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Chapter 35

Non-pharmacological treatments for epilepsy: the case for and
against complementary and alternative medicines

SALLIE BAXENDALE

Institute of Neurology, University College London, National Hospital for Neurology and
Neurosurgery, Queen Square, London, and Epilepsy Society, Chalfont St Peter,
Buckinghamshire

Introduction

The use of ‘alternative’, ‘complementary’ and ‘conventional’ as adjunctive terms in medicine
has emerged from a predominantly Western perspective on the treatment of disease.
Definitions of what constitutes a complementary or alternative medicine (CAM) vary, but
CAM is generally used as an umbrella term to refer to any treatment that falls outside the
sphere of the conventional Western medical school syllabus. While many CAM treatments
are derived from mystical or spiritual schemas of understanding of health and disease, others
are based on theories and hypotheses that depart to a greater or lesser extent from mainstream
scientific thinking.

Some have suggested that the alternative versus conventional distinction for medical
treatments is irrelevant, since the only important distinction in medicine is whether something
works or not. If it works, it’s a treatment, if it doesn’t, it’s not. This approach has considerable
clinical appeal. Any treatment approach in epilepsy that is effective in controlling seizures
should be given serious consideration. Although antiepileptic medications have proven
efficacy, they are not universally effective. Up to one-third of patients continue to experience
seizures even when they are taking multiple antiepileptic drugs (AEDs). Other patients may
look to CAM as they are not able to tolerate the side effects of conventional AEDs. People
with epilepsy will often consult their neurologist about the advisability of adding CAM
therapies to their treatment regimen. While neurologists are not expected to be experts in
every CAM approach, they should have some awareness of the dangers, interactions and
possible benefits of these treatments for their patients.

The evidence base and rationale behind some of the most popular CAM approaches in
epilepsy are briefly summarised in Table 1. However, with the multitude of CAM therapies
available today, it is beyond the scope of this short chapter to review every one. For a more
comprehensive evaluation of each treatment, readers are directed towards ‘Epilepsy:
Comprehensive and Alternative Treatments’1. This is also a useful, accessible resource to
point patients towards, if they are interested in pursuing CAM treatments for their epilepsy.

Standards of evidence

The gold standard test of any treatment in conventional Western medicine is a randomised
controlled trial (RCT), double-blind, with a crossover design. With the exception of
traditional Chinese medicine (TCM), very few CAM therapies have been subjected to this
scientific rigour. Although some CAM therapists assert that scientific evaluation is
antithetical to their treatment philosophy, the limited evidence base for most alternative
treatments is frequently due to a lack of research funding and inadequate practitioner training
in evidence-based medicine. With the right methodology it should be possible to prove the