Physicians should proactively ask patients what alternative therapies, if any, they are using.
Alternative medicine is commonly used by the families of children with epilepsy, but patients often do not mention it to their physicians, and there is a dearth of scientific evidence supporting many of the most common alternative therapies, according to a new review.
In the paper, published in Children (Basel), investigators said better studies into the use of complementary alternative medicine (CAM) in pediatric epilepsy would help facilitate better conversations between clinicians and patients and their families.
The study authors said treatment for epilepsy revolves around antiseizure medication, but they noted that about one-third of patients continue to experience seizures, despite medication.
Some families turn to CAM, a broad category that includes the use of dietary supplements, cannabis products, herbal remedies, massage therapy, or spiritual practice. The authors said the reasons families use CAM are equally broad, ranging from superstition to dissatisfaction with existing treatment options.
Previous research indicates that about half of the population of industrialized nations uses CAM, but the number is even higher—80%—in developing countries. Yet, despite its prevalence, its impact on health outcomes is poorly understood.
“As the popularity of CAM is high, there is a trend toward the integration of conventional medicine and CAM,” they wrote. “While many believe CAM treatments/therapies to be benign, side effects have been reported.”
The use of CAM is an important question for clinicians and families of patients with pediatric epilepsy, the authors said. They noted that certain herbal remedies can potentially interact with antiseizure medications.
They wanted to explore the use of CAM in pediatric epilepsy, as well as its perceived benefits and potential risks. They conducted a review of existing scientific literature focused on CAM and epilepsy in children. Their search yielded 46 articles, of which 11 were cross-sectional studies.
Among global cross-sectional studies, the prevalence of CAM usage ranged from 13% to 44%, but the numbers varied widely between regions. For instance, while 44% of children with epilepsy in Tehran, Iran, used CAM, a separate study in Shiraz, Iran, found a rate of just 10%. Similarly, in the United States, 35% of patients in a Minnesota study were reported to use CAM, but in Pennsylvania, another study found a prevalence of just 13%.
The types of CAM used also varied widely. In Pennsylvania, 60% of patients using CAM reported using cannabis-related products, but in Singapore, multivitamins and traditional herbs were the most common forms of alternative medicine. Prayer and spiritual healing were commonly reported in studies of patients in Turkey, Nigeria, Iran, and Alabama. Other regularly used CAM modalities included dietary therapy, aromatherapy, and traditional Chinese medicine.
One reason the investigators said clinicians should initiate conversations with patients about CAM is that rigorous clinical trials of CAM in epilepsy are essentially absent from the medical literature.
“We did not find high-quality clinical trials, meta-analyses, or systematic studies reporting adverse effects from these types of CAM modalities,” they said.
Rather than initiating CAM usage based on evidence of efficacy, many patients and families in the studies said they used CAM due to a belief that conventional approaches were ineffective.
The investigators noted that one of the fastest-growing forms of CAM is the use of cannabidiol (CBD) oil. They noted that many products claiming to contain CBD are mislabeled and do not provide sufficient safety information to patients. Furthermore, they said families often do not disclose to their providers that they use the products. Ultimately, they said, the prevalence of CAM in the pediatric epilepsy population means clinicians must be proactive to obtain a full picture of the therapies patients may be using.
“The increased utilization of CAM in the United States necessitates that practitioners be aware of the various CAM modalities used by pediatric patients with epilepsy, so that they can facilitate the safe use of these therapies and provide holistic care,” they concluded. “Caregivers or patients may not be fully aware of the effects of CAM and the potential side effects.”
Zhu Z, Dluzynski D, Hammad N, et al. Use of integrative, complementary, and alternative medicine in children with epilepsy: a global scoping review. Children (Basel). Published online April 12, 2023. doi:10.3390/children10040713