NEW ORLEANS—Complementary and alternative medicine—typically, vitamin and mineral supplements and herbal and natural products—represent a valued aspect of self-care for many Americans. But information regarding the prevalence of complementary and alternative medicine product use among persons with epilepsy is limited, according to Brian K. Alldredge, PharmD, and his colleagues from the University of California, San Francisco (UCSF). Additionally, risks and potential benefits of many complementary and alternative medicine products are not well defined, even though approximately one third of surveyed patients used products containing ingredients that could, according to a few published studies, either increase the occurrence of seizures or alter hepatic drug clearance.

Prompted by his experiences with patients at epilepsy clinics, Dr. Alldredge, who is a Professor of Clinical Pharmacy and Neurology as well as Associate Dean for Academic Affairs, School of Pharmacy, hoped to determine the prevalence of use and type of complementary and alternative medicine products taken by persons with epilepsy. “When we began asking [patients] about their use of complementary and alternative medicine products, I was surprised by the number of patients who seemed to be using them, and by the lack of information in the epilepsy literature that addressed whether or not these products were safe for our patients,” Dr. Alldredge explained at the 58th Annual Meeting of the American Epilepsy Society. “I thought we should start by surveying our patients to find out how many use complementary and alternative medicine products, what products they use, and the reasons for use.”

ALTERNATIVE ANTIEPILEPTICS?

The team sought to find out if complementary and alternative medicine products are used more often in patients with uncontrolled seizures or in patients who experience adverse effects from antiepileptic drug (AED) therapy. “We thought that patients with more frequent seizures or those patients with bothersome side effects from their AEDs might be more likely to use complementary and alternative medicine products—but we didn’t find any evidence of this,” Dr. Alldredge recounted. “Patients were just as likely to use complementary and alternative medicine products if their seizures were well-controlled or refractory to treatment; the same held true for side effects—patients with or without bothersome side effects were equally likely to use complementary and alternative medicine products.” A published literature review was used to evaluate the safety of the complementary and alternative medicine products used by persons with epilepsy.

Surveys were distributed to patients attending UCSF and San Francisco General Hospital tertiary care epilepsy clinics; 187 patients or their caregivers completed the 10-minute survey. In addition to standard demographic questions, information pertaining to seizure data, such as a description of event and frequency, was also elicited, as were data that established the type of AED taken and any adverse effects. Also queried were the kind of complementary and alternative medicine products used (see Table), reasons for complementary and alternative medicine product use, length of use, adverse effects, where complementary and alternative medicine products are purchased, monthly expenditures, and physician knowledge of patient complementary and alternative medicine use.

SUPPLEMENTAL HEALTH COVERAGE

The results indicated that 56% of patients used complementary and alternative medicine products, a figure that is higher than that reported in similar surveys, Dr. Alldredge pointed out. He recalled that “it turned out to be difficult to actually define ‘complementary and alternative medicine products.’ Initially, we were not going to include vitamins, but we realized that quite a few of our patients took vitamins in excess of just a daily multivitamin. So, we asked our patients to record any vitamin products in their responses. The majority of use was vitamins—80% of those who used complementary and alternative medicine products.” Some of this use was megavitamin therapy, which he said was evident from the types of vitamins the patients took, while others used a standard daily multivitamin. “If we removed multivitamins from our results, I suspect that the percentage use of complementary and alternative medicine products would be similar to other surveys.”

There may be another factor involved, Dr. Alldredge acknowledged, as he believes there are regional differences in complementary and alternative medicine product use. “San Francisco residents might be more likely to use complementary and alternative medicine products, and we have a large non-Western population that uses alternative medicine products and approaches for their health care. Most patients said that they took complementary and alternative medicine products for general health reasons or to supplement their diet in areas they thought they might be deficient; this represented 35% of the patients,” said Dr. Alldredge. Other common reasons were: “based on physician’s recommendation,” which was given by 13% of respondents; “to improve bone health,” also stated by 13%; “to increase energy,” indicated by 10%; and “to boost the immune system,” also indicated by 10%. It was also noted that 5.8% used a product for the explicit purpose of benefiting an epilepsy condition or to alleviate AED-related adverse effects. The investigators saw a low correlation that indicated no relationship between complementary and alternative medicine products and adverse effects of AED therapy.

The majority—68% of patients—reported that they did not disclose the use of complementary and alternative medicine products to their physician. Asked why he believes this figure is so high, Dr. Alldredge said, “I think that physicians and other health providers don’t often think to ask patients about over-the-counter or complementary/herbal products. This, along with the fact that most patients might not consider complementary and alternative medicine products to be ‘medicines’ in the traditional sense, leads to underreporting. I suspect that many patients would be willing to share the information with their physician—but that they don’t think to bring it up.”

SAFE MEDICINE?

As nearly one third of respondents used products containing ingredients with the potential to either increase the occurrence of seizures or alter hepatic drug clearance, “our results should prompt health care providers to always ask epilepsy patients about their use of concomitant prescription drugs, over-the-counter products, and complementary and alternative medicine products,” Dr. Alldredge said. Furthermore, he advised that patients be asked specifically about complementary and alternative medicine products through the use of terms such as “vitamins” or “herbals.”

Unfortunately, “there are not enough data in the epilepsy literature to adequately evaluate the safety of most complementary and alternative medicine products when used by our epilepsy patients,” Dr. Alldredge related. “Thus, there are no products—with the exception of ephedra, now removed from the US market—that should never be used by our patients.” Nonetheless, he asserted, even though health care providers cannot give specific guidance about “good” or “bad” complementary and alternative medicine products in most cases, health care providers should document the information and consider the impact that these products might have if a patient’s epilepsy condition changes. “We found that 14% of patients who used complementary and alternative medicine products were using a product that has been reported to increase the occurrence of seizures,” observed Dr. Alldredge. Admittedly, these were usually single case reports or very small series and do not constitute convincing evidence that these products are unsafe, he said, but it is of concern. In addition, 19% of patients were using complementary and alternative medicine products that have the potential to alter drug metabolism in the liver, which could lead to toxicity or lack of efficacy from AEDs.

NR

—Heidi W. Moore

Suggested Reading
Spinella M. Herbal medicines and epilepsy: the potential for benefit and adverse effects. Epilepsy Behav. 2001;2:524-532.

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