsy l.jpg

Alternative Treatments in Epilepsy

Shannon Brophy, RN, MSN, ANP-BC

October 2, 2010

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  • Define Complementary and Alternative Medical (CAM) treatments

  • Understand the role CAM can have in management of epilepsy

  • Understand the different treatment options

  • Promote your well-being through CAM

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Complimentary and Alternative Medical Treatments

  • Diverse group of health care practices and products that fall outside the realm of traditional Western medicine

    (National Center for Complementary and Alternative Medicine)

  • Used to complement or replace conventional medical therapies

  • Increased use over past 2 decades

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  • Varies slightly depending on populations studied

  • At least 24-44% of epilepsy patients are already using some form of CAM

    (McElroy-Cox, C)

  • High prevalence in developing countries

    • Nigeria, Zambia

    • Of 40 million people worldwide with epilepsy, 80% live in developing countries

      (Institute of Medicine: Neurological and Psychiatric disorders: meeting the challenge in the developing world)

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  • Many people achieve seizure freedom with conventional therapy

  • Up to 1/3 of patients are refractory to medical treatment (Kwan, P, Brodie, MJ)

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Reasons to consider CAM

  • Inadequate seizure control with drug therapy

  • SE from AED

  • Concern for harmful effects from long term usage

  • Teratogenicity

  • Allergic reactions

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  • Supplement rather than alternative to conventional drug therapy

  • Finding less toxic ways of improving quality of life

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Most common forms of CAM

  • Mind-body therapies

  • Biologic-based therapies

  • Manipulative and body-based therapies

  • Energy medicine

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Mind-body therapies

  • Facilitate development of mind’s inherent ability to affect body’s function

  • Relatively few SE

  • Yoga and Meditation

    • 62% reduction at 3 mos

    • 86% reduction at 6 mos

    • No significant change in control/placebo

      (Panjwani, et al)

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Mind-body therapies

  • Relaxation techniques

    • stress management and seizure reduction

  • Biofeedback

    • monitor HR, brain waves, or skin resistance

    • transmitted directly to patient

    • aware of unconscious process

    • gain control

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Mind-body therapiesconculsion

  • Studies have been small and of varying quality

  • May be useful as adjunctive

  • Poorly understood pathophysiological mechanism

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Biologic-based therapies

  • Herbal and dietary supplements

    • Do not undergo same regulatory scrutanty as prescription/OTC

    • Need to be aware of potential interactions

  • Omega-3 fatty acids

    • Neuronal transmission

    • Anti-inflammatory

    • Prevent neuropathological changes in hippocampal formation in rats with epilepsy

    • (Ferraru, et al)

  • Need further studies with larger sample sizes, doses, longer treatment

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Biologic-based therapies

  • Whole diets

    • Ketogenic diet

    • Modified Atkins diet

  • Herbal remedies

    • Chinese medicine

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Manipulative and body-based therapies

  • Manipulation or movement of body to stimulate healing and foster wellness

  • Chiropractic and massage therapies

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Energy Medicine

  • Acupuncture (traditional Chinese medicine)

    • May theoretically release inhibitory neurotransmitters

    • Effect on EEG conflicting

      Cochrane Review: 11 studies included

    • Has not been proven to be effective and safe for treating pts with epilepsy

    • Requires further investigation

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Energy Medicine (cont)

  • Reiki

    • Healing practice originated in Japan

    • Hands on or above pt to facilitate healing

    • Only 1 study: need further research

  • Homeopathy

    • Originated in Germany

    • “Like cures like”

    • Individualized for each person’s needs

    • Need further studies

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  • Important for seizure control and improvement in quality of life

  • Always maintain seizure precautions

  • Rare cases of exercise-induced seizures

  • Studies have generally shown:

    • Physical activity can decrease seizure frequency

    • Improve cardio and psychological health

    • Suggest anticonvulsant effect on pts with epilepsy

    • B-endorphins release inhibitory epileptic discharges

      (The potential role of physical exercise in the treatment of epilepsy)

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Cautions in sports participation

  • Determine whether benefits outweigh risks

  • Benefit/risk ratio

    • Dependent on sports activity

    • Type of seizure that may occur

    • Probability that seizure will occur during activity

      Contributing factors:

      Fatigue, stress of competition, hypoxia, hyperthermia, hypoglycemia

      Prohibiting pts from participating in sports can result in emotional distress (Livingston, S; Berman, W)

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  • Benefits on psychiatric conditions

    • Anxiety, depression

      Roth et al:

      physical exercise, stressful life experiences, and depression in adults with epilepsy

      Active subjects had significantly lower levels of depression and better psychosocial adjustments than inactive subjects

    • Sleep

    • Pain

    • Preventing and treating illness

    • Stress management

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General health benefits of exercise in patients with epilepsy

  • Increased maximal aerobic capacity

  • Increased work capacity

  • Weight reduction w/ reduced body fat

  • Bone density

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Other non-conventional treatments epilepsy

  • Steroids

  • Immunoglobulins

  • Diet

  • Vitamins

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Promotion of well-being epilepsy

  • Exercise

  • Sleep hygiene

  • Avoid ETOH

  • Coping strategies

  • Educational interventions

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Conclusion epilepsy

  • CAM increasingly popular over last 2 decades

  • Strong evidence to support that many pts with epilepsy are using CAM

  • Lack of evidence showing efficacy

  • Need better designed, large, prospective, randomized studies

  • Discuss with practitioner