Let’s Talk About…Seizures

I commonly see children with seizure disorders in my clinic.  In fact, up to 30% of children with Autism have a diagnosed seizure disorder.  Let’s start by defining what a seizure is.

A seizure results when there is abnormal regulation of brain electrical activity.  Neurons are the brain cells responsible for generating electrical impulses that control consciousness, language, movement, thoughts, senses, and bodily functions.  When neurons do not “behave” properly and just start generating nonsense impulses, the body complies.  Some of the affected brain cells may control the little finger so the abnormal firing of these brain cells only results in finger twitching.  Some of the brain cells may be large groups so when they fire abnormally they may cause loss of consciousness, rhythmic jerking of arms or legs, irregular breathing, and loss of urine and bowel control to name just a few of the major findings.  Some seizures can be life threatening themselves or potentially deadly if the seizure takes place in the bathtub, pool, or during an activity like riding a bicycle.

Some seizures can look so harmless such as a child just “spacing out” for 5-15 seconds, typically called an absence seizure, or a “drop” seizure where the child just flops his or her head or the child’s entire body just drops to the ground.  Other seizures can be associated with vomiting, tearing up, and even laughing.  For a complete list of the different types of seizure manifestations, please go to www.epilepsy.com.

The current theory is that seizures occur because there is increased electrical activity in a group of neurons.  If this is true, then if we can make it harder for these neurons to generate nonsense impulses, it would make sense that would cause fewer seizures to occur.  This process is called “raising the threshold,” that is, making it more difficult for nonsense electrical charges to occur.  The bottom line here is to make the neurons more stable and less apt to create nonsense signals.

In the process of evaluating a child with seizures, we need to cover our bases with:
History and physical
Consider genetic screening: Fragile X, Microarray, karotype, some suggest mitochondrial genetics
24 hour EEG
General Labs

Outside The Box Thinking
We may want to consider why these cells are so twitchy in the first place.  There are some theories that suggest exposure to inflammation, autoimmunity, immune dysregulation, and toxins may play a role in lowering the seizure threshold, thus making it easier for these cells to start the seizure process.
Anti-Epileptic Drugs (AEDs): It is beyond the scope of this blog to discuss each individual medicine.  This topic will really be covered in detail with your neurologist.  The goal of using medications like these is both to stop the seizure activity and to return the abnormal EEG to a normal EEG.

Dietary changes: There is strong evidence that a ketogenic diet can be helpful in controlling seizures.  This diet changes the primary energy source, forcing the body to burn fats instead of sugars and carbohydrates.  In the process of burning fats, ketones, chemical compounds released in this process, are liberated; thus the name ketogenic diet.  There is some clinical evidence that the ketogenic diet actually raises glutathione levels in the brain.  You can read more about this diet on www.atkinsforseizures.com.   This is one of the better diet plans I know of for children with seizures, but needs to be implemented with the help of a neurologist and dietician.

Gluten Sensitivity:  Some studies suggest immune system dysregulation may actually contribute to epilepsy.  Many children on the spectrum clearly improve with the removal of gluten anyway and the potential for possibly impacting seizure activity is a bonus.

Inflammation: Strong clinical evidence suggests that inflammation (activation of the innate immune system) results in lowering the seizure threshold.  Active anti-inflammatory measures should be undertaken in children with seizure disorder.  You can more about inflammation here.

Methylation:  This is a potential intervention that can increase glutathione levels in the brain.  There are studies that suggest increasing glutathione levels in the brain may increase the seizure threshold, making it harder to have a seizure.   You can read more about methylation here..

Interventions:  In the process of working with a neurologist, dietician, and your primary care provider, you ultimately are trying to control seizure breakthroughs in your child.  Below are some common interventions I find helpful in my clinic.

Magnesium: can be dosed 10mg/kg or 10mg per 2 pounds of body weight.  Any higher doses may need to have periodic blood tests to measure the blood level of magnesium.

Vitamin B6, in the form of P-5-P: we usually start at 50mg daily and depending on the age of the child, I can increase the dose up to 200mg per day.

Omega 3 fatty acids: There is some weak evidence that omega 3 fatty acids also increase the seizure threshold.  Though the mechanism is unknown, we do know that omega 3 fatty acids are anti-inflammatory. There is at least some evidence that anti-inflammation may be important in raising the seizure threshold.

Ibuprofen: this is an anti-inflammatory as well as an anti-pyretic (keeps the fever down).  It is especially useful in the beginning and during an illness since increases in body temperature and elevated temperatures in general can lower seizure thresholds in some children.

Hyperbaric Oxygen Therapy (HBOT): Children with traumatic brain injury or with a condition of the brain that seems to favor low levels of blood flow, demonstrated with a SPECT Scan or PET scan, may benefit from HBOT treatments.  The rationale is that brain cells that receive too little oxygen (hypoxic tissue) may be more unstable and thus, may have a lower seizure threshold.  By increasing the oxygen delivery to these hypoxic areas, the stabilization of these brain cells may increase the seizure threshold.

IVIG: IVIG could act on epilepsy by its broad immunomodulatory mechanism of action.

L-Carnosine: some studies have suggested that this supplement can have anti-epileptic properties.

Vitamin E: Researchers in Canada, in a very small study, demonstrated that seizures can be decreased with Vitamin E, in the form of  d-alpha-tocopherol acetate.  3 year olds and older can easily tolerate 400IU per day.
Rilutek (Riluzole):  can be used for anxiety and obsessive/compulsive disease and may be effective in decreasing seizures, especially when combined with some of the seizure medications.

Up to one third of my practice includes patients with autism who also have epilepsy.  It is one more disease process that has to be addressed and treated in these children.  Epilepsy is potentially life threatening and it must be taken very seriously.  It is important to involve an excellent neurologist not only help prevent further seizures, but improve overall brain health.

And that’s my approach to epilepsy.