complementary and alternative therapies for epilepsy

BOOK REVIEW

Complementary and Alternative

Therapies for EpilepsyOrrin Devinsky, Steven Schachter and

Steven Pacia, eds, Demos Medical Pub-

lishing, New York, 2005, 330 pp., hard-

cover, price $ 74.95, ISBN 1-888799-89-7

Epilepsy is a frequent illness and difficult

to control. Up to 30% of the patients do

not respond satisfactorily to traditional

treatments, and, therefore, many people

suffering from epilepsy chose to rely on or

incorporate complementary and alternat-

ive medicine (CAM) into their treatment

regimens. Edited by three renowned neu-

rologists from New York and Boston, and

written by a panel of experts, the present

book provides a timely overview of CAM

management schedules that may be

incorporated into the classical manage-

ment programme of epileptic patients, and

encourages them to safely continue all

necessary treatments. It contains 31

chapters, divided into eight sections. Part I

– Complementary and Alternative Ther-

apies: The Nature of Evidence – refers to

its relation to Western medicine and

discusses double- and dual-blindness –

raising the bar of proof for trials of

complementary and alternative therapies.

Part II – Learning to Reduce Seizures –

reviews stress and epilepsy, comprehensive

neurobehavioural approach, seizure

generation, neurofeedback therapy,

autogenic training, massage, aromather-

apy and hypnosis, meditation, exercise

and Yoga. Part III – Asian, Herbal and

Homeopathic Therapies – critically

discusses Ayurveda, the ancient Indian

system of medicine, and its influence on

epilepsy and other chronic disorders, her-

bal therapy in epilepsy, listing commonly

used herbs and mentioning herb–drug

interactions, furthermore phytotherapy as

well as epilepsy provoked by herbs, with

recommendation to use herbs wisely. The

chapter on homeopathy suggests that

parallel treatment programmes may be of

some help. Another chapter reviews na-

turopathic medicine related to dietary,

various metabolic and lifestyle influences,

followed by traditional Chinese medicine

that, when used improperly, may have no

or only very mild effects. In a brief

discussion of acupuncture, no beneficial

effects in patients with difficult-to-treat

epilepsy are evidenced. Part IV – Nutri-

tional Approaches – reviews the relation-

ship between nutrition and epilepsy, the

use of fatty acids in the diet or seizure

management, and the ketogenic diet. In

Part V – Alternative Medical Therapies –

hormonal therapy, and transcranial mag-

netic stimulation are briefly reviewed,

whereas in the part on Oxygen Therapies,

hyperbaric oxygen therapy and the role of

carbon dioxide in enhancing oxygen

delivery to the brain are critically re-

viewed. Follows Part VII – Manipulation

and Osteopathic Therapies – with chapters

on a chiropractic perspective on comple-

mentary and alternative therapies, the

osteopathic approach to children with

seizure disorders, and craniosacral ther-

apy, for which, unfortunately, no con-

trolled trials have been undertaken. In the

last section, music, art and Pei therapies

with their pros and cons and necessary

precautions are presented. Most articles

are concise, critically discussing the roles

and possibilities of complementary and

alternative therapies within the framework

of management of epilepsies, most admit-

ting that the role of many alternative

treatment regimens is unclear or without

definitive evidence-based results. Most of

the chapters include informative conclu-

sions and commentaries as well as exten-

sive reference lists. It appears of interest

that no mention is given to vagus nerve

stimulation, which according to a recent

consensus statement of the Austrian Sec-

tion of the International League against

Epilepsy, is the only therapeutic option,

except ketogenic diet, for patients with

otherwise therapy-resistant partial epi-

lepsy in whom surgical treatment is not

possible. Although for the demonstration

of most of the other complementary and

alternative treatment options, controlled

trials are necessary, the present book

provides a balanced scientific information

about the broad range of options available

to foster a broader perspective of effective

care of patients with epilepsy. The book,

respecting difficulties that may incorpor-

ate alternative medicine into a medical

management programme of epilepsy, is of

interest for physicians, healthcare profes-

sionals as well as for knowledgeable

laypersons.

K. A. Jellinger

Vienna, Austria

e10 � 2006 EFNS

European Journal of Neurology 2006, 13: e10 doi:10.1111/j.1468-1331.2006.01340.x