EAST MEETS WEST :
An Integrated Approach to Seizure Control
 Dr. Fred Hui is somewhat unusual in the medical world, being knowledgeable in both the "hard science" of Western medicine and the centuries-old traditions of Chinese medicine. A graduate of the University of Toronto, Dr. Hui has been practicing medicine for over 20 years. His approach uses the best of Eastern and Western medicine.
"My passion for medicine has led me to explore anything that could possibly work for my patients"
Dr. Hui has been the subject of TV documentaries, contributed to the Toronto Star, and has recently studied Chinese medicine at Beijing Hospital. According to Dr. Hui, although much of Chinese medicine has not yet been tested according to the standards of Western medicine, it works, and because the herbs have been used for hundreds of years, we can conclude that they are relatively safe.
Dr. Hui believes that in most "idiopathic" (cause unknown) cases of epilepsy, the seizures result from some scarring in the brain, perhaps too microscopically small to be detected. He describes this as a "hardware problem" underlying any "software problems" in the brain. Because of this underlying "hardware problem", Dr. Hui makes a point of saying he cannot offer a cure. The best treatments we have for most people with epilepsy involve anticonvulsant medications, and most people achieve good seizure control through these drugs.
For those who cannot achieve good seizure control with meds, Dr. Hui offers his suggestions of additional ways to enhance or improve seizure control. Because he is not a neurological expert, he offers this advice very informally, based on his own experiences helping his patients.
The body has many "homeostasis mechanisms," according to Dr. Hui. Together, these mechanisms are the "Control Department" for the body, and function very efficiently when all the parts of the system are doing well. But there are many factors in this control system, which create a certain amount of "room to play". This is why the frequency of seizures is not consistent, even with a single person. So there may be a "hardware problem", but we can work with the parts of the operating system- your body's various functions- to try for more good days and fewer bad days.
According to Dr. Hui, much of Western medicine is overly specialized. The treatment of epilepsy, for example, often focuses only on the brain and a specific problem in a specific area of the brain. This approach doesn't address the "surrounding area" - the rest of the body.
It is a basic principle of Chinese medicine that health comes from balancing all parts of the body - when all the parts work well, the machine runs "like clockwork." Epilepsy medications typically work to make neurons in the brain either less excitable or not excitable. The medications do their job, but also depress the entire central nervous system. Medications don't address any of the other factors that affect seizure control. These are the areas that we can work on to improve control.
Dr. Hui suggests the following principles, based on Chinese medicine, for achieving extra control beyond what is provided by medications:
- Decrease irritability in the faulty part of the brain.
- Nourish the brain.
- Balance the rest of the body.
Decreasing Irritability
Stimulants: We take medications to decrease the excitability of brain cells. Why would we then also ingest, often in large doses, substances that increase excitability?
Dr. Hui recommends that we avoid many substances that can affect the body's seizure threshold, including these stimulants: cola (including diet cola), coffee, chocolate, sugar, tea (including herbal teas containing caffeine), and cold remedies containing pseudo-ephedrine (a synthetic relative of adrenaline).
In addition to nicotine, cigarettes contain cadmium, lead, and other particles and combustion by-products, which interfere with the body's enzymes, which are responsible for, among other things, maintaining the body's electrical balance. Cigarettes also constrict blood vessels, interfering with blood flow, which is also important in maintaining the body's balance. Still, many smoke despite having seizures.
Sensory Inputs: The body's balance is sometimes described in terms of a "harmony" among the parts. Dr. Hui likens the brain to a musical instrument, a tuning of electrical vibrations. Exposing ourselves to very loud noises, even music, or psychedelic strobe lights, can be like striking a tuning fork, says Dr. Hui. The sensory inputs can cause the body's rhythms to resonate with the external environment, disturbing one's internal balance, and possibly worsening seizures.
Meditation: Meditation means different things in different cultures, but all meditation works in essentially the same way. Dr. Hui says that some people, when they feel a seizure coming on, can go to sleep, sleep it off, and believe that their body will be "reset" when they wake up. But not everyone can sleep on demand.
"Meditation is a controlled way, a sure-win way, of getting to that state." If the electrical vibration of the brain is becoming irregular, "meditation is a way to tune that down and recalibrate."
Some forms of meditation use ideas and imagination to focus the mind, but the easiest to learn uses a simple sound. One begins by humming a calming and soothing tone while breathing regularly and slowly. After a while, your mind continues as if it is humming and gradually your body becomes centred. This can calm down brainwave activity. "The brain will be somewhat recalibrated into a basal metabolic rate, and into a most simple fine state, and after twenty minutes you let the body come back, and then the body is reset."
Dr. Hui suggests this recalibration is a good way of protecting against overtiredness in your system, like a brief "power nap" that leaves you revitalized rather than, say, longer naps, which may further disturb your body's internal clock. Dr. Hui suggests using a meditation audiotape to help promote this "re-setting."
Herbs
[Note: Dr. Hui's comments on herbs for epilepsy set him apart from those of his medical colleagues who caution that herbals can indeed be unsafe for patients with epilepsy (see accompanying articles).]
Dr. Hui argues that medicinal herbs usually have no serious side effects. "Because they have been tried over hundreds of years, we know they are fairly safe." Medications, by comparison, are tested over relatively few years. While medications achieve their intended effects, these are very specific, and they often come with side effects.
Frequently, medications attempt to synthetically reproduce the "active ingredient" of a particular plant or herb, but this approach may miss benefits from other parts of the plant: "Unfortunately, the wisdom of human beings cannot be as good as God's."
Dr. Hui is careful to point out, "Keep your meds!" Medications provide excellent, though perhaps not total, seizure control for most people with epilepsy. Medications provide the best protection for you. However, when there are problems, doctors tend to add medications or raise dosages, which often means coping with additional side effects.
According to Dr. Hui, herbs are essentially extra medications with no serious side effects. For those without perfect control, they can provide a little extra protection.
Dr. Hui suggests using the following herbs:
Gaba is calming for people who are overly anxious, but it doesn't make you sleepy. Passion Flower (from the same plant as passion fruit)* and Kava Kava* also work along the same lines, cutting down excitability without drowsiness. Passion Flower is often sold as a tincture (mixed with a liquid such as alcohol). Some who use it feel dizzy, but it is generally safe for most people. Kava Kava is often brewed into a tea.
* NOTE: other medical practitioners do Not recommend this substance for patients with epilepsy.
Tin Ma is another common herb from a yam-like plant. Likely any prescribed mixture of herbs from a doctor in Chinese medicine will contain tin ma as a common ingredient. It is inexpensive, but you may not find it in a health food store; try your local Chinese grocery. Its effect is described in Chinese medicine as "cut-ting down the wind" in your brain. All aspects of Chinese medicine use metaphors from nature; the sense of this description is probably similar to "calming the storm".
Nourishing the Brain
Good Oils: For many years, dieticians have been telling us to cut down on oils, but this point of view has slowly changed. Many popular diets today, such as the Atkins Diet, favour a high protein, low carbohydrate approach. With the traditional carbohydrate-rich diet, the body has an excess of sugars which it converts into fat for storage. However, if you consume very few carbohydrates, the opposite effect is produced: the body converts fats into sugars. This is true even if you consume fats and oils.
The primary concern with oils, apart from weight gain, has been cholesterol. However, scientists are now discovering that some oils are good for you, even necessary to health, and that some oils help to reduce cholesterol. Dr. Hui reminds us that the brain is 99% an oil organ, and the brain needs certain oils, such as Vitamin E, to repair itself. We need to supply our brain with the materials it needs to be healthy.
Fish Oil, Evening Primrose Oil*, and Flax seed Oil, all commonly sold in health food stores, are good, healthy oils, according to Dr. Hui. Flax seed oil needs to be fairly fresh to be a benefit, so buy it out of the refrigerator at the store, if possible. For extra fibre, buy flax seed and grind it in your coffee grinder. Olive oil is also good. Dr. Hui recommends taking good oils liberally. It may be difficult to tell which one is best for you, so he also suggests using a combination oil that balances these ingredients.
* NOTE: other medical practitioners do Not recommend this substance for patients with epilepsy.
The Ketogenic Diet has been used to improve seizure control since before the advent of anticonvulsants. Even though the diet works best with children, Dr. Hui feels that following the principles of the diet can contribute to overall control for adults with difficult to control seizures, though the results may not be as pronounced as with children.
Conventional diets, which typically reduce both fat and carbohydrate intake, can cause the body to go into "starvation mode" - it conserves energy, burns less fat, and makes the person feel hungry and less energetic. This is why these diets are difficult to maintain. However, if one simply cuts back sharply on sugars and starches, then the body must get what it needs from fats and proteins.
When the body breaks down fats, the by-products are called ketone bodies and fatty acids. The ketone body can be used as "fuel,' just as sugars might be. However, in terms of the brain, the ketone body is a more stable, less volatile fuel; it burns slowly and consistently, so there is less excitability in the brain. Sugars by contrast work quickly and are processed quickly, producing more peaks and valleys of excitability. According to Dr. Hui, this is essentially why the ketogenic diet works.
Dr. Hui's advice is to cut down on starches, and eat plenty of green vegetables; meats, cheeses, and eggs are all allowed. By the way, you can find out if your body is producing ketones with a simple urine testing kit that can be purchased at any drugstore.
Other fatty substances that may help in this approach are gingko* and Phosphatidyl Serine (PS), both available in health food stores.
Vitamins: Studies have shown that deficiencies of certain vitamins and minerals may contribute to seizures. This may be because vitamins help to control the rates at which bodily fuels are burned. Very low levels of manganese or thiamine (B1) can cause seizures. Dr. Hui recommends taking mega-vitamins. It is not easy to measure brain levels of vitamins, though, because blood levels do not equal brain levels. This is why Dr. Hui suggests looking for a brand that has high levels of the following: all the B vitamins, Vitamin C, Vitamin E, Calcium and Magnesium.
Balancing the Rest of the Body
Internal Clock: Your body has an internal clock that responds to light and dark. Humans function best if awake during the day and asleep at night. The best approach is to keep these rhythms "going like clockwork," because your body's internal secretions of hormones and enzymes depend on this clock. Your epilepsy medications may make you drowsy, but you still need to do your best to maintain rhythms of day and night.
How? Caffeine should especially be avoided in the afternoon and evening. You should also cut down on sugars and other things that may make you excitable. This includes activities. As well, if you have trouble sleeping because of too much light, you might try sleeping with an eye cover. The body needs the hormone melatonin in order to sleep, and melatonin is removed from your system by exposure to light. The eye cover will keep you in darkness during the time when you want to sleep.
In contrast, during the daytime, get as much light as possible. If you have to work indoors, go over to the windows from time to time, or get out for a walk during lunch. Light helps to reset the internal clock, and to recharge your body' energy systems.
Bowels: Dr. Hui comments that "the bowel is one of the main high-ways of the body - if the main highway is plugged up, what do you expect the side streets to be like?" He recommends we take care to "keep the traffic going and flowing." Chinese medicine says that seizures are caused by an excess of congested energy in the top of the head. Blockages in the bowels also block the circular flow of energy through the body. So, use fibre and fluids to clean the bowel, unblock the energy flow and the brain will calm down.
Hormones: Hormones are a natural part of the body's balance. It is possible to take melatonin* supplements to help you sleep better, and thyroid hormones to regulate the metabolism. Blood sugar/Insulin imbalances can cause seizures, so people with epilepsy and diabetes should be very careful in regulating their intake of insulin. As well, it is possible to take sex hormones to help regulate seizures. Many women find their seizures decrease during menopause. This happens because the balance of estrogen and progesterone shifts. Estrogen can provoke seizures, and progesterone tends to decrease seizures.
* NOTE: indicates a substance about which the medical community has differing opinions.
Emotions: Stress increases seizure activity. Meditation, which we have already discussed, is a very useful technique for reducing stress. Another important facet of your emotional well-being, though, is how you handle adversity. Through philosophy and wisdom, you can teach yourself to handle problems well, so that they don't make a negative impact on your condition. Your Epilepsy Association can help you with this.
To sum up, Dr. Hui recommends that you balance your body through the principles of Chinese medicine. Remember, having no seizures doesn't mean that you need do nothing. Keep your body centred and you will continue to do and be well.
Editorial: Some Herbals Risky for Epilepsy
In this issue of "Epilepsy Matters", we discuss herbal and other "alternatives"- therapies other than traditional anticonvulsant medications. If you have investigated herbs before, you probably know that practitioners of herbal medicine run the gamut from responsible, well-informed scientists to well-intentioned but scientifically illiterate new age philosophers, and perhaps even frauds. Perhaps you have even encountered a person who claims to be able to "cure" seizures with herbs. Even in this publication, one practitioner advises using evening primrose oil, while another advises against its use. How can you know whether you are making the right choices?
Botanical substances are remarkably chemically diverse-this amazing synthetic chemistry of Nature is often what scientists try to reproduce in the laboratory. But this same diversity should also be the reason for some caution when using herbals. In most plants, there are many chemicals at work. Some may help control seizures. Some may lower your seizure threshold. Some may interact with your medications in some way, or have an effect on your liver. And some may have no effect whatsoever on seizures.
The best cure for this uncertainty is knowledge. Despite some practitioners' claims that herbs are merely "vegetables," they are also pharmaceuticals in a sense, and should be treated with respect. Remember, you are already taking very potent medicines for your epilepsy. Before you begin taking herbs, investigate them thoroughly-do research, ask others about their experiences, and contact your local epilepsy association for information. Don't be embarrassed to inform and involve your doctor in your decision to use herbs: 30% of you have already tried alternative therapies for seizure control. Your doctor needs to know about your decision in order to give you the best treatment, and may have specific reasons for not wanting you to take a particular herb. Many herbs have been used for centuries, but by the same token they are not held accountable to the same rigorous scrutiny as conventional drugs. Though some alternative practices clearly reflect ancient wisdom, some have proven to be disastrous.
Many of us are content to believe that if a substance is "natural," it is therefore not harmful, but this is simply not true. Many lethal toxins are produced in both plants and animals, and many plants contain chemicals that may be useful in medicine along with others that may be dangerous. Another common myth: if a little of something is good for you, a lot of it is even better for you. But consider that even vitamins can be toxic in very high doses.
Likewise, don't expect herbs to produce magical results. The best that herbs can do for you is to offer a little "extra protection" against seizures in addition to your medications. Herbals are "complementary" therapies, which can, for some people, work together with medications to optimize seizure control. If you decide to take herbs, investigate them fully, inform your doctor, and be careful of where you get them, as there may be toxins and pesticides in unregulated herbs. Beware of any practitioner who advises you to stop taking your medications-this is the surest way of bringing on a seizure!
Alternative Therapies: Dr. L.L. Georgevich's Report
What does the medical literature have to say about alternative therapies for epilepsy?
At the "Epilepsy in the 21st Century Conference" held last November in Toronto, Neurologist Dr. L.L. Georgevich provided a survey of some of the most prominent alternative therapies. Here is the 'bottom line' of what she found:
Biofeedback: This uses certain ways of thinking, etc. to change the brain waves. Can be effective in seizures with local (partial) onset, particularly temporal lobe, or if there is a specific stimulus that always triggers your seizures (eg. a certain smell), and an effective counter-measure (such as another smell) can be found.
Yoga: Two small studies showed decreased seizures in people who used Sahaja yoga.
Acupuncture: According to studies done in Norway, Acupuncture made no difference to epilepsy patients.
Herbs: This is a very broad category. Eastern studies report benefits to taking herbs for epilepsy, but these studies don't use placebos to verify results. Overall, not huge benefits likely.
Precautions with herbs: Evening primrose oil and borage can lower your seizure threshold. Sage and hyssop can be pro-convulsant. Some herbs (eg. sharkhapulshpl) decrease the level of anticonvulsants in your body. Watch out for toxins and pesticides in unregulated herbs.
Hyperbaric Oxygen: To be avoided by people with epilepsy.
Minerals: Low Calcium and Magnesium can trigger seizures. In a normal, healthy diet, though, no mineral supplement is needed.
Selenium: Selenium supplements probably not needed.
Carnitine: Only needed if you have significant neurological disease, carnitine deficiency or have liver damage from valproate.
Taurine: May be something to avoid.
Vitamin E: Studies show differing results, but the bottom line is that it probably won't hurt to take Vitamin E and it could benefit you.
Folic Acid: Needs to be supplemented during pregnancy, but at other times, studies show contradictory results. Check your B12 levels if you are taking folic acid as it can mask low ones.
Hormones: Melatonin gets mixed results. One study showed worsening of seizures in most patients taking Melatonin despite improved sleep. The hormone Progesterone is anti-convulsant, whereas estrogen is pro-convulsant. Natural progesterone taken by lozenge showed a 55% reduction in seizures. Consult your physician.
Marijuana: No good studies in humans with epilepsy, although a decreased incidence of seizures with marijuana is mentioned obliquely. Marijuana probably doesn't increase seizures, but can have side-effects like brain slowing. Marijuana is not good for depression, heart problems, lung health, and should be avoided during pregnancy. Could be used situationally for epilepsy.
Canadian Epilepsy Alliance Launched!
On April 28, 2000, representatives from epilepsy organizations from across the country met at the City Hall in Trois Rivieres, Quebec to officially launch the new Canadian Epilepsy Alliance/Alliance canadienne de L'Epilepsie. The occasion represented not only the launch of a new organization, but also first steps in the realization of a dream among Canada's grassroots epilepsy organizations. We believed that working together would make us stronger than we could ever be alone in our efforts to enhance the quality of life for Canadians affected by epilepsy.
As part of the celebration, we launched a Canada-wide survey on what people affected by epilepsy see as their most pressing concerns. The survey results will help direct our future efforts, and keep us in touch with the real life challenges of those living with epilepsy. To the best of our knowledge, no similar survey has ever been undertaken in Canada! We will share the results later this year.
The launch also coincided with the release of the "Out of the Shadows" postcard campaign, our contribution to the Year 2000 Global Campaign Against Epilepsy, declared by the World Health Organization, and supported by the International League Against Epilepsy, and International Bureau for Epilepsy. 55,000 postcards were distributed across Canada.
Our sincere thanks to all the special guests who were on hand to help make the launch a success.
Together We Can Make a Difference!
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