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Ask an expert - neuro and psycho logical - epilepsy

4 questions

Q:  I have been an  epilepsy patient for a year.  I have had 3 seizures but  when the doctor reduces my medicine I have numbness in my epileptic leg.  This makes me  feel like a seizure is  coming but it doesn't.

A:  It is always very difficult to give advice in circumstances where we would never interfere with the prescribed medicine which a patient is taking unless it was with the explicit consent and approval of the doctor who prescribed it. In your particular case, the fact that the medicine controlled the seizures but has ceased doing so once the medication has been reduced suggests that you ought to go back to the doctor and report what has happened. If there is no reason for you not to go back on the original dose, then the likelihood is that he will put you on the original dose again. If there were clinical reasons why the doctor had to reduce the dose there may be other medications which can be used instead.
 
We also feel that it is important that you report the sensation you have in your left leg of feeling a heartbeat. This is usually of no consequence, but there are one or two conditions which might produce this as a symptom, one of which might require urgent attention. You would not be wasting the doctor's time to go back and tell them what is happening.
 
There is a history of the use of acupuncture to treat epilepsy, although the Chinese medicine view of what causes it is very different from the western view. In some cases, the methods of Chinese medicine cam make a difference, but the much more comprehensive understanding of what causes epilepsy which conventional medicine has achieved through scans and a sophisticated understanding of brain function means that there is a majority of cases which would not be helped by treatment. A systematic review of studies
 
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0013215/
 
is far from encouraging.
 
A visit to a BAcC member local to you might determine whether the specifics of your case meant that acupuncture might be of use but we have to repeat the main caution, that the medication which people have for controlling their seizures is not one with which a BAcC will interfere, nor support a patient who has stopped using their tablets without their doctor's permission. The risks form doing so are too great.   
 

Q. I am currently 30 weeks pregnant and my morning sickness has unfortunately started to return. My yoga teacher suggested acupuncture may help. I am epileptic and currently 8 months seizure free. Is there any evidence or suggestion that acupuncture can cause seizures?

 

A. There is no evidence or suggestion that acupuncture can cause seizures when patients with controlled epilepsy have treatment.

All BAcC members are extremely careful to ensure that the patient remains on the medication they have been prescribed. The only treatments which are proscribed involved the use of electroacupuncture on people with poorly controlled epilepsy, and the only advice we give is to ensure that anyone with poorly controlled epilepsy is not left unattended during treatment. This is simply a common sense precaution to avoid accidents if someone did happen to have a fit while they had needles still inserted.

 

Q. My niece suffers from epilipsey and i wondering if Acupuncture might be able to help her?

 

A. The current evidence for the treatment of epilepsy with acupuncture is not that encouraging. A revised Cochrane Review
 
http://www.ncbi.nlm.nih.gov/pubmed/18843676
 
of trials and studies concludes that there is not a great deal of success, and other more recent trials tend to say the same. Anecdotally there are reports of patients coming off medication with the help of their practitioners and the consent of their GPs, but epilepsy manifests in many forms and it would be impossible to offer any general advice. The best course of action would be, if your niece is on medication, to discuss with the GP whether a reduction or change in medication was possible at all, as a first step, and then discuss with a well-trained practitioner how they might support that process.
 
The treatment of any condition for which a person may be taking essential prescribed medication has to be handled with great care. The BAcC often gets questions from people who have been taking medications for many years to control their epilepsy and believe that they would probably be OK without it, based on periods where they have simply neglected to take it and not suffered any ill effects. Our advice has always been that in this particular case, it is absolutely essential that the person's GP be involved in any discussion about changes to the medication. One highly salient point is that many people only continue to hold driving licences on the basis that they are fit-free and on medication. Any reduction in medication which led to a fit and caused an accident would probably invalidate their insurance and constitute a criminal offence.
 
As far as using acupuncture as a primary treatment for epilepsy is concerned, however, we would be reluctant to endorse its use as a primary and sole therapy. However, there is no evidence to suggest that acupuncture interferes with the treatment of controlled epilepsy, whether that control is through medication, diet or lifestyle, and many people use acupuncture treatment alongside their existing routines. It might be beneficial to seek the advice of a BAcC member local to your niece to see what they might be able to offer. As you will see from the answers to many of the questions on this site, acupuncture works from an entirely different perspective from western treatment, and there may be ways in which a practitioner may feel that they can help from within that perspective. 

Q. I am a 30 years old male that has never had any kind of epilepsy nor seizures, but I have suffered 7 nocturnal seizures since August 2010.

At first I thought that smoking cannabis could have been the reason for those seizures and I stopped, but after over 6 months I had an other few in the last three months (and I haven't been smoking since January 2011).

The only link I manage to find so far is physical exercise: I tend to get an episode the night after I have been running or going to the gym. My doctor suggested it might be linked to endorphin.

I was given a therapy (400mg of Tegretol) to be taken daily, but I don't want to start it as the side effects can be rather nasty.

I read on a few websites that acupuncture could help in cases like mine.

Could it?

and should I contact a specific kind of acupuncturist?

 

A. There is some evidence from Chinese research, which is not generally accepted in the West, that acupuncture alongside standard treatment may be beneficial for this problem, but the trials are mostly methodologically poor and inconclusive. This does not mean that it may not be helped by treatment, only that the evidence on which to base any predictive claims is not adequate. However, if someone has been prescribed medication, we would regard the most responsible course of action to be for the practitioner, with the patient's consent, to talk to the GP or hospital consultant who drew up the prescription about using acupuncture alongside, or instead of, the medication.

This is one of a number of situations where patients might want to come off, or not take, prescribed medications, but the duty of care which BAcC members have means that they cannot recommend or endorse this. There are also ethical issues about agreeing to treat someone who might be putting themselves at risk by doing so. While nocturnal seizures are not usually life threatening in themselves, it is highly likely that your medical practitioner will have a definite treatment plan in mind, and the BAcC would have some reservations about any member who compromised it. It is not clear from the question whether the seizures have been investigated and the diagnosis confirmed by EEG or scans. This may have a bearing on your doctor's reasoning.

There are no specific types of acupuncturist; all BAcC members are trained to the same high standards and capable of offering the same standard of treatment.