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Epilepsy — Scientific Evidence


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Based on scientific evidence the following approaches have shown to be effective. To review the supporting scientific evidence, select a treatment option.

  Acupuncture
  Aromatherapy
  Biofeedback
  Cognitive Behavioral Therapy
  Exercise
  General
  Herbal Medicine
  Meditation/Relaxation
  Music Therapy
  Nutrition/Supplementation
  Yoga

In order to help interpret the strength of the scientific evidence (the level of proof) provided, descriptions of the different types of studies, reviews and guidelines are available in the glossary. Please click on each term for a discussion of the topic: Case review, consensus statement, controlled clinical trial, guidelines and recommendations, literature review, meta-analysis, multi-center study, outcome study, systematic review.

Acupuncture
Author(s):
Kloster R, Larsson PG, Lossius R, et al
Institution:
The National Center for Epilepsy, N-1301Sandvika, Norway
Title:
The effect of acupuncture in chronic intractable epilepsy
Source:
Seizure. 8(3):170-4, 1999
Type of study:
randomized, controlled clinical trial
Control/comparison:
sham acupuncture
Sample characteristics:
29 patients with chronic intractable epilepsy
Type of intervention:
acupuncture treatment
Primary outcome measure(s):
seizure frequency
Outcome:
A non-significant reduction of seizures occurred in both the treatment and sham groups. There was also an increase in the number of seizure-free weeks for both groups, which reached a level of significance in the sham group. Researchers concluded that they were not able to prove a beneficial effect of acupuncture in chronic intractable epilepsy.

Author(s):
Stavem K, Kloster R, Rossberg E, et al
Institution:
Foundation for Health Services Research, Central Hospital of Akershus, Nordbyhagen, Norway. knut.stavem@klinmed.uio.no
Title:
Acupuncture in intractable epilepsy: lack of effect on health-related quality of life
Source:
Seizure. 9(6):422-6, 2000
Type of study:
randomized, controlled clinical trial
Control/comparison:
20 sham acupuncture treatments (bilateral needling with smaller needles of three points outside the traditional meridians) over 8 weeks
Sample characteristics:
34 patients with long-standing drug resistant epilepsy
Type of intervention:
20 acupuncture treatments (bilateral needling of three acupoints plus one or two individually chosen points) over 8 weeks
Primary outcome measure(s):
health-related quality of life scores determined using the 89-item Quality of Life in Epilepsy (QOLIE-89) questionnaire
Outcome:
The researchers found no difference between the acupuncture and sham acupuncture groups in score changes in any qualities of the QOLIE-89 questionnaire, despite testing a large number of dimensions. Nor were any changes observed in QOLIE-89 scores between baseline and 8 weeks in either of the groups. The researchers concluded that they could not demonstrate a significant effect of traditional acupuncture or sham acupuncture on the health-related quality of life of patients with intractable epilepsy.

Author(s):
Cheuk DK. Wong V.
Institution:
Department of Pediatrics and Adolescent Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong, China.
Title:
Acupuncture for epilepsy
Source:
Cochrane Database of Systematic Reviews. (4):CD005062, 2008.
Type of study:
Review (41 refs)
Control/comparison:
Not applicable
Sample characteristics:
Not applicable
Type of intervention:
Not applicable
Primary outcome measure(s):
Not applicable
Outcome:
Eleven small trials with 914 participants, of generally poor methodological quality and with short follow up were included in this review. Ten trials were carried out in China and one in Norway. Two trials found that more children treated with needle acupuncture plus Chinese herbs achieved 75% or greater reduction in seizure frequency and 50% or greater reduction in seizure duration compared with Chinese herbs alone. However, after combining the results of four trials that compared the treatment group with a control group, we found that there was no significant difference between the treatment and the control groups in any reduction of seizure frequency. The current evidence does not support acupuncture as a treatment for epilepsy.
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Aromatherapy
Author(s):
Nsour WM, Lau CBS, Wong, ICK.
Institution:
The School of Pharmacy, University of Bradford, Bradford West Yorkshiire and Department of Pharmacy, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
Title:
Review on phytotherapy in epilepsy
Source:
Seizure. 9: 96-107, 2000
Type of study:
Review (64 references)
Control/comparison:
not applicable
Sample characteristics:
not applicable
Type of intervention:
not applicable
Primary outcome measure(s):
not applicable
Outcome:
Reviewers concluded that plant species from a wide range of families offer significant in vivo/ in vitro antiepileptic activities. Among these plants a number of active chemical components have been isolated. However many remain unidentified and therefore further research into the use of natural products as antiepileptics is needed.
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Biofeedback
Author(s):
Goldstein LH
Institution:
Department of Psychology, Institute of Psychiatry, De Crespigny Park, London
Title:
Effectiveness of psychological interventions for people with poorly controlled epilepsy
Source:
Journal of Neurology, Neurosurgery and Psychiatry. 63(2):137-42, 1997
Type of study:
review (61 references)
Control/comparison:
not applicable
Sample characteristics:
not applicable
Type of intervention:
not applicable
Primary outcome measure(s):
not applicable
Outcome:
This review of clinical studies examining psychological interventions for uncontrolled epilepsy, including cognitive behavior therapy, relaxation and breathing techniques, biofeedback, and psychiatric interventions, showed promising results. However, the author found the majority of studies reviewed were either limited by their methodology or by the extent to which the results of one study could be compared to the results of another. The author therefore suggests ways in which future studies can correct these errors. Further long-term studies which permit the comparison of cognitive behavioral therapies and relaxation techniques with other therapies that are more neurophysiologically-based like EEG biofeedback are recommended.

Author(s):
Lubar JF
Institution:
University of Tennessee-Memphis, USA
Title:
Electroencephalographic biofeedback methodology and the management of epilepsy
Source:
Integrative Physiological and Behavioral Science. 33(2):176-207, 1998
Type of study:
review (32 references)
Control/comparison:
not applicable
Sample characteristics:
not applicable
Type of intervention:
not applicable
Primary outcome measure(s):
not applicable
Outcome:
Epilepsy appears in many forms but basically it is a disorder of the nervous system characterized by paroxysmal phasic discharges of pools of neurons. It has recently been shown that behavioral control of specific activity of 12 Hz to 15 Hz recorded from scalp electrodes overlying the sensorimotor or Rolandic cortex might be of considerable significance for the management of human epileptic seizures. In studies conducted by the reviewer, significant reductions in epileptic seizures resulted from the development of inhibitory activity in the nervous system through sensorimotor rhythm training. The author notes that the technology used is both costly and complex as well as time consuming. However, biofeedback does offer a viable alternative for the large population of epileptics whose medication is not sufficient to adequately control their seizures. It is a favorable alternative to those medications which are damaging to organ systems and possibly life limiting. The reviewer points out that new medications are being developed which should still be considered for treatment because it is far easier to deal with epilepsy pharmacologically than behaviorally.

Author(s):
Sterman MB. Egner T.
Institution:
Department of Neurobiology, School of Medicine, UCLA
Title:
Foundation and practice of neurofeedback for the treatment of epilepsy.
Source:
Applied Psychophysiology & Biofeedback. 31(1):21-35, 2006.
Type of study:
Review (74 refs)
Control/comparison:
Not applicable
Sample characteristics:
Not applicable
Type of intervention:
Not applicable
Primary outcome measure(s):
Not applicab le
Outcome:
This review focuses on the treatment of epilepsy with sensorimotor rhythm (SMR) training, arguably the best established clinical application of EEG operant conditioning. While more controlled clinical trials would be desirable, a respectable literature supports the clinical utility of this alternative treatment for epilepsy. However, the skilled practice of clinical neurofeedback requires a solid understanding of the neurophysiology underlying EEG oscillation, operant learning principles and mechanisms, as well as an in-depth appreciation of the ins and outs of the various hardware/software equipment options open to the practitioner.

Author(s):
Tan G, Thornby J, Hammond DC, et al.
Institution:
Michael E. DeBakey Veterans Affairs Hospital and Baylor College of Medicine, Houston, Texas
Title:
Meta-analysis of EEG biofeedback in treating epilepsy.
Source:
Clin EEG Neurosci. 40(3):173-9, 2009
Type of study:
Meta-analysis
Control/comparison:
not applicable
Sample characteristics:
not applicable
Type of intervention:
not applicable
Primary outcome measure(s):
not applicable
Outcome:
Ten studies were included in this meta-analysis. All studies consisted of patients whose seizures were not controlled by medical therapies. Nine of 10 studies reinforced sensorimotor rhythms (SMR) while 1 study trained slow cortical potentials (SCP). All studies reported an overall mean decreased seizure incidence following treatment and 64 out of 87 patients (74%) reported fewer weekly seizures in response to EEG biofeedback. EEG operant conditioning was found to produce a significant reduction on seizure frequency. This finding is especially noteworthy given the patient group, individuals who had been unable to control their seizures with medical treatment.

Author(s):
Sterman MB.
Institution:
Departments of Neurobiology and Biobehavioral Psychiatry, Geffen School of Medicine, University of California, Los Angeles, CA
Title:
Biofeedback in the treatment of epilepsy
Source:
Cleve Clin J Med. 77 Suppl 3:S60-7, 2010.
Type of study:
Review
Control/comparison:
not applicable
Sample characteristics:
not applicable
Type of intervention:
not applicable
Primary outcome measure(s):
not applicable
Outcome:
Studies in human epileptic subjects documented a significant reduction in seizure incidence and severity, together with EEG pattern normalization. This work expanded internationally, resulting in numerous well-controlled group and single-case studies summarized in recent meta-analyses. New findings in functional neuroimaging/EEG correlation studies provide a rational model for the basis of these clinical effects.
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Cognitive Behavioral Therapy
Author(s):
Fenwick P
Institution:
Department of Neuropsychiatry, Maudsley Hospital, London, England
Title:
The behavioral treatment of epilepsy generation and inhibition of seizures
Source:
Neurologic Clinics. 12(1):175-202, 1994
Type of study:
review (132 references)
Control/comparison:
not applicable
Sample characteristics:
not applicable
Type of intervention:
not applicable
Primary outcome measure(s):
not applicable
Outcome:
The author states that the articles reviewed provide ample evidence of the close relationship between seizure activity and behavior. This relationship strengthens the theoretical framework for behavioral treatment of epilepsy patients. The reviewer describes how practitioners should chart events surrounding the time of seizure in order to develop a countermeasure that will help stop the occurrence of future seizures. The information obtained from the patients should include their feelings, actions, and thoughts that will both trigger and inhibit seizure activity. The reviewer also stresses the importance of making the patients understand that their seizures are not necessarily random events, but are intimately related to their behavior and emotions. The reviewer concludes that a complete treatment of epilepsy involves not just medication, but extends to teaching the patients about their brain and its functioning, and how they can use their feelings, thinking, and behavior in the control of their epilepsy.
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Exercise
Author(s):
Arida RM. Scorza FA. da Silva SG.
Institution:
Universidade Federal de Sao Paulo, Sao Paulo, Brazil.
Title:
The potential role of physical exercise in the treatment of epilepsy
Source:
Epilepsy & Behavior. 17(4):432-5, 2010.
Type of study:
Review (56 references)
Control/comparison:
Not applicable
Sample characteristics:
Not applicable
Type of intervention:
Not applicable
Primary outcome measure(s):
Not applicable
Outcome:
The beneficial effects of exercise for people with epilepsy, including reduction of seizure susceptibility, improvement of quality of life, reduction of anxiety and depression, and better social integration, have increasingly been reported. This review presents data from human and animal studies supporting the role of exercise as a therapy for epilepsy complementary to standard treatments.

Author(s):
Arida RM, Scorza FA, Cavalheiro EA.
Institution:
Universidade Federal de São Paulo, São Paulo, Brazil.
Title:
Favorable effects of physical activity for recovery in temporal lobe epilepsy.
Source:
Epilepsia. 51(Suppl 3):76-9, 2010.
Type of study:
Review
Control/comparison:
Not applicable
Sample characteristics:
Not applicable
Type of intervention:
Not applicable
Primary outcome measure(s):
Not applicable
Outcome:
This review discusses the positive effects of physical exercise program in experimental models of epilepsy, and considerations of the potential application of physical exercise strategy for preventing or treating temporal lobe epilepsy are highlighted. Findings from animal studies indicate that exercise can modulate nerve vulnerability to epileptic insults. Behavioral analysis showed a reduced frequency of seizures during physical exercise programs. Studies confirm the positive influence of exercise on epilepsy. Exercise can exert beneficial actions such as reduction of seizure susceptibility as observed in animal studies, and improvement of quality of life and reduction of anxiety and depression in individuals with epilepsy. Physical exercise may thus be helpful when integrated with conventional therapy for epilepsy.
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General
Author(s):
Sheth RD. Stafstrom CE. Hsu D.
Institution:
Department of Neurology, University of Wisconsin, Madison, Madison, WI
Title:
Nonpharmacological treatment options for epilepsy.
Source:
Seminars in Pediatric Neurology. 12(2):106-13, 2005.
Type of study:
Review (91 refs)
Control/comparison:
Not applicable
Sample characteristics:
Not applicable
Type of intervention:
Not applicable
Primary outcome measure(s):
Not applicable
Outcome:
This review examines the role of vagus nerve stimulation, the ketogenic diet, and various forms of EEG biofeedback therapy in children with intractable epilepsy. Although the mechanism of action is not known precisely for any of these adjunctive therapies, they add an important and evolving dimension to the management of difficult to control epilepsy in children. In addition, pyridoxine-dependent seizures are discussed as an example of an etiology of refractory seizures that responds well to replacement therapy.

Author(s):
McElroy-Cox C.
Institution:
Columbia Comprehensive Epilepsy Center, Columbia University, Neurologic Institute, New York, NY.
Title:
Alternative approaches to epilepsy treatment.
Source:
Curr Neurol Neurosci Rep. 9(4):313-8, 2009.
Type of study:
Review
Control/comparison:
Not applicable
Sample characteristics:
Not applicable
Type of intervention:
Not applicable
Primary outcome measure(s):
Not applicable
Outcome:
Surveys have shown that up to 44% of patients with epilepsy are using some form of integrative treatment. This article reviews the modalities of meditation, yoga,relaxation techniques, biofeedback, nutritional and herbal supplements, dietary approaches, chiropractic care, acupuncture, Reiki, and homeopathy and what is known about their potential efficacy in patients with epilepsy.
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Herbal Medicine
Author(s):
Nsour WM, Lau CBS, Wong IC
Institution:
The School of Pharmacy, University of Bradford, West Yorkshire, UK
Title:
Review on phytotherapy in epilepsy
Source:
Seizure. 9(2):96-107, 2000
Type of study:
review (64 references)
Control/comparison:
not applicable
Sample characteristics:
not applicable
Type of intervention:
not applicable
Primary outcome measure(s):
not applicable
Outcome:
This review identified the plant/herbal preparations, which have been tested or reported for their antiepileptic/anticonvulsant activities either in vivo or in vitro over the past 30 years. For some of the plants listed, the active components have been identified and have been shown to fall into different classes. For example, the reviewers stated that previous studies showed some natural plant coumarins and triterpenoids as exhibiting anticonvulsant properties. Yet in most cases the active constituents of many of these plants have yet to be determined. For the plants where the active constituents are unknown and the plant is easily available plus has low toxicity levels, the researchers encourage further research to be carried out with sound methodology. The plants that fall into this category include Albizia lebbek, Casimirioa edulis, Egletes viscosa, Ipomoea stans, Piper guineense, Piper nigrum, Psidium guyanensis, Ruta chalepensis, Ternstroemia pringlei, and Tetrapleura tetraptera. The reviewers point out that many of these herbal medicines have been used for a long time without undergoing any testing. Therefore there is not a lot of data to support their clinical efficacy. Four Chinese herbal medications have shown impressive clinical results, yet these studies were not randomized nor placebo-controlled. The reviewers hope that their report will help stimulate further investigations into natural products for new antiepileptic agents.

Author(s):
Schachter SC.
Institution:
Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
Title:
Botanicals and herbs: a traditional approach to treating epilepsy
Source:
Neurotherapeutics. 6(2):415-20, 2009.
Type of study:
Review (59 refs)
Control/comparison:
Not applicable
Sample characteristics:
Not applicable
Type of intervention:
Not applicable
Primary outcome measure(s):
Not applicable
Outcome:
To date more than 30 herbal extracts and extract-derived compounds isolated from Chinese, Japanese and Indian herbal therapies have been studied by the Harvard program in animal models of epilepsy through the National Institute of Neurological Disorders and Stroke Anticonvulsant Screening Project and many have been evaluated using in vitro testing. Approximately two thirds of these compounds show activity in vitro, in vivo or both.

Author(s):
Samuels N. Finkelstein Y. Singer SR. Oberbaum M.
Institution:
The Center for Integrative Complementary Medicine, Shaare Zadek Medical Center, Jerusalem, Israel.
Title:
Herbal medicine and epilepsy: proconvulsive effects and interactions with antiepileptic drugs
Source:
Epilepsia. 49(3):373-80, 2008.
Type of study:
Review (104 refs)
Control/comparison:
Not applicable
Sample characteristics:
Not applicable
Type of intervention:
Not applicable
Primary outcome measure(s):
Not applicable
Outcome:
Many herbs may increase the risk for seizures, through their pro-convulsant properties or contamination by heavy metals, as well as through other effects. Herb-drug interactions may be difficult to predict, especially since the quality and quantity of active ingredients are often unknown. Further research is required on the effect of herbs on seizure activity and interactions with anti-epileptic drug treatment.
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Meditation/Relaxation
Author(s):
Puskarich CA, Whitman S, Dell J, Hughes JR, et al
Institution:
Epidemiology Program, Chicago Department of Health, Ilinois
Title:
Controlled examination of effects of progressive relaxation training on seizure reduction
Source:
Epilepsia. 33(4):675-80, 1992
Type of study:
randomized, controlled clinical trial
Control/comparison:
11 epilepsy patients who engaged in six sessions of quiet sitting and an 8-week follow up
Sample characteristics:
24 epilepsy patients at an urban neurology clinic
Type of intervention:
13 epilepsy patients received six sessions of progressive muscle relaxation training and an 8-week follow up
Primary outcome measure(s):
seizure frequency
Outcome:
There was a mean decrease in seizure activity of 29% in the group participating in progressive relaxation training compared to a 3% decrease in the control group. Researchers concluded that from the results of this study along with similar data from previous studies, progressive relaxation therapy is beneficial in reducing seizure activity in epileptic patients and should be incorporated into clinical practices.

Author(s):
Ramaratnam S, Baker GA, Goldstein L
Institution:
Department of Neurology, Apollo Hospitals, 21 Greams Lane, Off Greams Road, Madras, Tamil Nadu, India, 60006. rsridharan@vsnl.com
Title:
Psychological treatments for epilepsy
Source:
Cochrane Database Systematic Review. (4):CD002029, 2001
Type of study:
review (38 references)
Control/comparison:
not applicable
Sample characteristics:
not applicable
Type of intervention:
not applicable
Primary outcome measure(s):
not applicable
Outcome:
Psychological interventions, such as relaxation therapy, cognitive-behavioral therapy, EEG biofeedback and educational interventions, have been used alone or in combination as treatment for epilepsy. This review assessed whether any of these psychological interventions are effective at reducing seizure frequency or improving quality of life. Three small trials (50 patients) of relaxation therapy were identified, but no conclusions could be drawn due to poor methodology. Studies on cognitive-behavioral therapy, biofeedback, or combinations of the various psychological interventions offered conflicting findings or suffered from a poor study design. Educational interventions were found to be beneficial in improving the understanding of epilepsy as well as improving the compliance to medications and increasing social competencies. The reviewers stress that further trials are needed to evaluate the efficacy of psychological methods for treating epilepsy.
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Music Therapy
Author(s):
Sidorenko VN
Institution:
Mother and Child Health Institute of the Ministry of Health, Minsk, Belarus
Title:
Effects of the Medical Resonance Therapy Music in the complex treatment of epileptic patients
Source:
Integrative Physiological & Behavioral Science. 35(3):212-7, 2000
Type of study:
controlled clinical trial
Control/comparison:
traditional anti-epileptic therapy with the drugs Phenobarbital and Filepsin including anti-convulsants, and sedative therapy if necessary
Sample characteristics:
severe epileptic patients, whose attacks persevered despite comprehensive drug treatments
Type of intervention:
traditional anti-epileptic therapy plus Medical Resonance Therapy Music (MRT-Music) once daily for an hour for a total of 6 - 16 treatments
Primary outcome measure(s):
frequency and severity of epileptic attacks, the subjective state, psychological studies using the Minnesota Multiphasic Personality Inventory (MMPI), the dynamics of the inter-paroxysmal symptoms and the individual parameters of the functional asymmetry of the brain (IPFA)
Outcome:
The MRT-Music treatment group demonstrated significant improvements in many of the primary outcome measures: 90% of the MRT-Music group showed improvement in the subjective state, 80% had positive changes in the paroxysmal picture, and there was a 75% reduction in the frequency and severity of the attacks. The reduction was mainly observed as dissolving psychopathological paroxysms, and after the third sitting, there was a reduction of the generalized paroxysms and somatomotoric attacks with secondary generalization. The changes of the IPFA-values demonstrated a predominant influence of MRT-Music on the functions of the right hemisphere of the cerebrum. The researchers state the intense effect of this therapy on the epileptic patient results from the special natural rhythmical structure of MRT-Music. The harmonical rhythmical structure of MRT-Music corresponds to the natural rhythmical order of the healthy organism. Therefore it can work to restore the normal biological rhythms of the central nervous system via the way of resonance between natural orders and can thus cause a significant reduction of epileptic attacks.
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Nutrition/Supplementation
Author(s):
Eros E, Geher P, Gomor B, et al
Institution:
Department of Human Genetics and Teratology, National Institute of Public Health-WHO Collaborating Centre for the Community Control of Hereditary Diseases, Budapest, Hungary
Title:
Epileptogenic activity of folic acid after drug induces SLE (folic acid and epilepsy).
Source:
European Journal of Obsetrics, Gynecology, and Reproductive Biology. 88(2):217-19, 1998
Type of study:
randomized, controlled clinical trial
Control/comparison:
12,225 healthy women receiving periconception and prenatal care
Sample characteristics:
60 pregnant epileptic women
Type of intervention:
patients received a multivitamin containing 0.8 mg of folic acid as part of periconception and prenatal care
Primary outcome measure(s):
structural birth defects and epilepsy-related side effects in epileptic women who took a multivitamin containing folic acid before and during pregnancy
Outcome:
The physiological dose (< 1 mg) of folic acid did not increase the risk for epileptic seizures in both healthy and 60 epileptic women who were pregnant. One woman received a multivitamin with 1 mg of folic acid in addition to taking carbamazepine. She developed status epilepticus and later systemic lupus erythematodes. The researchers concluded that the epileptic pregnant patients’ autoimmune disease (probably drug-induced lupus) could damage the blood-brain barrier, therefore the therapeutic dose (> or = 1 mg) of folic acid triggered a cluster of seizures.

Author(s):
Freeman JM, Vining, EP, Cost S, Singhi P, et al
Institution:
Department of Neurology, Johns Hopkins Medical Institutions, Baltimore, Maryland
Title:
Does carnitine administration improve the symptoms attributed to anticonvulsant medications?: a double-blinded, crossover study
Source:
Pediatrics. 93(6 Pt1):893-5, 1994
Type of study:
randomized, double-blind, controlled clinical trial
Control/comparison:
children received four weeks of carnitine therapy and crossed over to receive four weeks of placebo
Sample characteristics:
47 children with seizures who were taking either valproic acid or carbamazepine.
Type of intervention:
oral carnitine (100 mg/kilo) for four weeks, followed by placebo for four weeks
Primary outcome measure(s):
well-being scores, as perceived by parents, were assessed weekly by phone and in person at the start and end of each four week phase of the trial
Outcome:
The children’s well-being scores improved weekly when receiving carnitine or placebo, but did not achieve statistical significance. Since no evidence exists to support the idea that anticonvulsant medications cause carnitine deficiency, it does not appear necessary to administer carnitine to children receiving this therapy. The researchers conclude that the way to identify children in need of carnitine, and when to administer carnitine therapeutically to children receiving valproate or other anticonvulsants, remains unclear.

Author(s):
Raju GB, Behari M, Prasad K, et al
Institution:
Department of Neurology, All India Institute of Medical Sciences, New Delhi
Title:
Randomized, double-blind, placebo-controlled, clinical trial of D-alpha-tocopherol (vitamin E) as add-on therapy in uncontrolled epilepsy
Source:
Epilepsia 35(2):368-72, 1994
Type of study:
randomized, double-blind, controlled clinical trial
Control/comparison:
Patients were enrolled in a 3-month baseline program followed by two treatment phases of vitamin E or placebo with crossover to the second phase after 3 months.
Sample characteristics:
43 patients with uncontrolled epilepsy
Type of intervention:
Vitamin E administration
Primary outcome measure(s):
seizure frequency
Outcome:
No significant change was seen in seizure frequency with Vitamin E as compared to placebo. Similar observation was noted in subgroups with generalized seizures, partial with secondarily generalized seizures, or complex partial seizures, This study did not support earlier studies that claimed Vitamin E had therapeutic efficacy as an add-on treatment for seizure management.

Author(s):
Gaby AR.
Institution:
not applicable
Title:
Natural approaches to epilepsy.
Source:
Alternative Medicine Review. 12(1):9-24, 2007.
Type of study:
Review (165 refs)
Control/comparison:
Not applicable
Sample characteristics:
Not applicable
Type of intervention:
Not applicable
Primary outcome measure(s):
Not applicable
Outcome:
This article reviews research on the use of diet, nutritional supplements, and hormones in the treatment of epilepsy. Potentially beneficial dietary interventions include identifying and treating blood glucose dysregulation, identifying and avoiding allergenic foods, and avoiding suspected triggering agents such as alcohol, aspartame, and monosodium glutamate. The ketogenic diet may be considered for severe, treatment-resistant cases. The Atkins diet (very low in carbohydrates) is a less restrictive type of ketogenic diet that may be effective in some cases. Nutrients that may reduce seizure frequency include vitamin B6, magnesium, vitamin E, manganese, taurine, dimethylglycine, and omega-3 fatty acids. Administration of thiamine may improve cognitive function in patients with epilepsy. Supplementation with folic acid, vitamin B6, biotin, vitamin D, and L-carnitine may be needed to prevent or treat deficiencies resulting from the use of anticonvulsant drugs. Vitamin K1 has been recommended near the end of pregnancy for women taking anticonvulsants. Melatonin may reduce seizure frequency in some cases, and progesterone may be useful for women with cyclic exacerbations of seizures. Nutritional therapy is not a substitute for anticonvulsant medications.

Author(s):
Beniczky S, Jose Miranda M, Alving J, et al.
Institution:
Danish Epilepsy Centre, Dianalund, Denmark.
Title:
Effectiveness of the ketogenic diet in a broad range of seizure types and EEG features for severe childhood epilepsies.
Source:
Acta Neurologica Scandinavica. 121(1):58-62, 2010
Type of study:
Retrospective study
Control/comparison:
not applicable
Sample characteristics:
50 consecutive patients with severe, pharmacoresistant epilepsy
Type of intervention:
ketogenic diet
Primary outcome measure(s):
Clinical and EEG data
Outcome:
Three months after the start of the ketogenic diet two-thirds of the patients had a more than 50% reduction in seizure frequency. Results support that the ketogenic diet is efficient in a wide variety of epileptic patients with a broad range of EEG features. However, patients with epileptiform discharges in the temporal region are less likely to achieve therapeutic response.

Author(s):
Lee SW, Chung SS.
Institution:
Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ
Title:
A review of the effects of vitamins and other dietary supplements on seizure activity.
Source:
Epilepsy Behav. 18(3):139-50, 2010.
Type of study:
Review
Control/comparison:
Not applicable
Sample characteristics:
Not applicable
Type of intervention:
Not applicable
Primary outcome measure(s):
Not applicable
Outcome:
Many patients with epilepsy and their physicians have gained interest in the role of vitamins and other dietary supplements for seizure management. This review examines the potential anticonvulsant and proconvulsant effects of commonly used dietary supplements, as well as their potential effects on cognition or behavior. Findings are summarized from clinical studies with commentary on practical considerations regarding dietary supplementation for patients with epilepsy.
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Yoga
Author(s):
Panjwani U, Selvamurthy W, Singh SH, et al
Institution:
Defence Institute of Physiology and Allied Sciences, New Delhi
Title:
Effect of Sahaja yoga practice on seizure control and EEG changes in patients of epilepsy.
Source:
Indian Journal of Medical Research. 103:165-72, 1996
Type of study:
randomized, controlled clinical trial
Control/comparison:
group 2 were 10 patients who did exercises mimicking Sahaja yoga; group were 12 patients who did no meditation or exercises
Sample characteristics:
32 patients with idiopathic epilepsy
Type of intervention:
group 1 consisted of 10 subjects practiced Sahaja yoga meditation for 6 months
Primary outcome measure(s):
measurement of seizure activity and EEG alterations
Outcome:
Patients using Sahaja yoga demonstrated a 62% decrease in seizure activity at three months, and a further decrease of 86% after six months of practice. This group also showed measurable changes in EEG patterns. The control groups showed no significant changes in any of the measured parameters. Researchers concluded that Sahaja yoga could be beneficial in managing epilepsy. Further study is needed to support these findings.

Author(s):
Panjwani U, Gupta HL, Singh SH, Selvamurthy W, Rai, UC
Institution:
Defence Institute of Physiology and Allied Science, New Delhi
Title:
Effect of Sahaja yoga practice on stress management in patients of epilepsy.
Source:
Indian Journal of Physiology and Pharmacology. 39(2):111-6, 1995
Type of study:
randomized, controlled clinical trial
Control/comparison:
group 2 consisted of 10 patients who did exercises mimicking Sahaja yoga; group 3) 12 patients who did no meditation or exercises.
Sample characteristics:
32 patients with idiopathic epilepsy
Type of intervention:
group 1 consisted of 10 subjects practiced Sahaja yoga meditation for 6 months
Primary outcome measure(s):
Galvanic skin resistance, blood lactate levels and urinary vinyl mandelic acid were recorded at 0, 3 and 6 months
Outcome:
The group practicing Sahaja yoga showed significant improvement at three and six months in the primary outcome measures compared to the control groups. Researchers concluded that Sahaja yoga reduced stress in epileptic patients, which in turn may be responsible for the subjects’ clinical improvement.

Author(s):
Panjwani U, Selvamurthy W, Singh SH, et al
Institution:
Defence Institute of Physiology and Allied Sciences, Delhi, India
Title:
Effect of Sahaja yoga meditation on auditory evoked potentials (AEP) and visual contrast sensitivity (VCS) in epileptics
Source:
Applied Psychophysiology & Biofeedback. 25(1):1-12, 2000
Type of study:
randomized, controlled clinical trial
Control/comparison:
group 2 practiced postural exercises mimicking the meditation twice daily for 6 months; group 3 was a control group that did not perform any exercises
Sample characteristics:
32 patients with idiopathic epilepsy on regular and maintained antiepileptic medication
Type of intervention:
group1 practiced Sahaja yoga twice daily for 6 months under proper guidance
Primary outcome measure(s):
Visual Contrast Sensitivity (VCS), Auditory Evoked Potentials (AEP), Brainstem Auditory Evoked Potentials (BAEP), and Mid Latency Responses (MLR) were recorded initially and at 3 and 6 months
Outcome:
There was a significant improvement in VCS following meditation practice for the group 1 participants. A specific peak of MLR also significantly increased in amplitude. The researchers noted that the Sadhaja Yoga meditation helps reduce stress levels, which may make patients more responsive to specific stimuli. The results of this study indicate that Sadhaja Yoga meditation may bring about changes in some of the electrophysiological responses studied in epileptic patients.

Author(s):
Ramaratnam S, Sridharan K
Institution:
Department of Neurology, Apollo Hospital, Tamil Nadu, India, 600006. rsridharan@vsnl.com
Title:
Yoga for epilepsy
Source:
Cochrane Database of Systematic Reviews. (3): CD001524, 2000
Type of study:
review (54 references)
Control/comparison:
not applicable
Sample characteristics:
not applicable
Type of intervention:
not applicable
Primary outcome measure(s):
not applicable
Outcome:
An extensive search for randomized control studies of the effects of yoga on epileptic seizures yielded only one trial that met the criteria of more than 50% reduction in seizure frequency or seizure duration. While this trial showed positive results, reviewers concluded that further studies with a larger population are needed to support the effectiveness of yoga in the treatment of epilepsy.
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Content last modified on Apr 25, 2011