complementary and alternative therapies for epilepsy
TRANSCRIPT
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