Herbs, Supplements, and People with Epilepsy

Epilepsy is often a difficult disorder with which to live, as seizures are unpredictable and the consequences are potentially severe. The pharmacotherapy of epilepsy frequently entails a careful balance of drug dosing and timing, and anything upsetting this can lead to seizures or toxicity. Superimposed on this fragile substrate is the frequent use of complementary and alternative medicine (CAM), which includes herbal remedies, dietary supplements, and such. 38.3% of US adults used such remedies in 2007, an increase from 36% in 2002. Presumably use is even more widespread now. In persons with epilepsy, CAM use may prove problematic if the agents used are epileptogenic or interfere with the metabolism of existing antiepileptic drug (AED) therapy. However, data on prevalence of CAM use in the setting of epilepsy, or types of agents employed, have not been widely available in the past.

In a recent survey-based study, Kaiboriboon et al. asked patients in a tertiary care epilepsy center about the use of such remedies. Over a one year recruitment period, all patients at the UCSF epilepsy clinic were asked to complete the survey. The survey asked about epilepsy types, various demographic characteristics, and supplement use, adverse effects, and cost. 187 patients completed the survey, of which 104 (56%) reported use of CAM. Of those, 34% used one such product, 32% two, and 34% took 3 or more CAM agents. 49% reported taking CAM products for five or more years. 71% disclosed use to their physicians. Multivitamins and minerals were the most commonly used preparations by a wide margin, taken by 83 of the respondents. 13 reported taking folic acid: I note that I often recommend supplemental folate use to my patients, as this vitamin may offset a number of AED related adverse effects.

Most CAM use was said to be for general health promotion, rather than directed at epilepsy per se. The most significant independent predictors of CAM use were partial epilepsy and Caucasian race. Of note, epilepsy severity and dissatisfaction with conventional treatment did not correlate with supplement use. Despite that lack of correlation, the authors note that some of the stated reasons for CAM use might be related to epilepsy or AED adverse effects: 13 patients reported CAM use to improve bone health and seven patients used CAM for memory improvement. Information sources were also surveyed. Most reported obtaining CAM information from a variety of sources. Fifty patients indicated that their primary physician was the main source of information.

Adverse effects were not especially common. Nine patients reported adverse effects, but no patient attributed seizures to the use of concomitant CAM products. That said, potential problems were more frequent, based on the specifics of the CAM products used: Twenty patients (19%) were taking a product which could affect metabolism throught changes in the hepatic cytochrome P450 systems. And 17 patients (16%) were taking potentially epileptogenic agents.

So, a majority of epilepsy patients in this study used CAM. This was higher than what had been previously reported in the literature. In this population, use of such remedies was prevalent. Half had been using CAM for five years or more, so use was often longstanding. Most disclosed use to their physicians. Adverse effects of CAM were not commonly reported. It is important to note that a tertiary care epilepsy center is likely to have a cohort of more refractory patients, and such patients are probably going to be more sensitive to the interactions discussed above between AEDs and CAM. So, in a wider population, adverse effects may be even less likely. And, this San Francisco population may be more likely to use alternative therapies than persons with epilepsy in other areas.

My conclusion: CAM use in epilepsy is more common than previously thought but is probably rarely problematic.