What Causes Epilepsy?

More than half of all epilepsy cases have no identifiable cause. Head injuries, strokes, or brain infections can sometimes be tied to the remaining cases. Heredity also seems to play a role in predisposing certain individuals to recurring seizures.

Low blood sugar levels (hypoglycemia) and a deficiency in certain nutrients, such as B vitamins or magnesium, can trigger seizures in people with epilepsy. Other factors, such as sleep deprivation, physical stress, illness, or drinking too much alcohol, can induce seizures even in people who don't have epilepsy.

Conventional Treatments

Although there is no cure for epilepsy, seizures can usually be controlled with antiepileptic drugs (AEDs)—Use of this acronym when discussing the subject of epilepsy or seizures, should not to be confused with the use of the acronym when referring to automated external defibrillators, commonly found in office buildings, airports and shopping malls, to treat cardiac arrests. Children who have absence seizures often outgrow them as they reach their late teens and early twenties. Adults with other types of epilepsy are often able to stop taking anticonvulsant medications after they have been seizure-free for two to five years. While not a substitute for prescription medications, supplements may also help control seizures and may eventually allow a doctor to reduce the dosage of anticonvulsant drugs.

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Medications

A large number of conventional anticonvulsant medications are available for use singly or in combination on a daily basis to prevent or reduce the frequency of seizures. The anticonvulsant properties of some benzodiazepine derivative drugs, such as diazepam, also can be used to stop active seizures. The specific AED therapy plan used depends upon the types of seizures being treated. Within the two broad categories of seizures -- generalized and partial -- are subcategories that describe the state of the patient during a seizure. Simple partial seizure (SPS) describes a seizure during which consciousness is not altered. With loss of consciousness, it is a complex partial seizure (CPS). A partial seizure can also evolve into a generalized seizure (with full-body loss of control and shaking) and is called a secondarily generalized seizure. Patients can also experience a combination of these seizure types. Several additional individual factors are considered when determining a treatment plan for AED therapy, including drug effectiveness for the seizure type, potential adverse effects of the drug, interactions with other medications or medical conditions, and lifestyle and patient preferences.

About half of epileptic patients experience success with the first AED prescribed. (1, 2) In patients who experience adverse effects from the first drug trial, about half will have success with a second drug trial; but only about 10% to 20% will have a successful second drug trial if the original failure was due to a lack of efficacy. (3) To note, the risk of adverse effects increases with each subsequent drug trial. Of particular concern is an increased risk of self-harm or suicide associated with AED therapy in patients with epilepsy, which the U.S. Food and Drug Administration reported in 2008. (4) Patients experiencing any signs of depression, anxiety, or suicidal thoughts while taking AEDs; or whose family notices these symptoms, should seek medical or mental health assistance promptly. Overall, up to 80% of patients can become seizure-free on AED treatment. (5-7) Alternative therapies can be useful in conjunction with AED therapy, particularly in patients who do not respond to conventional therapy.

Many AEDs can cause birth defects and also can interfere with the activity of oral contraceptives; so women of childbearing potential need to be extra cautious. Consult a neurologist and an obstetrician to discuss the risks and benefits of various birth control alternatives and seizure medications.

Tests and Procedures

An electroencephalogram (EEG), computerized tomography (CT) scan, or a magnetic resonance imaging (MRI) scan may be necessary to help diagnose epilepsy and rule out other underlying conditions. In cases that do not respond to AEDs, surgery may be considered. Two types of brain surgery--disconnection and resection--are used to treat epilepsy. Disconnection surgery involves interrupting nerve pathways that allow seizures to begin and to spread. It often provides relief from seizures, but it is not a permanent cure. In resective (cutting out) surgery, such as a temporal lobectomy, the area of the brain where the seizures begin is removed. Resective surgery has been shown to provide long-term relief (up to ten years) from seizures in patients with refractory epilepsy, the type that cannot be controlled with medication. A long-term study published in the Lancet in 2011 found that 52% percent of patients with refractory epilepsy were free of major seizures five years after resective surgery, and 47% were free of them ten years after surgery. About 30% of participants no longer needed medication to control seizures after resective surgery. (8)

Another option for patients with refractory epilepsy is called Vagus Nerve Stimulation (VNS). This involves implanting a pacemaker-like device in the chest. The device relays mild pulses of electricity to the vagus nerve, which travels between the brain and abdomen. Electrical signals traveling upward along the vagus influence several areas of the brain. VNS devices are approved by the FDA, although the exact mechanism by which VNS reduces seizures remains unknown. Most patients experience a reduction in seizure activity; however it varies with type of seizure and prior treatment. Many also experience improved quality of life independent of the amount of seizure reduction. (47)

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Treatment and Prevention

Treatment is aimed at stopping seizures, minimizing side effects from drug treatment, and restoring a patient's quality of life. While epilepsy cannot be prevented or cured, it can be treated very effectively with prescription AEDs. In fact, some patients eventually reach the point where they stop having seizures and no longer require medication (but do not stop taking medications without consulting a physician). Taking certain supplements and avoiding food chemical triggers may help some people. This approach is directed at correcting nutritional imbalances that may trigger seizures and at promoting brain and nerve health. A ketogenic diet, a special high-fat, low-carbohydrate diet, is also helpful for some people. (9) Do not use diet or supplements, however, as a substitute for anticonvulsant drugs.

Those who are being treated for epilepsy (or any other serious medical or psychological condition) should consult a doctor before taking supplements and should never stop taking prescribed medications or reduce the dosage on their own. If seizures began after a head or spinal injury, evaluation and treatment from an osteopathic physician (D.O.) specially trained in a form of neck and skull manipulation called cranial osteopathy may lead to a reduction in the frequency and intensity of seizures. Acupuncture, biofeedback, homeopathy, and massage therapy may also be helpful.

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How Supplements Can Help

The B vitamins, especially vitamin B6 and folic acid, play an important role in the production of neurotransmitters; brain chemicals that help transmit nerve impulses. Because B vitamins are most effective in combination, taking them in the form of a vitamin B complex supplement is recommended. Studies also show that folic acid supplementation (up to doses as high as 15 mg/day) is important for women and men receiving AEDs because many lower homocysteine levels, a risk factor for cardiac disease when using the medication. (10) A 2012 study found that taking folate and B vitamins in conjunction with conventional AEDs is a safe, effective, and inexpensive way to lower homocysteine levels. (11) Some newborns and infants younger than 18 months are susceptible to low levels of pyridoxine-related (vitamin B6) seizures, as a result of genetic pyridoxine dependence, use of high doses of vitamin B6 in pregnancy, or infections. For those children with low vitamin B6-related seizures that are resistant to conventional anticonvulsants, continuous high-dose, supplementation of 25 to 100 milligrams of vitamin B6 given intravenously daily is recommended. (12-15) High-dose supplementation has been shown to stop seizures within two to six minutes after being administered. (16) However, the maintenance dosage needed to prevent recurrence is unclear. Dosages have ranged from 10 to 200 milligrams per day.

Calcium and magnesium both foster brain and nerve health. Preliminary results indicate antiepileptic medications may lower magnesium levels, which can lead to seizures. (17) Those who are diagnosed with a seizure disorder or who are taking anticonvulsant medication can get the basic amounts needed by taking a broad-spectrum daily multivitamin and mineral supplement. Two uncontrolled trials have shown magnesium to be of benefit in controlling seizures, though scientists are not sure of the mechanism of action. (18, 19) A 2009 review of studies suggests the anti-seizure mechanism of magnesium is likely to be a combination of several actions, including relaxation of blood vessels to improve blood flow in the brain and protection of the blood-brain barrier, a layer of cells around the brain that prevent some materials from passing between the brain and the bloodstream. (20) Early evidence shows that magnesium supplementation may increase the efficacy of conventional antiepileptic drugs like valproate. (21)

Preliminary evidence involving calcium indicates that supplementation may help to control seizures that result from sudden declines in blood calcium levels. (22) However, scientific studies are limited. More research is needed.

A deficiency of GABA (a brain chemical) seems to play a role in triggering seizures. Supplementation with the amino acid GABA (gamma-aminobutyric acid) or with taurine, an amino acid derivative, may prevent seizures in epilepsy. Taurine apparently duplicates the action of GABA in the body, so supplementing with only one or the other may be beneficial. In two separate studies, daily oral doses of 0.05 to 0.3 grams per kilogram or of 750 milligrams of taurine, respectively, decreased seizures by more than 30% in 11 of 34 patients who were unresponsive to any other anticonvulsants. (23, 24) Several studies in mice have shown that taurine supplementation protects against brain damage from seizures and may help to prevent seizures. These results seem to be related to taurine's effect on GABA receptors. (25-28) In a 2010 study, mice that were fed taurine 15 minutes prior to an injection that induced seizures had a significant delay in seizure onset and a decrease in the number of seizures. Taurine-fed mice also had a significantly reduced mortality rate compared to controls. (28) More human studies are needed. Preliminary results have been conflicting on the use of GABA. A 1994 pilot study found GABA supplementation had no benefit in epileptic patients whose seizures were set off by exposure to flashes of light. (29) Earlier studies reported that GABA helped people with various types of epilepsy who did not respond to conventional medicines. Consult a doctor before taking GABA, which can also have a tranquilizing effect. If taking taurine for longer than a month, add a mixed amino acid supplement to ensure a proper balance of amino acids.

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Self-Care Remedies

Lack of sleep and fatigue can induce seizures. Make a point of getting enough sleep every night.

Because it can interfere with anticonvulsant drugs and may even lead to seizures, stay away from alcohol.

Cut down on chemically treated products, including foods with artificial colorings and sweeteners and preservatives. Some people with chronic seizures are unusually sensitive to chemical triggers.

If you are with someone who is having a seizure, do not restrain the person or place a gag or anything else in his or her mouth. Try to cushion the person's fall and clear away any sharp or hard objects that could cause injury. When the seizure has ended, roll the person on their side to prevent possible choking.

Alternative Therapies

According to a 2005 study by the Neuropathy Center of Dallas, it is possible through EEG biofeedback, to train the brain to de-emphasize the rhythms that lead to generation and spread of seizures and to emphasize rhythms that make seizures less likely to occur. Biofeedback, therefore, might be beneficial in the treatment of epilepsy, particularly in children. (30) Two reviews of studies found research that supports the use of biofeedback to treat epilepsy as a viable alternative to conventional treatment. The studies showed that biofeedback significantly decreases the incidence of seizures, particularly in patients with refractory epilepsy. (31, 32)

Anecdotal reports suggest that some children with epilepsy have fewer seizures after chiropractic manipulation of upper cervical vertebrae. A review of literature from 1996 to 2000 regarding chiropractic care for epileptic children found that 14 out of 17 patients who did not respond to anticonvulsive medications reported positive outcomes as a result of chiropractic care. (33)

Some anecdotal evidence also indicates acupuncture may be effective in treating epilepsy; although, two sham-controlled studies by same research group found no benefit. (34) However, while acupuncture did not seem to improve seizure frequency, a separate analysis of the participants found that many patients reported improvements in their sense of well-being after acupuncture. (35) Studies have been inconclusive. A 2008 Cochrane Database review found conflicting evidence and did not support acupuncture for epilepsy. (36)

Yoga may be useful as an adjunctive therapy. (37, 38) In a preliminary study of 20 patients with refractory epilepsy, two 20-minute sessions of yoga meditation daily for 12 weeks significantly reduced the frequency of seizures. (Six patients reported a 50% or greater reduction in the frequency of seizures.) Of patients who continued the yoga practice beyond the initial 12-week trial period, six patients were seizure-free for three additional months, and three patients remained seizure-free after an additional six months of treatment. (37) More research is needed to confirm or refute these preliminary findings.

Aromatherapy has shown some efficacy in preventing seizures. In one of the earliest studies regarding aromatherapy to treat epilepsy, jasmine aroma seemed to prevent an oncoming seizure, and after time, the memory of the fragrance was enough to prevent a seizure. (39) In a two-year follow-up study in England in 2003, 100 patients with refractory epilepsy received treatment that involved aromatherapy massage, aromatherapy massage plus hypnosis, or hypnosis alone. Treatment with aromatherapy plus hypnosis had the best and most lasting effect, with one-third of patients still seizure-free after two years. (40) More research is needed to confirm these preliminary findings.

Preliminary evidence indicates that reiki may help to prevent seizures in epilepsy. Practitioners believe this technique, which channels healing energy from the practitioner's hands to the patient, works through the fifth chakra, the major energetic center triggering seizures. (41) In a 2003 study of 15 patients with refractory epilepsy, the frequency of seizures was significantly reduced after three months of treatment. (42) However, research is limited. More studies are needed.

In homeopathy, a 200 year old system of medicine that originated in German, highly dilute doses of medicines are chosen to match an individual patient's complete set of symptoms. Homeopathy has been used to treat epilepsy, particularly in countries where it is commonly used. Because of the unique nature of each patient's seizure pattern, it would be difficult to study the effectiveness of specific homeopathic remedies in treating epilepsy. The choice of remedy for seizures is best done by an experienced homeopathic practitioner. As an example, a few of the more commonly used homeopathic medicines for epilepsy are listed below. (41, 43-46)

• Silicea (recommended in children and young adults with nighttime symptoms, such as nightmares and spasms, that can lead to seizures
  
  
• Cuprum (recommended for spasms caused by mental or physical overexertion, or as a result of sleep deprivation)
  
  
• Causticum (recommended for patients who experience violent seizures -- thrashing of the arms and legs, often accompanied by screams and constriction of the facial muscles)
  
  
• Hyosyamus (recommended for patients whose seizures are brought on easily, such as after meals, after a fright, after a dream, and after sexual intercourse; and for those who often hallucinate and experience delusions after seizures)
  
  
• Aethusa cynapium (recommended in patients who have food intolerances or allergies, most often to milk)
  
  
• Agaricus muscarius (recommended in patients with seizures from suppressed eruptions, with tremors and weak lower limbs, and those with stiff back muscles associated with twitching and pain)
  
  
• Artemesia absinthium (recommended for alcohol-related seizures
  
  
• Stramonium (recommended for patients with spasms of the neck, upper airway and mouth muscles)
  
  
• Cicuta virosa (recommended when the aura begins in the stomach or head and extends downwards, and for seizures associated with redness of face, blue lips, bloody and foamy mouth, spasms of the jaw, violent stomach spasm, and prolonged loss of consciousness)

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When to Call a Doctor

After suffering a seizure or when experiencing any of the symptoms of a seizure for the first time. (Subsequent seizures usually do not require immediate medical attention, except in the situations listed below.)

When injured in a seizure-related fall

If a seizure is unusually prolonged (lasting for more than five minutes) or if one seizure is followed immediately by another, seek emergency medical assistance without delay.

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