Introduction

Integrative medicine (IM) has become one of the most frequently requested medicine to be used by itself or in conjunction with conventional medicine or other treatments to treat a variety of challenging illnesses, including pain, seizures, Cushing’s disease, skin problems, and cancer. Practitioners of IM use many different modalities, including acupuncture, Chinese herbal medicine, supplements, massage, and dietary therapy to treat or prevent health problems, improve outcomes, and enhance quality of life.¹

Seizure disorder or epilepsy is one of the most challenging neurological conditions affecting pets and represents a significant number of referrals to veterinary neurologists. It is estimated that 1% of the canine population has some form of seizure disorder.² The incidence of idiopathic (inherited) epilepsy in certain breeds of dog can be as high as 15% to 20%.²

To date, there is no cure nor ideal treatment for epilepsy. While antiepileptic drugs (AEDs), such as diazepam, midazolam, phenobarbital and potassium bromide (KBr), can be very helpful in the control of seizure activity, they reduce the clinical signs but do not treat the cause², and not all treatments provide absolute control. Approximately 20% to 40% of epileptic dogs may become refractory to phenobarbital and KBr.³ In addition, some animals are less tolerant of their side effects, which include lethargy, polyuria/polydipsia, polyphagia, vomiting, sedation, and weight gain (phenobarbital).⁴ Although these newer drugs, such as levetiracetam, zonisamide, felbamate, topiramate, gabapentin, and pregabalin, have gained considerable popularity in the management of epilepsy, scientific data on their safety and efficacy are very limited and cost is often prohibitive.

Traditional Chinese Veterinary Medicine (TCVM)

Regardless of the causes of epilepsy, TCVM is an effective treatment to help complement current medications and improve seizure management. Indications for TCVM therapies include side effects caused by AEDs, refractory seizures, and quality of life of the patient.

• A number of published studies demonstrate the anti-epileptic effects of acupuncture as an adjunctive treatment for seizures in animal models and humans.^5-13 Different modalities of acupuncture have been used to treat seizures, including needle insertion,^5,10 electrostimulation,¹⁴ scalp acupuncture,¹² auricular acupuncture,^6,7,15, and gold bead/wire implants on acupuncture points.^8,11 Accumulating data have showed that acupuncture may have an effect on epilepsy by increasing the release of inhibitory neurotransmitters, such as serotonin, GABA, nitric oxide, or opioid peptides.¹⁵
• Herbal medicine is another major component of TCVM and has been advocated as an adjunctive therapy in seizure control, usually in conjunction with acupuncture.¹⁶ TCVM practitioners usually prescribe combinations of herbal medicines. The most frequently used Chinese herbal medicine in the management of seizures is Di Tan Tang (Chinese herbal equivalent of phenobarbital). The author uses 0.5g per 10–20 pounds q12h. It contains Uncaria, Arisaemi, Acorus, poria and Glycyrrhiza, which have been shown to possess anti-epileptic activity in animal models.¹⁷ Nux vomica, Illicium henryi, betelnut and mulberry are only a few herbals that should be avoided as they have been found to induce seizures.¹⁸
• Form the TCVM standpoint, pattern differentiation (diagnosis) is important for the treatment strategy for seizures. Selections of acupoints and herbal formulas are based on the pattern differentiation of the patient.

The TCVM Philosophy of Seizures

The philosophy of disease treatment in TCVM differs from that of Western medicine. TCVM treats the individual, not the disease. From the TCVM standpoint, seizure is caused by “internal Wind” invading the channels of Liver due to Heat generated by the Liver (known as Liver Yang rising). The metaphor of “Wind” implies the shaking of tree leaves in a strong breeze, which resembles seizure activity. The Heart and Kidneys are also involved in seizures. The Kidney, in TCVM, is Water. Water nourishes Wood (Liver) and hinders Fire (Heart), so if the Kidneys are out of balance, it could influence the Liver or Heart imbalances that trigger seizures.

TCVM treatment for seizures involves calming the Liver, eliminating Wind, calming the Mind, clearing Phlegm, and restoring consciousness (see table).¹ It is also important to balance the Qi, Blood, Yin and Yang if they are involved. Acupuncture can be given once every two to four weeks for five to eight sessions initially, along with Chinese herbal medicine. After that, the treatments can be spaced out to once every three to six months for maintenance. Once the seizures are under control, you can gradually reduce the dosage of phenobarbital, potassium bromide, or other AEDs to the lowest effective dose (one at a time). Gold bead or wire implant can be considered for refractory epilepsy as a last resort. In one study, nine of 15 dogs had at least a 50% reduction in seizure frequency after gold wire implantation in acupoints.⁸ Acupuncture and herbal medicine should be tried before permanent materials are implanted, since metal implants may interfere with future MRI testing.

Dietary Supplements

1.  Omega 3 fatty acids had reported a significant positive association between omega-3 fatty acids (EPA and DHA) and epileptic seizures in reducing the frequency of seizures in human patients.¹⁹ The author doses 1,000–1,500 mg daily per 1,000 kcal of food intake daily.

2.  Thiamine (vitamin B₁) can be considered as an add-on treatment in deficient and non-deficient thiamine epileptic patients, and might improve attention and other mental abilities in people with epilepsy.²⁰

3.  Vitamin E: Co-administration of Vitamin E 400 IU/day with antiepileptics for 6 months has shown to improve seizure control and reduces oxidative stress in a double-blind, placebo-controlled trial.²¹

4.  S-adenosyl methionine (SAMe) and milk thistle (Silybum marianum) provide hepatocellular protection by stabilizing hepatic cell membranes. SAMe (15 to 20 mg/kg q24h) and/or milk thistle extract (5 to10 mg/kg q24h) or silybin (1–2 mg/kg q24h) to prevent liver damage from AED.

5.  Melatonin has been shown to be effective in both experimental models and patients suffering from epilepsy. It is also potent antioxidant enzymes scavenging oxygen free radicals.²² The author commonly supplements 3–5 mg orally before bed time.

6.  Antioxidant levels like catalase, glutathione peroxidase (GPx), vitamin E, glutathione (GSH), thiol group (SH), uric acid, and total antioxidant capacity (TAC), were found significantly low levels of antioxidant in epileptic patients as compared to controls. AED did not influence the antioxidant status suggesting that seizures induce oxidative stress.²³

7.  Hemp-based cannabidiol (CBD) oil is an extract from industrial hemp plants that contains mainly non-psychoactive CBD with minimal to no psychoactive THC. Emerging data support its use as a therapeutic option for refractory epilepsy in humans.²⁴

8.  Huperzine A is a compound isolated from Chinese club moss Huperzia serrata, and is available as an over-the-counter supplement to enhance memory. It has been shown to have anti-seizure action in animal models.²⁵ Huperzine A is given orally (1 μg/kg q8–12h).

Nutrition Therapy

A ketogenic diet, a diet that is high in fat and low in protein and carbohydrates (typically with ratios of up to 4:1 fats to proteins and carbohydrates), has showed some promising results in controlling the frequency of seizures in children. In two canine epilepsy studies, ketogenic diet (5.5% MCT. MCT content was about 10% of the total formula calories), when added to standard AED treatment, was associated with a lower seizure frequency and reduced some ADHD-like behaviors, compared to the placebo diet.^27,28

Summary

Integrative Medicine may prove to be an excellent adjuvant to conventional therapy in the treatment of seizures in animals, especially those with poorly controlled seizures. In mild cases, Integrative therapies, especially TCVM can be used on its own to help prevent and minimize the occurrence of further seizures. It may reduce the requirement for anti-epileptic medication. Nevertheless, there is a need for evidence-based research in the study of integrative therapies for managing seizures in animals. A pet owner looking at integrative medicine for epilepsy should ensure their pet is treated by a veterinarian specialized in integrative medicine, in addition to having the animal evaluated by a veterinarian or a veterinary neurologist.

Common acupuncture points for seizures

Notes: Additional acupoints based on pattern diagnoses as follows:
Wind-Phlegm: BL-20, BL-21, ST-36
Phlegm-Fire: LIV-2, ST-36, Wei-jian
Blood Stagnation: LI-4, GB-41
Yin-Blood Deficiency: BL-23, LIV-8, SP-6, KID-3

References

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2.  Bollinger-Schmitz K, Kline K. An overview of canine idiopathic epilepsy for the small animal practitioner, Iowa State University Veterinarian, Vol. 62, 23–29, 2000.

3.  O’Brien D, Simpson S, Longshore R, Kroll R, Goetze L. Use of nimodipine in canine epilepsy. Journal of the American Veterinary Medical Association, 210:1298–1301, 1997.

4.  Kline K. Complementary and alternative medicine for neurologic disorders. Clinical Techniques in Small Animal Practice, Vol 17, No 1: 25–33, 2002.

5.  van Niekerk J, Eckersley N. The use of acupuncture in canine epilepsy. J S Afr Vet Assoc, 59(1):5, 1998.

6.  Janssens LAA. Ear acupuncture for treatment of epilepsy in dogs. Progress in Veterinary Neurology, 4 (3):89–94, 1993.

7.  Panzer RB, Chrisman CL. An auricular acupuncture treatment for idiopathic canine epilepsy: a preliminary report. Am J Chin Med, 22(1):11–17, 1994.

8.  Goiz-Marquez G, Caballero S, Solis H, Rodriguez C, Sumano H. Electroencephalographic evaluation of gold wire implants inserted in acupuncture points in dogs with epileptic seizures. Res Vet Sci, 86(1):152–161, 2009.

9.  Klide AM, Farnbach GC, Gallagher SM. Acupuncture therapy for the treatment of intractable idiopathic epilepsy in five dogs. Acupuncture Electrotherapy Research, 12 (1):71–74, 1987.

10.  Kloster R, Larsson PG, Lossius R, et al. The effect of acupuncture in chronic intractable epilepsy. Seizure, 8:170–174, 1999.

11.  Zhang J, Li YZ, Zhuang LX. Clinical observation on catgut implantation at acupoint for treatment of generalised tonic-clonic epilepsy. J Clinical Acupuncture and Moxibustion, 22(6):8–10, 2006.

12.  Shi JF. Absence seizures of epilepsy treated by scalp acupuncture combined with hydroacupuncture at renying point. Shaanxi Journal of Chinese Traditional Medicine, 22(1):43–44, 2001.

13.  Zhang JL, Zhang SP, Zhang HQ. Antiepileptic effect of electroacupuncture vs. vagus nerve stimulation in the rat thalamus. Neurosci Lett, 2008 Aug 22;441(2):183–187.

14.  Shu J. The effects of ear-point stimulation on the contents of somatostatin and amino acid neurotransmitters in brain of rat with experimental seizure. Acupuncture and Electrotherapeutics Research, 29 (1–2), 43–51, 2004.

15.  Liu J. Changes of amino acids release in rat’s hippocampus during kainic acid induced epilepsy and acupuncture. Zhen Ci Yan Jiu 20, 50–54, 1995.

16.  Conry JA, Pearl PL. Herbal therapy in epilepsy. In  Devinsky   (eds). Complementary and Alternative Therapies for Epilepsy. New York: Demos Medical Publishing. 129-142, 2004.

17.  Schachter SC, Acevedo C, Acevedo KA, et al. Complementary and alternative medical therapies. In Engel J, Pedley TA (eds). Epilepsy: A Comprehensive Textbook, 2nd ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. 1407–1414, 2008.

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19. Fatma A.S. Ibrahim, Kebreab Ghebremeskel, Manar E. Abdel-Rahman, et al. The differential effects of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) on seizure frequency in patients with drug-resistant epilepsy: A randomized, double-blind, placebo-controlled trial. Epilepsy & Behavior, Volume 87, 2018;32-38. [Editor's note: Citation corrected 9/25/19; previously Pourmasoumi M, Vosoughi N, Derakhshandeh- Rishehri S-M, Assarroudi M, Heidari-Beni M. Association of Omega-3 Fatty Acid and Epileptic Seizure in Epileptic Patients: A Systematic Review.  2018;9:36.]

20.  Mesdaghinia A, Alinejad M, Abed A, Heydari A, Banafshe HR. Nutr Neurosci. 2017 Aug 2:1–9.

21.  Mehvari J, Motlagh FG, Najafi M, et al. Effects of vitamin E on seizure frequency, electroencephalogram findings, and oxidative stress status of refractory epileptic patients. Advanced Biomedical Research. 2016;5:36.

22.  Vishnoi S, Raisuddin S, Parvez S. Glutamate Excitotoxicity and oxidative stress in epilepsy: modulatory role of melatonin. J Environ Pathol Toxicol Oncol. 2016;35(4):365–374.

23.  Menon B, Ramalingam K, Kumar RV. Low plasma antioxidant status in patients with epilepsy and the role of antiepileptic drugs on oxidative stress. 2014;17(4):398-404. doi:10.4103/0972-2327.144008.

24.  Devinsky O, Cilio MR, et al. Cannabidiol: pharmacology and potential therapeutic role in epilepsy and other neuropsychiatric disorders. Epilepsia. 55(6):791–780, 2014.

25.  Tonduli LS, Testylier G, Masqueliez C, Lallement G, Monmaur P. Effects of Huperzine A used as pre-treatment against soman-induced seizures. Neurotoxicology. 22:29–37, 2001.

26.  Schneider BM, Dodman NH, et al. Clinical use of an herbal-derived compound (Huperzine A) to treat putative complex partial seizures in a dog. Epilepsy Behav. 15(4):529–534, 2009.

27.  Packer RM, Law TH, Davies E, Zanghi B, Pan Y, Volk HA. Epilepsy Behav. 2016 Feb;55:62–8.

28.  Law TH, Davies ESS, et al. A randomised trial of a medium-chain TAG diet as treatment for dogs with idiopathic epilepsy. 2015;114(9):1438–1447.