Epilepsy is a brain disorder in which abnormal bursts of electrical activity occur in cells of the brain, resulting in seizures.
There are many types of epilepsy, usually categorized by the symptoms that occur during seizures. The cause of many types of epilepsy is unknown, and frequently no cure is available. Rather, treatment focuses on reducing the frequency and severity of seizures.
What are the symptoms of epilepsy?
There are many types of seizures in epilepsy. They are categorized as either partial or generalized, depending on how much of the brain is involved. Some types of epilepsy involve seizures characterized by convulsive muscle contractions of all or some parts of the body. Other types can involve momentary loss of consciousness, amnesia, unusual sensations or emotions, and other symptoms. Symptoms that indicate an imminent seizure (called auras) may occur. Similarly, non-convulsive symptoms, including deep sleep, headache, confusion, and muscle soreness (called a postictal state), may follow a generalized seizure.
Dietary changes that may be helpful for epilepsy
The ketogenic diet was developed in the early twentieth century when few drug treatments for epilepsy were available; until recently, it had been used only when drug therapy was ineffective. The dietary approach was based on the observation that ketosis (increased blood levels of chemicals called ketones) is associated with reduction of seizures.1 Ketosis can be produced by a diet high in fat and very low in carbohydrate and protein. The ketogenic diet has been evaluated in several preliminary and a few controlled trials. According to a 1996 review, the ketogenic diet appears to be very effective in one-third to one-half of epilepsy cases in children, and partially effective in another one-third of cases.2
Recent trials continue to support this success rate;3 4 5 one preliminary trial demonstrated a 50% reduction in seizure activity in 71% of children in a group after 45 days on the diet. There is little research on the effects of the ketogenic diet in adults, but it may be effective in those who are able to comply with the strict dietary guidelines.6 7 The diet is usually initiated by fasting under close medical supervision, often in a hospital, followed by introduction of the diet and training of the family to ensure successful maintenance.
Possible side effects of the ketogenic diet include gastrointestinal upset, dehydration, anemia, low blood protein levels, high blood levels of fat and acidity, kidney stones, and signs of liver toxicity.8 9 Vitamin and mineral supplementation is necessary due to the many deficiencies of this unusual diet.10 The ketogenic diet should not be attempted without the supervision of a qualified healthcare professional. Practical information about the ketogenic diet is available in recent texts 11 and articles,12 as well as on the Internet.13
Allergic reactions to food have been reported to trigger epileptic seizures in individual cases,14 15 some of which were proven with double-blind testing.16 One report found people with epilepsy to have significantly more biochemical evidence of allergy than do non-epileptics.17 A study of children who suffered from both epilepsy and migraine headaches found that a diet low in potential food allergens reduced seizures in the majority of cases; however, children who had epilepsy alone without migraines did not respond to the diet.18 Another report confirmed that children who have epilepsy without migraines do not improve on a low-allergen diet.19 Some doctors recommend that people with epilepsy and other allergic symptoms, such as asthma or hay fever, should be checked for food allergies that may be causing seizures.20
Nutritional supplements that may be helpful for epilepsy
Vitamin E has been studied as a possible add-on to conventional drug treatment for epilepsy. A double-blind trial found that adding 400 IU per day of vitamin E reduced seizure frequency in children without side effects.21 Other preliminary trials22 23 have reported similar results, and, while some preliminary research suggested this effect might also be achieved in adults,24 a double-blind trial found no effect of vitamin E supplementation on adults with epilepsy.25
Folic acid supplementation (5 mg per day) was reported to reduce epileptic seizure frequency, though the effect was not significantly better than with placebo.26 Folic acid supplementation of as little as 800 mcg per day has also been reported to interfere with the action of anticonvulsant medications, resulting in an increase in the frequency and/or severity of seizures;27 28 29 30 this effect occurs only in a small number of cases.31 32 People taking anticonvulsant medications should consult with the prescribing physician before deciding whether to use folic acid.
Vitamin B6 has been used to treat infants and small children who have seizures related to a genetic enzyme defect.33 34 35 36 However, this condition is not considered true epilepsy, and whether people with epilepsy would benefit from taking vitamin B6 supplements is unknown.
Taurine is an amino acid that is thought to play a role in the electrical activity of the brain; deficits of taurine in the brain have been associated with some types of epilepsy. However, while some short-term studies have suggested that taurine supplementation may reduce epileptic seizures in some people, the effect appears to be only temporary.37
Case reports have suggested that evening primrose oil may worsen symptoms in people with temporal lobe epilepsy.38 Until more is known, people with this type of epilepsy should avoid using evening primrose oil supplements, except perhaps under the supervision of a qualified physician.
In a preliminary study, supplementation with 3.25 grams per day of a mixture of omega-3 fatty acids (primarily eicosapentaenoic acid [EPA] and docosahexaenoic acid [DHA]) for six months markedly reduced the frequency of seizures in five severely retarded epileptic patients.39 Additional research is needed to confirm this report and to identify which people with epilepsy are most likely to benefit.
A small, preliminary trial found that 5 to 10 mg per day of melatonin improved sleep and provided “clear improvement of the seizure situation” among children with one of two rare seizure disorders.40 More research is needed to determine whether or not melatonin could benefit other people with epilepsy.
Two elderly individuals with well-controlled epilepsy reportedly developed recurrent seizures within two weeks of starting Ginkgo biloba extract.41 Individuals with epilepsy should not, therefore, take Ginkgo biloba without medical supervision.
Are there any side effects or interactions with epilepsy?
Refer to the individual supplement for information about any side effects or interactions.
Herbs that may be helpful for epilepsy
The Chinese herb bupleurum is included in two similar Chinese herbal formulae known as sho-saiko-to and saiko-keishi-to; these combinations contain the same herbs but in different proportions. The other ingredients are peony root, pinellia root, cassia bark, ginger root, jujube fruit, Asian ginseng root, Asian scullcap root, and licorice root. Both formulas have been shown in preliminary trials to be helpful for people with epilepsy.42 43 44 No negative interactions with a variety of anticonvulsant drugs were noted in these trials. The usual amount taken of these formulas is 2.5 grams three times per day as capsules or tea. People with epilepsy should not use either formula without first consulting with a healthcare professional.
Are there any side effects or interactions with epilepsy?
Refer to the individual herb for information about any side effects or interactions.