Epilepsy is a brain disorder characterized by short, recurrent, periodic attacks of motor, sensory or psychological malfunction. These attacks, called epileptic seizures, are caused by the abnormal, synchronous electrical discharge of millions of neurons in the brain, perhaps resulting from abnormal reverberating circuits. The incidence of seizure disorders is about 2%, with about 0.5% of those suffering from epilepsy on a regular basis. At least four types of epileptic seizures have been identified: grand mal, temporal lobe, focal and petit mal. Grand mal (tonic-clonic seizure) is characterized by generalized involuntary muscular contraction and cessation of respiration followed by tonic and clonic spasms of the muscles. EEG recordings indicate a high voltage synchronous discharge that occurs over the entire cortex on both sides of the brain, originating in the basal regions of the brain that drive the cortex. The reticular activating system may be temporarily depressed so that the person loses consciousness. The teeth may be clenched, the tongue may be bitten and control of bowel and bladder may be lost. After the seizure consciousness shortly returns and breathing begins with noisy respirations. The person may feel sleepy, fall asleep or experience confusion and has no memory of the episode upon awakening. The prodromal symptoms of grand mal may include auras, as well as unusual odors and sounds.
Temporal lobe (psychomotor seizure) is characterized by psychic symptoms (visual or auditory hallucination, déjà vu), loss of judgment and autonomic behavior, and abnormal activity. Typically, there are no apparent convulsions, but there may be a loss of consciousness or amnesia for the episode. During the seizure the patient may appear drowsy, intoxicated, violent or commit asocial behaviors, but other activities such as driving a car or eating remain unaffected. Psychic symptoms may be accompanied by chest pain, transient respiratory arrest, tachycardia, abnormal taste and/or smell sensations, and GI disturbances. EEG readings during a psychomotor attack show a low frequency rectangular wave with a frequency of between 2 and 4 Hz, superimposed with 14 Hz waves.
Focal epilepsy can involve almost any region of the brain, resulting from localized lesions such as a tumor or damaged neural tissue, or from congenitally deranged circuitry. Such lesions can promote the rapid discharge of local neurons, and when this electrical activity passes a threshold of about 1000 Hz, it begins to spreads to adjacent cortical regions, as slow as a few millimeters per second to as fast as a few centimeters per second. When such a wave progresses over the motor cortex, it often causes a progressive series of muscular contractions throughout the body, while the person remain conscious. It may begin in the fingers and toes and progress upwards, or it may begin in the mouth region and progress downward to the legs. This particular manifestation of progressive muscular contraction is called Jacksonian epilepsy.
Petit mal (absence seizure) is characterized by a sudden momentary loss of consciousness (10-15 seconds), occasionally accompanied by myoclonus of the neck or upper extremities, slight symmetric twitching of the face or a loss of muscle tone. EEG recordings in petit mal show a characteristic spike and dome pattern.
Brain samples from epileptic foci of experimental animals have been shown to have abnormally low concentrations of GABA and abnormally high levels of glutamate. Physiologically, the role of glutamate is excitatory, promoting neuronal firing in the cerebellum and depolarization in the cerebral cortex. GABA, on the other hand, inhibits cerebral firing. Administration of glutamate in experimental animals has been shown to induce epileptic seizures. Thus, excessive amounts of glutamate may be a mechanism of seizure. Seizures are believed to stop because of neuronal fatigue, and the active initiation of inhibitory neurons.
Epileptic seizures are known to be initiated by strong emotional stimuli, alkalosis caused by hyperventilation, drugs (e.g. metrazol, insulin), fever, loud noises and flashing lights. Other possible causes of epilepsy include severe head injuries (even in gestation), atherosclerosis, brain tumors or abscesses, intracranial infection, drug abuse, cerebral ischemia, exposure to rapid fire images common to some kinds of television programming and video games, food allergies, and Leaky-Gut syndrome.
Many epileptics report an unusual odor prior to seizure, which may or may not be present in the environment. Neural pathways from the basal ganglia and many other brain regions extend into the olfactory bulb, and thus odor may be a trigger or a symptom for seizure. Some clinicians have speculated that it may be possible to prevent seizures by anticonvulsant essential oils such as Aniseed, Celery seed and Lavender. Some kinds of essential oils are reported to initiate seizures, such as Artemisia spp., and should be avoided.
With most types of muscular seizures, burns, cuts, and bruises are common results of uncontrolled thrashing. Injury to the tongue is very common, from the clamping of the jaw. Thrashing can also result in severe injury and even death in certain situations, like driving, bathing, working with power tools, or swimming. Death associated with epilepsy is mostly related to accidents that occur at the same time, and in a very few cases, failure of the heart or lungs from excess muscular contraction.
Medical treatment of epilepsy
Medical treatment rests on the usage of a variety of anticonvulsant drugs that act in a variety of ways. Barbiturates such as phenobarbital and primidone depress excitatory postsynaptic discharges, thereby raising the convulsive threshold for electrochemical stimulation. Benzodiazepines such as clonazepam enhance the activity of GABA. Hydantoins such as phenytoin inhibit seizure activity by blocking the propagation of electrical impulses, through decreasing sodium transport or by blocking calcium channels. Other anticonvulsants such as valproic acid act as GABA agonists by inhibiting GABA metabolism and presynaptic uptake, and enhancing post-synaptic uptake. Surgical options in the treatment of epilepsy may consist of the removal of the corpus callosum, the hippocampi and other brain regions. Electro-convulsive therapy is another technique used to treat epilepsy.
Holistic treatment of epilepsy
In Ayurveda, epilepsy is called apasmara, and it relates to an imbalance of vata. As such, general measures to reduce vata will be helpful, such as following a regular routine, going to bed early (9-10pm), the avoidance of overstimulation, breathing exercises (pranayama), and oil massage (abhyanga). The seat of vata in Ayurveda is the bowel, and thus bowel issues such as constipation can increase and vitiate vata, promoting neuro-regulatory dysfunction. Likewise, environmental factors such as dry, windy and cold environments will increase vata, as will foods and beverages that are dry, light and cold in quality.
Given the relationship between vata and epilepsy, it would come as no surprise to those familiar with Ayurveda that a high-fat, vata-reducing diet is highly effective to limit, reduce and even eliminate epileptic seizures. Carbohydrate-rich foods digest rapidly, flooding the brain with sugar. When glucose is metabolized in the brain, it leads to the production of pro-inflammatory metabolites, resulting in hyperactivity and neuro-dysregulation. In contrast, when the brain is fed fatty acids, metabolites such as beta-hydroxybutyrate inhibit inflammation, and lead to neuro-stabilization of the brain. Thus, the very low carbohydrate diet called the ketogenic diet, can be very helpful to stabilize brain function in epileptics.
When attempting to wean a patient off of anticonvulsants it is imperative that it is performed slowly, and only in mild to moderate cases. Treatment can be given with the anticonvulsant, as long as it doesn’t have a similar activity, such as using a GABA agonists like valproic acid with Valeriana spp. The use of botanical GABA agonists can be gradually increased as the medication is being weaned. This initial phase of botanical support that doesn’t directly interfere with the medication can occur over a one to three month period. Weaning is performed over a six month period, gradually reducing the dosage of the anticonvulsant, but depending upon the symptoms of the patient, the entire weaning process may actually occur a little faster. Regardless, at all time during the weaning process and for the length of the holistic treatment, the patient should keep his or her anticonvulsant medication on hand, and be directed to pay strict attention to prodromal symptoms such as headaches, visual disturbances, olfactory disturbances, odd sensations, or dizziness. When the weaning process is completed, the patient should be symptom free for at least two years before discontinuing the supporting therapy. Even if weaning is not attempted, however, many of the recommendations below are useful.
- to stabilize the electrical activity of the brain; ease spasm and convulsion: Valerian, Ashwagandha, Black Cohosh, Mistletoe, Sweet Flag, Lobelia, Kava, Passionflower, Calamus
- to protect neurons and enhance brain function: Gotu Kola, Brahmi, Calamus, Ashwagandha, Rosemary, Milky Oats, Eleuthero, Bala, Amalaki, Ginseng, American Ginseng, He Shou Wu, Dong gui,Reishi, Cordyceps, Maitake, Coriolus
- To reduce neuronal inflammation: Turmeric, Boswellia, Guggulu, Hawthorn, Amalaki Brahmi, Guduchi, Ginkgo, Rosemary, Gotu Kola, Milk Thistle, Buplerum, Astragalus Reishi, Shilajitu
- To ensure proper elimination and bowel motility: Triphala, Barberry, Yellow Dock, Dandelion, Chinese Rhubarb, Trivrit, flax seed husk, hemp seed husk
- implement elimination-challenge diet, and remove known dietary triggers, e.g. gluten, dairy, sugar, etc.
- implement a low-carbohydrate, ketogenic diet; avoid sugar
- emphasize antioxidant rich foods, e.g. garlic, onions, cruciferous vegetables (broccoli, cauliflower, Brussels sprouts, kale, cabbage, and bok choy), foods rich in anthocyanidins (blueberries, huckleberries, elderberries, red and black grapes)
- avoid stimulating foods and beverages such as coffee, tea, and chocolate
- avoid refined foods such as sugar
- avoid aspartame (NutraSweet®)
- vitamin A, 20,000 IU daily
- vitamin B complex, 100 mg b.i.d.
- vitamin C, to bowel tolerance
- vitamin E, 800-1200 IU daily
- fish oil (triglyceride oil) or krill oil, 2000 mg each daily
- calcium/magnesium, 1:1, 800 mg each b.i.d.
- chromium, 200 mcg t.i.d.
- selenium, 200 mcg b.i.d.
- zinc, 50 mg daily
- lavender, celery seed, aniseed
- abhyanga (self-massage)
- therapeutic massage, e.g. Balashvagandha taila in shirodhara
- cranial sacral therapy
- ensure proper bowel elimination; address constipation
- de-stress environment, create a calm/nurturing place
- reduce exposure to high stimulatory media (e.g. video games) and emotionally disturbing stimuli (e.g. horror movies)
- therapeutic biofeedback