THE ROLE OF CAM IN THE TREATMENT OF

By: Maria Isabel OteroHonors College - USF

Literature Review Mentor : Dr. Amal Hakki

Swedish Chemist (1833 - 1896)

Poem describing his epileptic SEIZURESMy cradle looked a deathbed, and for

years a mother watched with ever anxious care so little chance, to save the flickering light, I scarce could muster strength to drain the breast, and the convulsions followed, till I gasped upon the brink of nothingness - my frame a school for agony with death for goal.

Founder of the Nobel Prizes

Technically speaking, Epilepsy is a disorder of the brain functions characterized by paroxysmal stereotyped alterations in behavior associated with synchronous excessive discharges in large aggregates of neurons.

A person has to have 2 or more recurrent unprovoked seizures, meaning not caused by obvious issues such as alcohol withdrawal, heart problems, or extremely low blood sugar to be diagnosed with this illness. In other words, the seizures may result from a hereditary tendency or a brain injury, but often the cause is unknown and therefore these are considered to be the brains response or reaction to a disturbing, irritating or damaging stimulus that manifests by abnormal electro-chemical excitatory processes in the cerebral nerve cells.

The normal brain constantly generates electrical rhythms in an orderly way; although, in the case of Epilepsy the series is disrupted by some neuron discharging signals inappropriately and this pathological synchronized process crumbles. The electrical storm that blows fuses takes place when unexpectedly an abnormal large amount of nerve cells are simultaneously stimulated producing a difference in the voltage between the outer side of the cell wall and the inside of the cell, scientifically known as the membrane potential.

Its linguistic roots are derived from the Greek words epilepsia and epilambanein, meaning to attack or seize. Epilepsy was first recognized by ancient cultures, including those of ancient Egypt, China, and India; but diagnosed by ancient Greek, Roman and later Byzantine physicians.

19041904 19681968 19701970

20002000 19971997 19901990

Steven C. Schachter, M.D.

Epileptic seizures are unique in the sense that they display themselves in different manners because they could involve any part of the brain where the unnatural firing takes place. They are divided depending on the portion of the brain they affect; but the 3 most commonly diagnosed types are the “Generalized”, “Partial”, and “Jacksonian”, in addition to the other 18 syndromes that the NYU Langone Medical Comprehensive Epilepsy Center has identified.

The types of seizures exhibited, the age at which these begin, the causes for them [whether inherited or provoked], the part of the brain involved, their severity, patterns by the time of day, patterns on the EEG [during and between seizures], other disorders in addition to seizures that the patient may present, and the prospects for recovery or worsening define the type of epileptic syndrome someone may suffer from.

Generalized Tonic Clonic Seizure lasts Approx. 2 minutes, in which both hemispheres of the brain are simultaneously disturbed and the attack dominates the entire body from the onset. Foaming of the mouth, incontinence of urine and biting of the tongue may occur.

“Salam Spasm” in a Five Month-Old BabyLasting Approx. 2-3 Seconds

Myoclonic SeizureNon-rhythmic jerks

resulting from involuntary muscle

twitching that normally target the upper

extremities, and after an episode, patients may describe the perceived

sensation as momentary electrical shocks.

These seizures are mainly seen in children and adolescents but are outgrown by the age of 18. are characterized by brief episodes of abruptly stopping activity and blankly staring for up to 20 seconds. During this time the patient is unconscious of his/her environment and actions; and as it is likely to occur after a seizure, they will be unaware that anything has happened except for the possible realization of losing time. Additionally, the Atypical Absence seizure could last up to 30 seconds, time in which the patient’s eyes constantly blink, the lips jerk, and they might lose some responsiveness.

In a motor seizure or better said Jacksonian, the person’s muscles become rigid and he/she would make sudden jerks including turning of the head. This kind of disturbance of functions begins in one part of the body and spreads to adjacent areas; for example, a person may have twitching of a finger and then it might expand to the whole side of the body opposite to the affected area of the brain or in some cases to both sides. Other examples are weakness, which can even affect speech, and coordinated actions such as laughter or automatic hand movements that the individual may or may not be aware of.

In the Sensory form, the patient perceives strange sensations affecting one or more of the five senses [taste, touch, sight, hearing, or smell]. When anyone experiences these symptoms, it is referred to as an aura and it is considered to be an indication that a worse seizure is announcing its arrival. Moreover, Psychological seizures include a variety of experiences such as re-experiencing memory, falling into a dreamy state, and feeling intense emotions not brought on by environmental factors.

With the help of the FAMILY MEMBERS, most of the time, the doctors are able to determine if and which kind of seizure or Epilepsy syndrome best explains the event the patient experienced and build a case file.

LABORATORY EXAMS (BLOOD TESTS) confirm whether the liver, kidneys, and/or other organ systems are not working properly, as usual these sort of failures could be accompanied by seizures.

The EEG or electroencephalography, developed by Professor Hans Berger in the 1920’s is one of the most determinant and specific diagnostic tests due to the fact that it records the electrical activity of the brain in a safe and painless graphical manner. Each trace of its recording corresponds to a different region of the brain and they could be easily interpreted by the specialists.

The CT scan, which stands for computed tomography, is equivalent to an X-Ray of the head which would usually appear normal in most patients with Epilepsy. Decreases in brain substance, scar tissue, tumors, abnormal blood vessels or abnormal spinal fluid circulation are a few of the abnormalities that might be projected with this kind of test.

Magnetic Resonance Imaging [MRI] was first introduced in the USA in the early 1980s revolutionizing the practice of neurology and neurosurgery because of the excellent detail resemblance of the brain’s structure. This is extremely helpful because it identifies brain scar tissue, areas of abnormal brain development or dysplasia, small brain tumors, blood vessel abnormalities, and changes in the brain’s white matter.

• Dilantin• Tegretol• Trileptal• Topamax• Zarontin

Epileptic surgery removes the focus of the epilepsy, i.e. the part of the brain where the seizures are triggered

70% of patients manage their epileptic attacks with the use of drugs.

But the other 30% are treated with surgery.

Epileptic surgery removes the focus of the epilepsy, i.e. the part of the brain where the seizures are triggered

By large, medications can control seizures in about 70% of patients, but in the other 30% SURGERY OR OPERATIVE THERAPY is their superlative treatment with a likelihood of completely controlling the seizures from 50% to 95% of the time depending on the Epilepsy syndrome treated and the operation performed. Nonetheless, even if this procedure has been increasingly favored since the 1980s and 90’s, the most important risk to bethink by the patient before committing to the decision is the non-reversible injury to the brain that could be caused due to an intracranial hemorrhage or stroke.

LOBE RESECTION, the most common procedure among adults and adolescents, is the removal of the lobe where the onset of the seizure takes place.

LESIONECTOMY detaches isolated brain lesions, such as areas of injury, tumors, or malformed blood vessels.

CORPUS CALLOSOTOMY or the so called Split-Brain Surgery disconnects the 2 hemispheres of the brain by cutting the corpus callosum, which is the band of nerve fibers connecting the 2. This is mainly performed in patients with uncontrollable seizures with a potential of severe injury due to falls.

In a FUNCTIONAL HEMISPHERECTOMY, one hemisphere is disconnected from the rest of the brain, but only a specific area of brain tissue is removed. This surgery is typically done on children younger than 13 years old who have one hemisphere that is not functioning normally.

MULTIPLE SUBPIAL TRANSECTION (MST) is used to help control seizures that begin in areas of the brain that cannot be safely removed. The surgeon makes a series of shallow cuts or transections in the brain tissue to interrupt the course of seizure impulses but do not disturb normal brain activity, leaving the person's abilities intact.

NATUROPATHY is the belief that avoiding certain drugs such as caffeine and alcohol; chemicals; and maintaining a well-balanced gluten-free diet high in vitamins D and B6, as well as zinc, calcium, and magnesium, which have anticonvulsant properties, and the amino acid taurine, would help control seizures.

Yoga therapy aims at developing control over the neuron excitations that triggers the seizure by training the individual to develop an internal balance through techniques of decreasing activity rates at all levels, reaching a deep resting state that heals the mind and body complex.

Acupuncture, China's medical heritage for over 3,000 years, which was introduced into the USA and Canada in the 1970's and that people find helpful when trying to control seizures but that in rare cases may also cause them, seeks to help the body to heal itself but not as a self-help treatment. This therapeutic mode relieves some of the problems which provoke Epilepsy such as stress and poor sleep by restoring the harmony within the individual’s body by concentrating on the patterns of energy that flow through the body just below the surface of the skin. Steel needles are inserted in vital specific areas of the body of the epileptic person that influence the brain energy and flow of blood to the head. Acupuncture treatments usually last from 1 - 18 months, and 65 people showed marked improvements with an absence of seizures during a one year period without the use of standardized drugs in a recent study that also proved that this procedure has low risk factors even if previous researchers found 110 serious injuries and four fatalities.

Hypnotism has been proven to be a mean of relief that is normally safe and beneficial for patients with partial seizures. Commonly, to be in a hypnotic state it takes an effort of intense concentration and some studies found a degree of high arousal in the EEGs of people being hypnotized, which means that this could, in certain cases induce a seizure.  When patients have been taught to concentrate, either on a bodily sensation, a body part or some external object, they pass into a state of dissociation and suggestibility; in other words, although they are completely aware of what is happening to them, they are able to accept suggestions and carry them out.  In people with Epilepsy, who are often taking medications, the method of hypnotic induction, which is usually the eye fixation, is difficult because the patient’s eyes shake too much under the influence of these and the hand elevation method is used instead. In this technique the patient has to concentrate on one hand, preferably the opposite to the side where the epileptic lesion is, and fixate on it until eventually reaching the resting position.  After the initial instruction, then the individual is to practice alone and develop the technique without the therapist’s intervention, and when this has been achieved a suggestion is given to smell a chosen oil to associate with this state.  Once the association has firmly been made, the patient is to carry a small bottle of the oil and practice inhaling the scent to induce relaxation in a situation where a seizure is likely to occur.

Colloidal Silver, composed mainly of silver proteins suspended in a liquid, most likely water that are used to treat disorders such as Epilepsy, gonorrhea, and colds. This type of therapy was uncommon until the mid-20th century but is now promoted as a cure for AIDS, cancer, and diabetes. No human clinical data has been found to support its oral use even if it is composed of an essential mineral, and apparently it does not serve any physiological function in the body. Its long term use can cause silver deposition in the skin and mucous membranes leading to an irreversible condition called argyria; therefore pregnant women should abstain from the use of it.

PASSION FLOWER, Maypop, Apricot vine, Passion vine, Purple passion flower, Fleur de la passion, Passiflore, Corona de Cristo, or Maracujà are common names for Passiflora incarnate, an herb and fruit that is typically used to treat Insomnia, Anxiety, Epilepsy, Neuralgia, and withdrawal syndromes from opiates or benzodiazepines that is well known to act as a sedative and tranquilizer. Its exact mechanism of action is not precise and thus it is not FDA regulated or approved. In addition, dizziness, sedation, ataxia or the inability to control the muscle movements, allergic reaction, and impaired cognitive functions have been reported while using this in conjunction of alcohol, pentobarbital, benzodiazepines or anticoagulants.

SCULLCAP, Blue Pimpernel, Helmet Flower, Hoodwort, Mad Weed, Quaker Bonnet, Side-Flowering Scullcap, Virginian Scullcap or as its scientific name determines, Scutellaria baicalensis can increase the risk of bruising and bleeding in anyone, same as treat Hysteria, Epilepsy, Chorea, and other nervous disorders. This indigenous plant which grows in Europe and measures about 60 cm height is used also as a sedative, antispasmodic, anti-inflammatory, and as a lipid peroxidation inhibitor. Its dosage in powder or liquid extract are 425 mg, 429 mg, 430 mg daily (“Scullcap”, 2006), and its healing procedure is not known.

GROUNDSEL, another herb that is commonly found in all of Europe, northern and central Asia, northern Africa, Australia and the Americas grows from about 10 to 30 cm high and is usually known as Bid Seed, Chicken Weed, Grundy Swallow, Ground Glutton, and Simson. Its internal use is not advised because it may cause hepatotoxicity and carcinogenicity due to the pyrrolizidine alkaloids with 1, 2 unsaturated necic parent substances in its makeup. Nonetheless, the pressed juice of it has been used for Dysmenorrhea, or menstrual cramps, Epilepsy, and as a styptic in dentistry in addition to the treatment of worm infections.

The artemisia annua, or as the pseudonyms name it, Bulwand-Wormwood, Felon Herb, MUGWORT, and the St. John's Plant, has a peculiar taste that pregnant women have to evade. Its roots are strongly sweet and the herb is aromatic and bitter. This plant is indigenous to Asia and North America, and is also distributed in Europe. In China for instance, is used to treat female complaints on irregular menstruation as well as for ulcers and burns, and in the rest of the world it is commonly used for worm infestations, Epilepsy, persistent vomiting, as a sedative, and to promote circulation. Up to date no health hazards or side effects are known to occur when this is properly administrated for therapeutic dosages, which are normally as an infusion or drug 0.5 to 2 g 3 times daily, or as the typical tea cup 2 or 3 times daily.

YEW, on the contrary of the others, is a poisonous toxic needles of Taxus baccata that are commonly called Chin Wood, English Yew, or European Yew. The leaves of this plant are used as an abortifacient, better said, to promote menstruation; to treat Diphtheria, Epilepsy, worm infestation, and Tonsillitis; and in some cases it has helped to the improvement in the cardiac metabolism. It should not be used during pregnancy because it could cause an abortion and the recommended dosages are 1 to 2 ml sc, 3 times daily when the condition is acute; and once a day when it is chronic.

Herbal medicines are less likely to be as effective and expensive as prescribed over the counter medications doctors have recommended for us. Many of them have been known to work directly by decreasing a seizure threshold or unfortunately indirectly with a mixture of prescribed drugs only to be understated.

Knowledge of these side effects is nowhere near its finalization, thus far research and analyses is to be carried out; but it is deductible that these differ according to the kind of medicine and herbal remedy taken in addition to the type of seizure the patient exert.

Herbs are classified by the government as dietary supplements and are regulated by the 1994 Dietary Supplement and Health Education Act [DSHEA]

Nearly 1 in 3 people with Epilepsy uses some form of complementary and alternative medicine.

In 1996 herb sales were $1.2 billion dollars in the USA.

It has been estimated that 0.5-2% of the world's population is affected by this chronic illness; perhaps as many as 80 million people and around 1.1–2.3 million people in the USA alone.

Epilepsy is known to afflict Americans more than Low Gehrings disease combined with cerebral palsy, multiple sclerosis, and Parkinson’s disease.

Everyday 500 new cases are diagnosed and around 25,000 to 50,000 people die because of this disease more than AIDS, Breast Cancer, or car accidents combined.

The approximate annual cost of the public health department of the USA is of 15.5 billion dollars spent on the treatment and diagnosis of such an illness.

Unfortunately, 80% of the world’s population still relies on traditional medicines for their health care needs without the knowledge that 30% of the basis of the modern drugs that the pharmacies are making us believe are pure chemicals that can only be made in laboratories are herbs.

CAM treatments, in general, supplement the traditional procedures and increase the possibilities of recovery in a faster and safer rate.

Herbal remedies complement and heal in certain occasions of many sufferings that ill our organisms, and we as humans, should take advantage of what is naturally given to us as medicine instead of intoxicating our systems with substances we do not need. Yoga and Acupuncture balance our energy, as well as Hypnotism relaxes us and Naturopathy purifies our bodies from the extra chemicals we do not need for living.

THESE TREATMENTS ARE AN EXCELLENT RESOURCE FOR OUR OVERALL WELLBEING!!