Alternative approaches to epilepsy treatment

Complementary and alternative medicine (CAM) is a diverse group of health care practices and products that fall outside the realm of traditional Western medical theory and practice and that are used to complement or replace conventional medical therapies. The use of CAM has increased over the past two decades, and surveys have shown that up to 44% of patients with epilepsy are using some form of CAM treatment. This article reviews the CAM modalities of meditation, yoga, relaxation techniques, biofeedback, nutritional and herbal supplements, dietary measures, chiropractic care, acupuncture, Reiki, and homeopathy and what is known about their potential efficacy in patients with epilepsy.     

Use of complementary and alternative medicine in epilepsy

Complementary and alternative medicine (CAM) has become much in vogue, and CAM practitioners have increased in tandem with this. The trend of using CAM for treating epilepsy does not differ from that in other medical conditions, with nearly one half of patients using CAM. In this article we review the major complementary and alternative medicines used for treatment of epilepsy. They include mind-body medicines such as reiki and yoga; biologic-based medicine such as herbal remedies, dietary supplements, and homeopathy; and manipulative-based medicine such as chiropractic. In the available literature, there is a sense of the merit of these therapies in epilepsy, but there is a paucity of research in these areas. Individualized therapies such as homeopathy and reiki cannot be compared with medicines in a conventional pharmaceutical model. Hence, many studies are inconclusive. In a science of double-blind, randomized controlled trials, appropriate designs and outcome measurements need to be tailored to CAM. This article explains the principles of the major CAM therapies in epilepsy, and discusses peer-reviewed literature where available. More effort needs to be put into future trials, with the assistance of qualified CAM professionals to ensure conformation to their therapeutic principles.     

Survey of public awareness, attitudes, and understanding toward epilepsy in Nhan Chinh, Hanoi, Vietnam, in 2003

PURPOSE: Many studies have shown that cultural and social awareness of, attitudes toward, and knowledge about epilepsy can have an impact on the acceptance of treatment. The aim of this study is to characterize public awareness of attitudes toward and understanding of epilepsy in a Vietnamese community and to compare results with those obtained in other cultures. METHODS: A survey concerning the knowledge, attitudes, and practices of Vietnamese people with respect to epilepsy was carried out in the Nhan Chinh precinct of Hanoi. One thousand people were randomly selected for face-to-face interviews regarding epilepsy. RESULTS: Of the subjects surveyed, 54.6% had heard of epilepsy; 45.5% knew someone with epilepsy; 49.2% had witnessed an epileptic seizure; 56% would not allow their son or daughter to marry someone with epilepsy; 42.1% did not believe that epileptic patients could hold down a normal job; 77.8% believed that epilepsy is an organic disorder of the brain; 23.8% thought that epilepsy is a form of dementia; and 91% thought that epileptic patients require medical care. CONCLUSION: As compared with surveys conducted in other countries, our survey showed that the awareness of epilepsy in this Vietnamese community is limited, and gives rise to alternative attitudes and practices.     

Caregiver-reported religious beliefs and complementary and alternative medicine use among children admitted to an epilepsy monitoring unit

Complementary and alternative medicine (CAM) includes a wide range of practices and products that are generally outside the use of conventional medicine as practiced in Western cultures. Use of CAM in persons with epilepsy is high, even compared to individuals with other chronic health conditions. In this study, we surveyed caregivers of children admitted to a regional epilepsy monitoring unit (EMU) in the southeast United States to assess CAM use among patients (N = 225). Thirteen percent of respondents indicated current use of CAM by their child, 16% reported past use, and 43% reported interest in future use, most commonly in marijuana as a potential treatment (23%). Over 25% of respondents expressed interest in CAM use related to side effects of anti-epileptic medications. Regarding prayer as a form of CAM, a large majority of respondents in this sample identified as Christian and actively prayed for their child's illness, revealing a high prevalence of spiritual practices in this population. Eighty-one percent of respondents reported that they had not discussed CAM use with their doctor. Discussing CAM use with a health care provider was significantly related to past CAM use (p < .02), but not current use or willingness to try CAM in the future (p > .05). These results have important implications for future practice and support increased communication and patient education, as many anti-epileptic medications interact with certain herbs and supplements, posing a potential health risk and treatment barrier in this population.     

Use of Alternative Medicine by Patients with Epilepsy: A Survey of 265 Epileptic Patients in a Developing Country

Summary: We evaluated the use of alternative treatment methods, in various forms, by epileptic patients who had used these forms of treatment before seeking hospital treatment. Among the 265 epileptic patients, 47.6% used African traditional medicine alone: 24.1% combined traditional medicine with spiritual healing, 20.4% used spiritual healing alone, and 7.5% used other forms of alternative medicine. Patients used the alternative treatments for <1 year to >5years before seeking hospital treatment, presumably when alternative medicine failed to control seizures. Relatives, friends, and neighbors had marked influence on the health-seeking behavior of these epileptic patients: 86% of them were influenced to use alternative medicine. After initiation of hospital treatment, only 14.6% of patients who had earlier used African traditional medicine continued with such treatment; more than two thirds of the patients who had earlier used spiritual healing continued using such treatment, suggesting that many of these patients perceived some continuing benefits from these alternative treatments. This observation suggests that alternative medicine, especially spiritual healing, cannot be considered irrelevant in management of epilepsy in Africa. Further investigations are required to determine the efficacy, supportive role, and limitation of alternative medicine in management of epilepsy in developing countries.     

Patient perspectives on epilepsy in a developing country

Adolescent and adult epileptic patients attending the Neurological Clinics at the Lagos University Teaching Hospital were interviewed to assess patient perspectives of epilepsy. Although all of them admitted to having recurrent seizures, 35.9% did not accept that they had epilepsy. Among those who accepted the diagnosis, only 34.5% were willing to disclose it to other people. The majority thought that people generally fear epilepsy and avoid contact with epileptic patients. Most of the patients did not know the causes of epilepsy. The majority, however, had many positive views on epilepsy and favorable attitudes toward other epileptic patients. Although many of them rated epileptic persons lower than nonepileptic persons with respect to contribution to society, hard work, temperament, and ability to make close friends, a majority thought that epileptic patients were not disabled and had the same intelligence, ambition, and ability to be educated as nonepileptic persons. Only 50.4% of them thought epileptic persons should not drive motor vehicles, and 19.7% thought epilepsy should be reported to the licensing authority. On their treatment 62.4% were satisfied with medical treatment alone, whereas 32.5% combined medical treatment with "native medicine" or spiritual church healing.     

Legal Implications of Epilepsy

Summary: Physicians who care for patients with epilepsy may function as agents or targets of social control. As agents, they may assist in the identification and control of epileptic drivers, may provide information that enables fair and appropriate job placements for epileptic persons, and give testimony that helps the legal system resolve issues relating to the liability of epileptic persons for harm attributed to seizures or interictal behavioral disturbances. As targets, they may be charged with negligent failure to diagnose, treat, or inform about epilepsy or its associated problems, with failure to exercise due care in protecting persons harmed by their patients, or with failure to preserve confidentiality of medical information. Although legislation and judicial decisions have defined some of the physician's legal duties with reasonable clarity, areas of uncertainty remain, particularly regarding the issue of violating medical confidentiality for the benefit of persons other than the patient.     

Predictors of Intractable Childhood Epilepsy

Our study sought to identify early predictive factors of medically intractable childhood epilepsy. A cohort of epileptic children from the city of Mersin was retrospectively investigated. All patients received care from the same Department of Pediatric Neurology. The epileptic cohort was divided into a drug-responsive epilepsy group and an intractable epilepsy group. Intractable epilepsy is defined as continued seizures in children despite adequate therapy with two or more antiepileptic drugs for more than 18 months. Strong univariate association was observed between intractability and several factors: age of onset, high initial seizure frequency, symptomatic etiology, mixed seizure types, previous history of status epilepticus, febrile and neonatal seizures, mental and motor developmental delay, multiple seizures in 1 day, electroencephalogram abnormalities, magnetic resonance imaging findings, and specific epileptic syndromes. Logistic regression analysis revealed that a previous history of epilepticus status, abnormal electroencephalogram results, and multiple seizures in 1 day comprise independent predictors of medically intractable childhood epilepsy. We suggest that medical intractability in childhood epilepsy can be predicted by monitoring these factors. Along with early prediction, alternative therapies may be designed to provide patients better seizure control and quality of life.     

Music and healing in cancer care: A survey of supportive care providers

This paper explores the role of music activity and music therapy in health care drawing on a survey of UK cancer care providers offering music interventions and music therapy. The survey examined the extent and type of music provision and explored providers’ views about the role and contribution of music and music therapy in healing. As well as music, the survey organisations offered a range of supportive therapies including complementary and alternative therapies (CAM) and creative therapies such as art therapy. The results provide insight into the way in which music and creative therapies are viewed by those responsible for care provision in this sector. The data point towards some of the challenges facing music therapists in the changing world of cancer care. These include responding to changes arising from developments in treatment and the organisation of care as well as increased collaboration with a diverse range of supportive care practitioners. These include providers of music and arts for health activity as well as complementary and alternative therapy practitioners who are increasingly involved in cancer care provision. We discuss the implications of these changes for the development of music therapy in cancer care.     

Attitudes and practices of families and health care personnel toward children with epilepsy in Kilifi, Kenya

PURPOSE: Epilepsy is common in underresourced countries, where most people with epilepsy do not take antiepileptic drugs (AEDs). This underutilization, referred to as the treatment gap, was investigated in Kilifi, Kenya, by exploring the sociocultural context in which children with epilepsy and their families live. This study focused particularly on what effect attitudes and practices might have on service utilization, particularly the use of AEDs. METHODS: Attitudes and practices toward children with epilepsy were examined using qualitative data collection methods, namely, interviews, focus group discussions, group activities, and observations. These were carried out with children diagnosed as having active epilepsy, their parents, their grandparents, and health care personnel. RESULTS: The responses illustrate both positive and negative attitudes, underpinning a wide variety of practices toward children with epilepsy. They also indicate the use of several types of services that vary between the traditional, medical, educational, and religious. The choice of these services was affected by different socioeconomic factors, the complex interrelationship of which offers some explanation for the underutilization of AEDs. CONCLUSIONS: The treatment gap may be explained by a "health versus sickness" model, accounting for families' health-seeking behavior in relation to their perception of cause and treatment. In this model, occasional convulsions associated with fever in younger children are placed in the "health sphere," making recommendations of regular and continued medication illogical for what is perceived to be a healthy child. When seizures persist beyond a certain age, the child is placed in the "sickness sphere," meaning that the child is incurable and treatment attempts are futile. Better levels of understanding and information sharing among children with epilepsy, their families, and health care personnel are required to improve use of medical services. Possible interventions include community-based services and health education programs for the community and service providers.     

Complementary and alternative medicine and multiple sclerosis

Complementary and alternative medicine (CAM) is used by one-half to three-fourths of multiple sclerosis (MS) patients. Although it is used widely, CAM may not be discussed during a conventional medical visit. In MS, CAM therapies exhibit a broad range of risk-benefit profiles; some of these therapies are low risk and possibly beneficial, whereas others are ineffective, dangerous, or unstudied. Health professionals who provide objective and practical information about the risks and benefits of CAM therapies may improve the quality of care for those with MS.     

The relationship between epilepsy and religiosity illustrated by the story of the visionary mystic Wise-Knut

The story of Wise-Knut is remarkable. He was born in a poor mountain district in Norway in 1792 and lived for 84 years. He had severe and untreated epilepsy with apparent ictal, postictal, and interictal religious symptoms. He heard voices and had religious delusions; a spiritual awakening after a seizure cluster was a turning point in his life. Contemporary biographers have narrated his major life events in detail, but without a precise separation between ictal and postictal spiritual symptoms. Religious and supernatural significance was attributed to his experiences; he himself believed that his extraordinary abilities were a gift from God: “The prophets have had it like myself.” His story corroborates the impression that epilepsy may have had a considerable role in the history of religions.However, apart from anecdotes on visionary and healing abilities, his biographies contain nothing that is miraculous or incredible. He falls into the line of various mystics and religious figures of the past that are currently thought to have had epilepsy. Apparently, the advancing understanding of epilepsy and its complications have influenced the dynamic balance between faith, superstition, and rationalism.     

Spirituality, environmental consciousness, and health awareness and use of complementary and alternative medicine

Context Complementary and alternative medicine (CAM) refers to a wide range of disease-treating and preventive therapies that are not considered traditional or conventional by biomedical standards. Research suggests that CAM use is increasing. Understanding lifestyle differences based on level of CAM use may be important knowledge for health-care providers. Objectives To understand the relationship between level of CAM use (high, medium, or low) and three lifestyle factors-spirituality (ie, a sense of fulfillment from being spiritual), environmental consciousness (ie, a concern for the environment), and health awareness (ie, monitoring the nutritional value of food). Design Participants completed the Perspectives on the Use in Communities of CAM questionnaire (Robinson et al, 2007), which measures levels of spirituality, environmental consciousness, and health awareness among CAM users. Participants also rated their frequency of CAM use across a wide array of CAM practices. The authors calculated total CAM use by summing the frequency of use of 28 CAM therapies, and they grouped individuals into three categories of usage: low (n = 42), medium (n = 108), and high (n = 40). They then examined the relationships between the use categories and the three lifestyle categories. Setting The study occurred at a midsized Midwestern university, the University of South Dakota. Participants Participants included 131 female and 59 male college students (young adults). Outcome Measures The authors performed a multivariate analysis of variance (MANOVA) with three dependent variables: spirituality, environmental consciousness, and health awareness. The independent variable was level of CAM use. Results MANOVAs indicated significant main effects, suggesting changes in lifestyle practices based on level of CAM use, Wilks' Λ criterion: F(6, 368) = 5.54, P < .001, R2 = .16. Follow-up results and planned pairwise comparisons suggest that level of CAM use affected all three lifestyle practices. Moreover, unexpected results demonstrated that as the level of CAM use increased from medium to high, health awareness also increased. All post-hoc tests used Bonferroni corrected alpha levels. Conclusion The results suggest that as CAM use increases, positive lifestyle factors increase. These findings highlight the importance of CAM use as a method of increasing overall health as well as improving practitioners' understanding of and ability to assist patients in increasing overall well-being through nontraditional or nonconventional means. (Adv Mind Body Med. 2012;26(1):8-12.).     

Effects of religiosity and religious coping on medication adherence and quality of life among people with epilepsy

The epidemiologic information demonstrates the importance of caring people with epilepsy (PWE). Indeed, the impaired quality of life (QoL) and medication nonadherence rate among PWE have been reported. However, religiosity and religious coping could be potential factors for clinicians to foster appropriate intervention on epileptic care. This study investigated two models to further understand the relationships between religiosity, religious coping (including positive and negative coping), medication adherence, and QoL in an Iranian sample with epilepsy. Eligible PWE (n = 760) completed the religiosity scale (Duke University Religion Index; DUREL) at baseline; the religious coping scale (Brief Religious Coping Scale; Brief RCOPE) one month later; the medication adherence scale (Medication Adherence Report Scale; MARS-5) two months later; and the QoL scale (Quality of Life in Epilepsy; QOLIE-31) twelve months later. Their antiepileptic drug serum level was measured during the period they completed the MARS. Through structural equation modeling (SEM), we found that religiosity directly correlated with negative religious coping and medication adherence, and indirectly correlated with medication adherence through negative religious coping. Both positive and negative religious coping directly correlated with medication adherence and QoL. Therefore, religiosity and religious coping may be determinants of medication adherence and QoL in PWE; health professionals may consider asking PWE if religion is important to them and how they use it to cope with their epilepsy.     

Knowledge of,perceptions of,attitudes and practices regarding epilepsy among medical students in Turkey

PurposeMedical practitioners' attitudes have a significant impact on the quality of care for patients with epilepsy. This study was conducted to assess the current level of knowledge about epilepsy and treatment together with attitudes and perception toward patients with epilepsy among medical students in Turkey.MethodThe study was conducted using a structured questionnaire to assess knowledge, awareness, and practices about epilepsy among medical students at Selçuk University, Konya, Turkey.ResultsEight hundred and ninety subjects were interviewed, and 73.5% reported their awareness about epilepsy. Of these, 38.1% knew someone who had epilepsy, and 38.5% had witnessed an epileptic seizure. Although most of the students had heard about epilepsy, 38.4% of the students believed that epilepsy was primarily a genetic disease. About one-fifth of the students attributed the causes of epilepsy to vitamin deficiency (8.8%) and psychiatric (19.1%), infectious (19.5%), mental (4.4%), and hematological disorders (3.4%). According to 4.8% of the students, epilepsy could be a punishment from God, and 2.1% of students thought that it could be caused by an evil spirit. Eighty-eight percent considered epilepsy as a dangerous disease, and most of them thought that epilepsy is a lifelong condition. Fifty point six percent indicated that putting an object into the patient's mouth to prevent tongue-biting during a seizure is appropriate while 91.9% stated that drug therapy was the only treatment available for epilepsy. The most common negative attitudes toward people with epilepsy were students' objection to marrying someone with epilepsy and patients with epilepsy having children.ConclusionMisconceptions about the causes, treatment, and nature of epilepsy are common among medical students at a Turkish medical school. Negative attitudes toward patients with epilepsy still exist. Medical school training programs should be designed to increase awareness of students about epilepsy.     

Stigma experience of people with epilepsy in Mexico and views of health care providers

Epilepsy is a neurological disorder with neurobiological, cognitive, psychological, and social consequences. Epilepsy stigma is a social determinant of ill health that affects the quality of life of people who suffer from epilepsy and that renders a poor social prognosis even worse than the clinical one. From a phenomenological approach, between January and July 2011, we explored the experience of epilepsy stigma through 25 in-depth qualitative interviews with 10 persons with temporal lobe epilepsy (PWE) (we avoided terms such as “epileptics” or “epileptic patients” because they can be labeling and stigmatizing), 10 carers (CEs) of PWE who attended the epilepsy clinic of the Institute of Neurology and Neurosurgery of Mexico, and 5 physicians specialized in epilepsy. The objective of the study was to identify the following: perceptions that could indicate any form of discrimination due to having epilepsy, reactions of people in front of a person having seizures, and social functioning of PWE since epilepsy onset, particularly their interpersonal relationships and participation in educational or working activities. Through the health providers' narratives, we explored the mainstream care practices, their perspectives on epilepsy, and their views about how the disease should be addressed. Thematic guidelines were elaborated for each type of participant. All information was processed with the use of the computer-assisted data analysis, Atlas.ti5. We made a codification of broad themes that corresponded to the main topics of the interview guidelines and then proceeded to finer categorization to elaborate the analytical categories. Epilepsy was attached to a powerful stereotype that includes notions of contamination, danger, sin, divine punishment, supernatural forces, and madness. Internalized, interpersonal, and institutional stigma prevents PWE from participating in school and employment and reduces their opportunities to establish peer and couple relationships. Mexican's overt impunity of structural discrimination towards PWE shows a lack of available legal resources that protect their human rights. The narrow biomedical concept that physicians have of epilepsy is consistent with the limited medical practices that are offered to treat epilepsy at the health services in Mexico. Comprehensive treatment and integrated services for epilepsy must incorporate psychosocial programs that include epilepsy stigma as a major component of the disease.     

Ethical, legal, and social dimensions of epilepsy genetics

PURPOSE: Emerging genetic information and the availability of genetic testing has the potential to increase understanding of the disease and improve clinical management of some types of epilepsy. However, genetic testing is also likely to raise significant ethical, legal, and social issues for people with epilepsy, their family members, and their health care providers. We review the genetic and social dimensions of epilepsy relevant to understanding the complex questions raised by epilepsy genetics. METHODS: We reviewed two literatures: (a) research on the genetics of epilepsy, and (b) social science research on the social experience and social consequences of epilepsy. For each, we note key empiric findings and discuss their implications with regard to the consequences of emerging genetic information about epilepsy. We also briefly review available principles and guidelines from professional and advocacy groups that might help to direct efforts to ascertain and address the ethical, legal, and social dimensions of genetic testing for epilepsy. RESULTS: Genetic information about epilepsy may pose significant challenges for people with epilepsy and their family members. Although some general resources are available for navigating this complex new terrain, no guidelines specific to epilepsy have yet been developed to assist people with epilepsy, their family members, or their health care providers. CONCLUSIONS: Research is needed on the ethical, legal, and social concerns raised by genetic research on epilepsy and the advent of genetic testing. This research should include the perspectives of people with epilepsy and their family members, as well as those of health care professionals, policymakers, and bioethicists.     

What I learnt from studying epilepsy: epileptology and myself

My life work with epilepsy has allowed me to learn a great deal. As an old soldier, I would like to give an account of some important milestones in my lifetime learning. The first factor that linked me to epilepsy was listening to a lecture delivered by Dr Yushi Uchimura on 'The pathogenesis of Ammon's horn sclerosis' at a conference of the Japanese Society of Neurology (now Japanese Society of Psychiatry and Neurology) in 1928 when I was a 4th year medical student at Tokyo University. The following year, I started to study under Dr Uchimura at the Department of Psychiatry, Hokkaido University School of Medicine. Another factor that linked me to clinical care and research of epilepsy as a psychiatrist was my encounter with the two volumes of 'Selected Writing of John Hughlings Jackson' edited by J. Taylor. Jackson's greatest asset and contribution to modern epileptology include (i) the discovery of 'Jacksonian epilepsy', (ii) 'conceptual revolution of epilepsy' by recognizing transient mental disorders as seizures, (iii) modern definition of epilepsy by defining epileptic seizures as discharges in the gray matter, and (iv) discovery of 'new epilepsy' (now temporal lobe epilepsy). In 1940, I reported clinical courses indistinguishable from schizophrenia in epilepsy cases. Through my studies, I disputed the then prevailing interpretation of this condition as epilepsy complicating schizophrenia, and proved that these cases were in fact epileptic mental disorders caused by epilepsy. Many patients with epilepsy require medical care as well as rehabilitation and welfare support. We need to further promote the facilities for rehabilitation and employment in the community for persons with epilepsy, such as co-operatives and welfare worksites. The issues that epileptology and epilepsy face in the 21st century is to realize the goals of liberating epilepsy from social stigma and protecting all the citizen's rights for persons with epilepsy.     

A caregiver perspective of complementary and alternative medicine use among patients with schizophrenia and bipolar disorders

The World Health Organization estimates that about 40%–60% of patients with mental illness use Complementary and Alternative Medicine (CAM), but little is known about the types and outcomes of these CAM therapies in Ghana. This study therefore sought to describe the patterns of use and perceived outcome of CAM therapy among patients with schizophrenia and bipolar disorders in a health facility in Ghana. The qualitative study involved both clinical and family caregivers of patients with schizophrenia and bipolar disorders. Semi-structured interviews were conducted over a period of 3 months to identify the pattern of CAM use and perceived outcome from caregiver perspectives. The interviews were audio recorded, transcribed and analyzed thematically using NVivo 10. About 92% of family caregivers reported that their patients had used some form of CAM therapy. The therapies used included spiritual interventions (100%) herbal therapies (83%), dietary supplements (50%) and music therapies (6%). Both clinical and family caregivers perceived CAM therapies to be ineffective in resolving mental illness when used as an alternative to antipsychotic therapy. However when used as complementary, better outcomes were perceived. Spiritual interventions, herbal therapies, dietary supplements and music therapies were the types of CAM therapies used. Both negative and positive outcomes of CAM therapies were highlighted by caregivers. CAM use may therefore not be an alternative choice but rather complementary to mental health care.