Transcript non-drug alternatives for seizures

NON-DRUG ALTERNATIVES
FOR SEIZURES
Allan E. Sosin, MD
Institute for Progressive Medicine
Irvine, California
www.iprogressivemed.com
Background
• I was the assistant medical director at the
Institutes for the Achievement of Human
Potential (IAHP) in Philadelphia from 1981-1995.
• IAHP treats children with brain injury of many
kinds, excluding only those with progressive
degenerative disease.
www.iahp.org
IAHP Diagnoses
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Autism
Cerebral Palsy
Downs Syndrome
Near Drowning
Others…
Over 50 years, IAHP has treated over
25,000 children
Program Components
1. Nutrition, including elimination of sugar,
hormones, and all food additives and
preservatives
2. Extremely vigorous programs of physical,
physiological and intellectual stimulation,
carried out by parents 7 days a week
3. Nutritional supplements including vitamins,
minerals and essential fatty acids
4. Reduction and elimination of anti-seizure drugs
as much as possible
Seizure Incidence
• At IAHP, seizures were common,
especially in children with cerebral palsy
• Many children were on anti-seizure drugs
when they arrived
• Some children were on 2-3 drugs at the
same time
• Frequently, seizures were still not
controlled
Effect of Seizure Drugs
• The children were uniformly sedated when
on anti-seizure drugs.
• Often so sedated that they did not move or
eat, and could make no progress toward
neurological
improvement.
• All anti-seizure
drugs are sedating.
Medications and EEGs
• Children were treated
with anti-seizure
medications, even
when seizures were
minor.
• Many were treated
with drugs based
solely on EEG
abnormalities when
no seizures were
noted by the parents.
EEG Abnormalities
• Some doctors have the idea that EEG
abnormalities alone can damage the brain.
• Recently, doctors of an autistic child wanted to
start Depakote because of an abnormal EEG
spike - even though seizures were never
witnessed by the parents.
• Depakote causes sedation, weight gain and
diabetes.
• I told the parents not to put their child on this
drug.
Cognitive Function
and Drugs
• “At 3 years of age,
children who had been
exposed to valproate
(Depakote) in utero
had significantly lower
IQ scores than those
who had been exposed
to other anti-epileptic
drugs.”*
*Meador et al, NEJM,
April 16, 2009 pp1597-1605.
Cognitive Function and Drugs
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Average IQ of those exposed to Depakote was 92.
IQ of those exposed to other drugs was 98-101.
This effect was DOSE RELATED.
The brain does not stop developing after birth.
The obvious next question:
– “What is the effect of anti-seizure drugs on the IQ of
children who are taking them?”
Seizures in Children*
“The long term
impact of seizures
is small for most
children… the risk
depends on the
underlying epilepsy
syndrome, or
cause of seizures.”
- Angus Wilfong, MD
*http://www.utdol.com/patients/content/topic.do?topicKey=~1oGo6mj.JhmiWE
Conflicting Ideas:
“Most of the increase in
mortality among patients with
epilepsy has been related to
the underlying cause…”
(Cecil Textbook of Medicine, 23rd Edition, p 2687.)
“each and every seizure
carries with it the risk of
brain damage, physical
harm, or even death.”
(Newsweek, April 20, 2009, p 49.)
Eliminating Drugs
• The experience at the Institutes has been that
medications cause far more trouble for children
than their seizures do.
• Detoxification and elimination of antiseizure
medications is attempted in all children.
• When drugs are gradually reduced and eliminated
(when possible) children become more alert and
responsive, start to move, breath deeper, are
healthier and improve when previously they had
made no progress.
Eliminating Drugs
At the Institutes for the Achievement
of Human Potential:
• Antiseizure drugs are reduced and eliminated
when possible because of their sedative
effects and other undesirable side effects.
• 53% of children have a history of seizures at
some time in their lives.
• 84% of children on anticonvulsant
medications still have seizures.
• More than 2/3 of children are able to get off
these medications. Of these, half have NO
seizures for at least 6 months following detox.
Patient Case: Before
• Emma, a child brought to the Institutes:
– Anoxic encephalopathy
– Severe cerebral palsy
– Needed oxygen and feeding tube
– Onset of seizures at 6 months
– Treated with Phenobarbital
– Always lethargic and sleepy
Patient Case: After
• Detoxified from Phenobarbital within 3
months of starting a program
• More alert, smiling and laughing
• Starting to move
• No seizures
Patient Case: Aksel
• Aksel is 3 years old and lives in Denmark.
• He began a program at IAHP.
• He was taking valproic acid and valium for
seizures.
• Had previously taken 9 other medications.
• His parents took him off all medication.
• Now he only has a seizure if he eats
something cold, like ice cream.
Specific Measures for Seizures
1. Fluid Restriction- Children given 16-24 oz of
fluid per day. Too much liquid may increase
fluid in brain by lowering sodium concentration.
Brain swelling can increase seizures.
2. Supplements- Magnesium at 200-400mg daily,
Vitmain B6 at ~200mg/day, dose dependant on
child size. Calcium at 800-1200mg/day,
Vitamin D at 400-800IU/day - measure levels.
3. Masking-under careful supervision and
direction of a physician.
Masking
• Masks are made of plastic with a straw at
one end to allow air flow in.
• Masks fit closely over the face to prevent
air from leaking around the edges
• There are different sizes for smaller and
larger children and adults.
Masking: Theory
• Wearing the mask causes the patient to
rebreath CO2, that he exhaled with his last
breath.
• CO2 dilates arteries in the brain only and
increases blood flow to the brain.
• The brain gets more oxygen.
• CO2 also drives the respiratory center of
the brain, so the patient breaths more
rapidly and deeply, developing the chest
wall muscles and diaphragm.
Masking: Theory
• Masking is done 30-60 times a day.
• Frequency depends on the status of the
patient and severity of the case.
• Response is reflex, no instructions to the
child are needed.
• Mask is worn for 60 seconds to achieve
about 30 seconds of deep breathing.
Masking: Theory
• Allow at least 7 minutes between masking
sessions.
• DO NOT perform masking if the patient
has a fever or is ill.
• The patient should not have any food or
fluids in the mouth during masking.
Masking: Results
• Masking reduces seizures, frequency, severity
and duration.
• On days when the child has more seizures,
masking is done more often.
• Children being treated at IAHP are given
masking, with or without the presence of
seizures.
• Masking increases blood flow and grows the
brain in all children and assists recovery.
Medical Disclaimer
• DO NOT attempt to mask your child without first
having a medical evaluation and instruction by a
doctor familiar with masking techniques.
• The child should be evaluated for any existing
cardiac problems.
• Masking must be demonstrated by a doctor and
done with the child in the exam room first.
• Masks can only be obtained through a physician
associated with IAHP, after approval from the
medical director that proper instruction has been
given.
4 Hughes #175
Irvine, CA 92618
Tel. 949-600-5100
www.iprogressivemed.com