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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

Alternative Treatments in Epilepsy

Shannon Brophy, RN, MSN, ANP-BC

October 2, 2010

objectives
Objectives
  • 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
complimentary and alternative medical treatment s
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
prevalence
Prevalence
  • 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)

epilepsy
Epilepsy
  • Many people achieve seizure freedom with conventional therapy
  • Up to 1/3 of patients are refractory to medical treatment (Kwan, P, Brodie, MJ)
reasons to consider cam
Reasons to consider CAM
  • Inadequate seizure control with drug therapy
  • SE from AED
  • Concern for harmful effects from long term usage
  • Teratogenicity
  • Allergic reactions
slide7
GOAL
  • Supplement rather than alternative to conventional drug therapy
  • Finding less toxic ways of improving quality of life
most common forms of cam
Most common forms of CAM
  • Mind-body therapies
  • Biologic-based therapies
  • Manipulative and body-based therapies
  • Energy medicine
mind body therapies
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)

mind body therapies10
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
mind body therapies conculsion
Mind-body therapiesconculsion
  • Studies have been small and of varying quality
  • May be useful as adjunctive
  • Poorly understood pathophysiological mechanism
biologic based therapies
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
biologic based therapies13
Biologic-based therapies
  • Whole diets
    • Ketogenic diet
    • Modified Atkins diet
  • Herbal remedies
    • Chinese medicine
manipulative and body based therapies
Manipulative and body-based therapies
  • Manipulation or movement of body to stimulate healing and foster wellness
  • Chiropractic and massage therapies
energy medicine
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
energy medicine cont
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
exercise
Exercise
  • 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)

cautions in sports participation
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)

exercise19
Exercise
  • 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
general health benefits of exercise in patients with epilepsy
General health benefits of exercise in patients with epilepsy
  • Increased maximal aerobic capacity
  • Increased work capacity
  • Weight reduction w/ reduced body fat
  • Bone density
other non conventional treatments
Other non-conventional treatments
  • Steroids
  • Immunoglobulins
  • Diet
  • Vitamins
promotion of well being
Promotion of well-being
  • Exercise
  • Sleep hygiene
  • Avoid ETOH
  • Coping strategies
  • Educational interventions
conclusion
Conclusion
  • 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