NON-DRUG ALTERNATIVES FOR SEIZURES

1. NON-DRUG ALTERNATIVES FOR SEIZURES Allan E. Sosin, MD Institute for Progressive Medicine Irvine, California www.iprogressivemed.com

2. Background • I was the assistant medical director at the Institutes for the Achievement of Human Potential (IAHP) in Philadelphia from 1981-1995. • IAHP treats children with brain injury of many kinds, excluding only those with progressive degenerative disease. www.iahp.org

3. IAHP Diagnoses • Autism • Cerebral Palsy • Downs Syndrome • Near Drowning • Others… Over 50 years, IAHP has treated over 25,000 children

4. Program Components • Nutrition, including elimination of sugar, hormones, and all food additives and preservatives • Extremely vigorous programs of physical, physiological and intellectual stimulation, carried out by parents 7 days a week • Nutritional supplements including vitamins, minerals and essential fatty acids • Reduction and elimination of anti-seizure drugs as much as possible

5. Seizure Incidence • At IAHP, seizures were common, especially in children with cerebral palsy • Many children were on anti-seizure drugs when they arrived • Some children were on 2-3 drugs at the same time • Frequently, seizures were still not controlled

6. Effect of Seizure Drugs • The children were uniformly sedated when on anti-seizure drugs. • Often so sedated that they did not move or eat, and could make no progress toward neurological improvement. • All anti-seizure drugs are sedating.

7. Children were treated with anti-seizure medications, even when seizures were minor. Many were treated with drugs based solely on EEG abnormalities when no seizures were noted by the parents. Medications and EEGs

8. EEG Abnormalities • Some doctors have the idea that EEG abnormalities alone can damage the brain. • Recently, doctors of an autistic child wanted to start Depakote because of an abnormal EEG spike - even though seizures were never witnessed by the parents. • Depakote causes sedation, weight gain and diabetes. • I told the parents not to put their child on this drug.

9. “At 3 years of age, children who had been exposed to valproate (Depakote) in utero had significantly lower IQ scores than those who had been exposed to other anti-epileptic drugs.”* Cognitive Function and Drugs *Meador et al, NEJM, April 16, 2009 pp1597-1605.

10. Cognitive Function and Drugs • Average IQ of those exposed to Depakote was 92. • IQ of those exposed to other drugs was 98-101. • This effect was DOSE RELATED. • The brain does not stop developing after birth. • The obvious next question: • “What is the effect of anti-seizure drugs on the IQ of children who are taking them?”

11. “The long term impact of seizures is small for most children… the risk depends on the underlying epilepsy syndrome, or cause of seizures.” - Angus Wilfong, MD Seizures in Children* *http://www.utdol.com/patients/content/topic.do?topicKey=~1oGo6mj.JhmiWE

12. “Most of the increase in mortality among patients with epilepsy has been related to the underlying cause…” (Cecil Textbook of Medicine, 23rd Edition, p 2687.) Conflicting Ideas: “each and every seizure carries with it the risk of brain damage, physical harm, or even death.” (Newsweek, April 20, 2009, p 49.)

13. Eliminating Drugs • The experience at the Institutes has been that medications cause far more trouble for children than their seizures do. • Detoxification and elimination of antiseizure medications is attempted in all children. • When drugs are gradually reduced and eliminated (when possible) children become more alert and responsive, start to move, breath deeper, are healthier and improve when previously they had made no progress.

14. Eliminating Drugs At the Institutes for the Achievement of Human Potential: • Antiseizure drugs are reduced and eliminated when possible because of their sedative effects and other undesirable side effects. • 53% of children have a history of seizures at some time in their lives. • 84% of children on anticonvulsant medications still have seizures. • More than 2/3 of children are able to get off these medications. Of these, half have NO seizures for at least 6 months following detox.

15. Patient Case: Before • Emma, a child brought to the Institutes: • Anoxic encephalopathy • Severe cerebral palsy • Needed oxygen and feeding tube • Onset of seizures at 6 months • Treated with Phenobarbital • Always lethargic and sleepy

16. Patient Case: After • Detoxified from Phenobarbital within 3 months of starting a program • More alert, smiling and laughing • Starting to move • No seizures

17. Patient Case: Aksel • Aksel is 3 years old and lives in Denmark. • He began a program at IAHP. • He was taking valproic acid and valium for seizures. • Had previously taken 9 other medications. • His parents took him off all medication. • Now he only has a seizure if he eats something cold, like ice cream.

18. Specific Measures for Seizures • Fluid Restriction- Children given 16-24 oz of fluid per day. Too much liquid may increase fluid in brain by lowering sodium concentration. Brain swelling can increase seizures. • Supplements- Magnesium at 200-400mg daily, Vitmain B6 at ~200mg/day, dose dependant on child size. Calcium at 800-1200mg/day, Vitamin D at 400-800IU/day - measure levels. • Masking-under careful supervision and direction of a physician.

19. Masking • Masks are made of plastic with a straw at one end to allow air flow in. • Masks fit closely over the face to prevent air from leaking around the edges • There are different sizes for smaller and larger children and adults.

20. Masking: Theory • Wearing the mask causes the patient to rebreath CO2, that he exhaled with his last breath. • CO2 dilates arteries in the brain only and increases blood flow to the brain. • The brain gets more oxygen. • CO2 also drives the respiratory center of the brain, so the patient breaths more rapidly and deeply, developing the chest wall muscles and diaphragm.

21. Masking: Theory • Masking is done 30-60 times a day. • Frequency depends on the status of the patient and severity of the case. • Response is reflex, no instructions to the child are needed. • Mask is worn for 60 seconds to achieve about 30 seconds of deep breathing.

22. Masking: Theory • Allow at least 7 minutes between masking sessions. • DO NOT perform masking if the patient has a fever or is ill. • The patient should not have any food or fluids in the mouth during masking.

23. Masking: Results • Masking reduces seizures, frequency, severity and duration. • On days when the child has more seizures, masking is done more often. • Children being treated at IAHP are given masking, with or without the presence of seizures. • Masking increases blood flow and grows the brain in all children and assists recovery.

24. Medical Disclaimer • DO NOT attempt to mask your child without first having a medical evaluation and instruction by a doctor familiar with masking techniques. • The child should be evaluated for any existing cardiac problems. • Masking must be demonstrated by a doctor and done with the child in the exam room first. • Masks can only be obtained through a physician associated with IAHP, after approval from the medical director that proper instruction has been given.

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