4/02/2012

Complementary and Alternative Therapies for Epilepsy Review

Complementary and Alternative Therapies for Epilepsy
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I am a physician with a personal interest in epilepsy. To read about complementary and alternative therapies for epilepsy in a medical text that is edited by recognized experts has been a real joy. They have done us all a great service by presenting the information in a respectful but scientifically critical manner.
This book should be on every neurologist's shelf. It should also be on the shelf of all other physician practitioners that treat epilepsy. Drs. Devinsky, Schachter and Pacia have produced a work that is long overdue.
Treating epilepsy can be frustrating since traditional medicine is not always successful in delivering the ideal result (no seizures and no side effects). Patients in desperation are looking for something that will work. Some patients may just want another option because of any one of a number of reasons including fear of potential long-term side effects of medications, or because they harbor a general mistrust of modern medicine for example.
With the advent of the Internet, patients and their families are discovering that there are options available which their physicians have not told them about. Some of the options may have merit and some may not. Most patients do not have the medical sophistication to tell the difference. Many doctors do not have the time or the interest to find out. The problem is that when patients go to their physicians with their new-found knowledge, and they are met with total ignorance, indifference or worse yet, arrogance, the physicians immediately lose credibility with their patients.
By reading and understanding this book that covers a broad range of "alternative and complementary therapies for epilepsy," physicians will be able to better understand what their patients are talking about and will be able to speak with knowledge and credibility when these ideas are brought up by patients. Having this knowledge will also prompt physicians during the intake interviews to ask if any of these alternative approaches are being used. That information may help with drug dosages (some herbs or supplements can affect enzyme induction) and help to explain treatment failure.
Medical practices that serve many well informed patients may see increasing numbers of people asking about these things. That type of patient is expecting more than just a prescription refill and a follow-up in 3-6 months. It could be that some physicians will suggest some of these ideas on their own if they seem right for a particular patient. Spending the extra time and effort may be hard to do because physicians are pushed harder and harder to do more and more in less time, and most practices don't have time during a visit to do more than just the basics. Just the same some people are expecting more.
The chapters are generally concise and mostly well referenced and are organized in a very interesting fashion; an expert that champions a particular form of alternative or complementary therapy writes the chapter, and the editors in a very respectful fashion make comments on the ideas presented. They often point out how well the available scientific evidence may or may not support the assertions of the chapter authors. The editors' comments range from very encouraging to highly doubtful, especially when judged by the standard of the double-blind study.
Chapter contents include: 1) Relation of Complementary and Alternative Therapies for Epilepsy to Western Medicine, 2) The standards for clinical trials to prove effectiveness of a therapy (the Double Blind trial), 3 Treating epilepsy with stress reduction, 4) The neurobehavioral approach, 5) Self control, eliminating triggers etc., 6) Neurofeedback, 7) Autogenic training, 8) Massage, 9) Aromatherapy and Hypnosis, 10) Meditation, 11) Exercise and Yoga, 12) Ayurveda, 13) Herbal therapy, 14) Phytotherapy (more herbal therapy), 15) Homeopathy, 16) Naturopathic Medicine, 17) Traditional Chinese Medicine, 18) Acupuncture, 19) Nutrition, 20) Fatty acids in the diet, 21) The Ketogenic diet, 22) Hormonal therapy, 23) Trancranial magnetic stimulation, 24) Hyperbaric oxygen, 25) Rebreathing to use CO2 to dilate cerebral vessels to increase cerebral oxygen delivery, 26) Chiropractic, 27) Osteopathic Approach, 28) Craniosacral Therapy, 29) Music Therapy, 30) Art Therapy, 31) Pet Therapy
Particularly enlightening chapters are numbers12-22, where herbs, vitamins, food supplements and other nutritional approaches are described rather nicely. Two somewhat disturbing chapters for me are the ones on Naturopathic Medicine (16), and the Osteopathic approach in children (27). The part of the naturopathic medicine chapter that disturbs me the most is the philosophy that epilepsy is possibly a result of lifestyle, diet or habits of the individual and can be cured if the practitioner can find the correct cause and effect a change. Fully subscribing to such an approach could lead to spending big bucks on food supplements and other things that have no proven value or could actually complicate standard medical treatment. In spite of that problem, naturopaths have many fascinating ideas that are worthy of further investigation. The Osteopathic chapter is largely anecdotal. The references are quite dated as well. From modalities that purport to be scientifically oriented I expected better.
The greatest value of the book for me is, understanding how others besides those in mainstream medicine think about epilepsy. I highly recommend this book.


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Epilepsy is a difficult illness to control; up to 35% of patients do not respond fully to traditional medical treatments.For this reason, many sufferers choose to rely on or incorporate complementary and alternative medicine (CAM) into their treatment regimens.Written for physicians, knowledgeable laypersons, and other professionals, Complementary and Alternative Therapies for Epilepsy bridges the worlds of traditional medicine and CAM to foster a broader perspective of healthcare for patients.The book respects cultural differences that may incorporate alternative medicine into a medical management program, and encourages patients to safely continue receiving necessary medical treatments. Wherever possible, scientific evidence supports the choice of treatment modalities, as well as the effectiveness of a combined traditional and CAM approach.Readers will find incisive discussions in sections on: Learning to Reduce Seizures Asian, Herbal and Homeopathic Therapies Nutritional Therapies Alternative Medical Therapies Oxygen Therapies Manipulation and Osteopathic Therapies Music, Art, and Pet Therapies
From stress and epilepsy, to acupuncture, massage, craniosacral therapies, homeopathy, ketogenic diets, aromatherapy, hypnosis, and more, the book is all-inclusive and enlightening.Additional commentary by the editors provides a critical vantage point from which to interpret the data and viewpoints of the contributors, all experts in the therapies presented. This balanced, scientific approach will appeal to even those most skeptical of alternative therapies, making the book essential for every professional who seeks to provide the broadest range of effective patient care. (20100503)

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