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efficacy of any treatment. It is relatively straightforward to see whether something works or
not, regardless of its provenance. In the absence of any well conducted trials, the evidence
base for many CAM approaches has to be limited to an evaluation of the ideas and philosophy
that underpin the approach, backed up with occasional, poorly controlled, supportive case
reports. Case-controlled designs and cohort studies are relatively rare, but those that have
been reported can provide useful data to direct future research towards the most promising
approaches.

Holistic approaches

Many CAM treatments are based on a holistic approach to wellness. Practitioners often offer
bespoke treatment programmes, taking account of the person and their environment, social
and physical. This is in marked contrast to Western medicine where most people will go
through a standardised procedure, initially trying one of the ‘first line’ drugs at a standard
dose when they are first diagnosed with epilepsy. In Western medicine, individualised
treatment plans evolve over time if the first line medications do not work and more drugs
need to be added and withdrawn to achieve control. The whole-person approach is often
missing in conventional medicine, where the disease or symptoms are the primary focus of
the physician, rather than the person. This is evidenced by the elaborate classification systems
and schema for symptoms and presentations, with no reference to the person experiencing
them. Regardless of the ideas or philosophies that underlie the various holistic approaches in
CAM, it is possible that the holistic approach, in and of itself, may confer tangible, clinical
benefits in epilepsy, via indirect effects on anxiety, depression and other aspects of
psychological wellbeing.

The power of the placebo

The placebo effect is a real phenomenon that produces tangible, replicable results in a wide
variety of patients, including those with epilepsy. The literature is clear; patients receiving
placebos do better than those who receive no treatment at all.

Holistic approaches tend to tick all the boxes when it comes to the attributes a placebo needs
to maximise its effectiveness. The remedy is prescribed by a practitioner who has a firm
belief that it works. They often conduct a very thorough, deeply personal interview with the
patient, asking them about almost every aspect of their lives including events, sensations,
memories, dreams, emotions and thoughts. This deep interest in the patient is an integral part
of creating the remedy. The rituals surrounding the preparation of the remedies are frequently
elaborate, shrouded in metaphysical concepts, or ancient wisdom, and the result is a bespoke
treatment. If someone were to pull together all the scientific data on the placebo effect and
create the optimal approach, it would look very like many of the popular holistic treatment
approaches available today.

This is clearly illustrated in Queen Square, London. Queen Square is home to the Hospital
for Integrative Medicine (formerly the Royal Homeopathic Hospital). The hospital is a smart
clean, cream building with a light and spacious, modern interior. A patient attending this
hospital will be the absolute centre of care and attention while a homeopathic practitioner
takes a more detailed history than they will have ever experienced in a traditional neurology
clinic or in the six minutes normally allotted to them at their NHS GP surgery. After a long
face-to-face consultation, they will leave with a medicine specifically chosen and designed
not just for their symptoms but their wider circumstances too.

The Hospital for Integrative Medicine is next door to and indeed shares a party wall with the
Department of Clinical and Experimental Epilepsy at the National Hospital for Neurology
and Neurosurgery. The National Hospital is an old Victorian hospital of dull red brick. On