Seizures / Epilepsy

Seizures and THIS B Vitamin; Could it be the Key?

November 28, 2015 by James Bogash

Natural remedies for seizures — Vitamin B6 and your seizures

It is not in my nature to promote a one cause/one cure mentality. But sometimes certain approaches are so important that they need to be mentioned separately.

This goes for many conditions from diabetes to Alzheimer’s dementia. And certainly over the years I have pointed out research on single approaches that have been proven to help with migraines and seiuzres.

Some approaches, like exercise or the Ketogenic diet, require more much commitment from you. Some, on the other hand, are as simple as a daily supplement. Magnesium, melatonin, fish oils and vitamin D are some examples of interventions that have been demonstrated in medical research to help with seizures and chronic migraine headaches.

Some of these supplements work directly. Fish oils improve the health of the brain cell membrane, ensuring that messages get transmitted appropriately. Magnesium is essential for brain cell to generate energy (in the form of ATP) to function.

This particular article reviews a simple single-nutrient approach that works differently. Pyridoxine is the fancy name for vitamin B6. You may also hear it referred to as P-5-P, or pyridoxine-5-phosphate (the activated form, which skips the need for the liver to activate the B6 molecule).

Pyridoxine plays many roles in the human body, but there are a few functions that rise to the top. Especially when it comes to seizures and chronic migraine headaches.

But before we get into these important functions of vitamin B6, we need to have a brief primer on two different neurotransmitters in the brain:

Gamma amino butyric acid (GABA) is an inhibitory transmitter in the brain. It calms things down. Applies the brakes to an overactive brain. Think Ativan, benzodiazepines, alcohol, phenobarb .
Glutamate is the opposite. It is stimulatory and puts your brain cells into overdrive. There are drugs that block the action of glutamate like Ketamine that are used for seizures. MSG will also activate this pathway and this is why so many patients are sensitive to processed foods.

Based on this, it would seem that anything that could increase GABA and decrease glutamate would be a really good thing.

Yeah—you guessed it. Vitamin B6 plays a role in both of these actions.

Which brings us back to the study. Researchers discovered low blood levels of pyridoxine in an 8-year old girl with superrefractory status epilepticus (the worst-case scenario; seizures that continue to occur for 24 hours or more after initiation of heavy-duty anti-seizure drugs). Restoring her pyridoxine levels improved her brain function as demonstrated by EEG. This led the doctors to look at vitamin B6 levels in 81 adults admitted to the neurological ICU with status epilepticus. We reviewed the records on patients admitted to the neurological ICU for status epilepticus (SE). Here’s what they found when these patients were compared to a group of epileptic patients in the outpatient clicic:

All but six patients admitted to the neuro ICU had low normal or undetectable pyridoxine levels.
This translated to 94% of patients with status epilepticus have vitamin B6 levels in the low to undetectable range (compared to 39.4% in the outpatients).
However, supplementing with B6 did not lead to an immediate resolution of the status epilepticus.

So what does this mean? It would make sense that vitamin B6 plays an important role in keeping neurotransmitter balance away from seizures and towards a calm brain. But it would also makes sense that, once the cat is out of the bag, so to speak, that something as simple as vitamin B6 will not be strong enough to stop the wave of seizures that makes up status epilepticus.

This would put vitamin B6 on the list of must-haves for any person with epilepsy (and likely chronic migraines headaches as well). A good quality multivitamin (not your cheap “one per day” type of vitamin) should provide you with what you need.

The Ketogenic Diet; How to Make a Good Thing Better

November 8, 2015 by James Bogash

The ketogenic diet has been a powerful tool for seizures forever. Longer even then the drugs to treat seizures that are commonly used.

The unfortunate fact is that natural approaches to seizures are almost always the last tool recommended by neurologists, despite the fact that they typically perform better than medications.

Maybe one of the reasons that doctors don’t recommend natural approaches like the ketogenic diet because they require a much greater commitment to care than does taking a medication once or twice a day. But this decision should ALWAYS be left up to the patient—it is not your doctor’s choice to decide whether or not you will make the commitment.

There are basically two “problems,” if you will, with the ketogenic diet. One is compliance (needing to avoid carbohydrates can be too restrictive for some, especially with hidden triggers in all kinds of foods) and the other is effectiveness.

What if these two issues could be address with additional tools? And what if these tools were the same?

This cannot be said of medication. Let’s say you’re on Topamax for your seizures (for the sake of simplicity we won’t go into how often epileptic patients end up on multiple medications). Really the only options for you to increase seizure control would be to increase the dose. And along with that added dose comes greater side effects.

(And just in case you thought you’d try the ketogenic diet along with your medication, recent research suggests that certain anti-epileptic drugs can actually reduce the effectiveness of the ketogenic diet–this should be of grave concern to anyone on anti-epileptic drugs.)

And the risks of increasing your anti-epileptic drug dose includes getting shot by overzealous video game addicts who have played one too many zombie-killing games. That and drooling on a new shirt.

Or you could always add another medication. Although most often this is mere guesswork and just increases the side effect list without a real improvement in quality of life.

This is not going to be the case when you add tools to the ketogenic diet. Adding tools could mean that you need to adhere to a slightly less stringent protocol or that you could get even better seizure control. Just imagine living life on the edge by staring into a strobe light or going to see Blue Man Group.

Let’s cover these two options separately.

First has to do with modifications to the standard ketogenic diet. Some of these are modifications, while some of them I’m including because they are diets that you should be aware of. The best resource, unquestionably, is the Charlie Foundation, which was formed to promote the use of the ketogenic diet.

Standard ketogenic diet—this one is the most restrictive, with a 4:1 ratio of fats to carbs/proteins.
MCT ketogenic diet–this diet uses MCTs from coconut oil as the main source of calories, allowing for a higher carb intake and more variety in the diet
Modified Atkin’s Diet (MAD)—the ratio is less restrictive at 1:1 of fats to carbs/proteins
Glutamate/Aspartate Restricted Diet (GARD)—designed to restrict the intake of the excitatory neurotransmitter glutamate found in certain foods (the best resource on the specifics can be found here).

All of these can be extremely powerful natural tools for managing seizures. The clinical studies have been done and the anecdotal stories from patients are everywhere. I remain amazed by one particular group on Facebook specifically geared towards Diets for Epilepsy. The specific knowledge of the people in this group has continually reminded me of how much I have to learn.

One of the problems with the ketogenic diet is that we just don’t really know how it works specifically. There is lots of educated conjecture, but nothing to date has nailed it. Some theories about how the ketogenic diet works include:

Alteration of the gut bacteria, changing the neurotransmitters released from the gut to a less excitatory pattern
Avoidance of gluten on the ketogenic diet (gluten has been established as a player in many persons with epilepsy)
Change in dietary fat intake since fat plays such a major role in brain cell function and health

Besides these theories, looking at it from a deeper biochemical level, ketogenic diets are known to increase levels of a compound in the brain called hypoxia-inducible factor-1α (HIF-1α). HIF-1α is a compound that is released in response to lowered levels of oxygen. Basically a protective compound released that causes the brain to go into “uh-oh” mode and snap to attention, leading to all kinds of VERY positive changes in brain cell function.

Besides HIF-1α, there is also evidence that the ketogenic diet can activate Sirt1 in brain cells. For those of you not familiar with Sirt1, it is a gene that does all kinds of wonderful things in our body and is considered by some as a “longevity gene.” Well-known is its ability to increase both the number and function of the mitochondria in cells. More mitochondria means more ATP with less by products. More ATP means a much healthier brain cell able to control firing and thus seizure activity.

Thanks to the author of this particular article, we can look at this mechanism of the ketogenic diet and see if there are other tools that we can use to make the ketogenic diet even more powerful. The author suggests that the biochemical changes induced by the ketogenic diet can go as far as helping the brain cells “clean house;” removing damaged mitochondria within brain cells.

Here are some ideas of how we could help this process naturally:

Berberine, a compound found in certain herbs such as goldenseal.
Metformin (not a natural approach and not my preference, but if a drug like metformin could reduce or eliminate the need of far more toxic anti-seizure drugs, well….).
Compounds known to increase Sirt1 activity such as nicotinamide riboside and resveratrol.
Medium-chain triglycerides (found in coconut oil)
Compounds known to increase the formation of ketone bodies (the compounds formed during the ketogenic diet from the higher intake of fats and very low levels of carbs) like carnitine and hydroxycitrate.

These are just some of the tools that could work. This list is practically endless as there are a lot of other natural compounds that affect this pathway.

Interestingly, many of these approaches are already well-known to patients using the ketogenic diet. Carnitine and coconut oil are common additions to the diets of people on the ketogenic diet.

If these tools can help to increase the effectiveness of diets for epilepsy or can make less restrictive diets work for others, this would be a drastic change to the way medicine handles seizures.

If this type of approach seems to make more sense to you then guessing which seizure med you should try next, then I’d strongly advise you joining the Diets for Epilepsy Facebook group as well as getting your hands on a copy of my Migraines and Epilepsy book.

Red Wine and the Brain

July 30, 2015 by James Bogash

DO I NEED TO DRINK MORE WINE TO PROTECT MY BRAIN?

It’s no surprise that wine (or specifically, the resveratrol content of red wine) has protective benefits in moderation, but you may not understand exactly how resveratrol works.

Calorie restriction without nutrient restriction has consistently shown to extend lifespan in mammals. This calorie restriction works by improving the health and number of the mitochondria by activating a set of genes called the Sirtuin genes.

Research on resveratrol has found that it resveratrol activates this same Sirtuin pathway. In this particular study, researchers looked at the additional ability of resveratrol to protect the brain from a neurotransmitter called glutamate, which can create a wave of brain damage with seizures and migraines.

Read study here

Sudden Unexpected Death in Epilepsy – Closer to an Answer?

July 25, 2015 by James Bogash

Among epilepsy sufferers, one of the greatest fears is SUDEP – sudden unexplained death in epilepsy.

Maybe this is because it seems like we don’t know why it happens. Maybe it’s because it seems to happen for no reason.

SUDEP is a very real concern for people with epilepsy. People with epilepsy are at an increased risk of dying when compared to the general population who do not have seizures. Some of this increase risk is from obvious causes like drowning and motor vehicle accidents as a direct result of things that happen during a seizure.

But other deaths are not quite as clear cut. For this reason researchers are constantly searching for answers. High on the list of potential suspects is cardiac rhythm abnormalities. This particular study attempts to clarify the links between sudden cardiac arrest and epilepsy. Specifically, ventricular tachycardia and fibrillation (VT/VF) were identified. V-fib is a condition where the heart is beating out of sync. As a result, blood cannot be efficiently pumped through the heart. This is a life-threatening condition.

Ventricular tachycardia is a condition where the ventricles of the heart are beating at too fast of a rate. While not as life-threatening as V-fib, it is a sign that something is seriously wrong with the ability to control the rate that the heart is beating.

With this in mind, the researchers looked at 3 groups of participants:

18 people with active epilepsy as well as ECG-confirmed VT/VF.
470 individuals with VT/VF without epilepsy
54 individuals with epilepsy but without identified without VT/VF

These groups of individuals were then compared to see how

Here’s what they found:

In the group of 18 epileptics with VT/VF, 10 had an obvious cardiac cause for the heart rhythm problems and 5 had a presumed cardiovascular cause.
In 2 of the remaining 3 epileptics with VT/VF, near–sudden unexpected death in epilepsy (SUDEP) was established after successful resuscitation.
In these two, there was a higher prevalence of congenital/inherited heart disease (17% vs 1%), and they experienced VT/VF at younger age (57 vs 64 years) than VT/VF individuals without epilepsy.

Based on this, the authors concluded that the heart rhythm abnormalities that occurred in epileptic patients was a result of underlying cardiovascular disease rather than something related to the epilepsy. In other words, a “comorbidity,” or two conditions occurring at the same time but not necessarily related.

Here’s my take…

For some reason, we have been very, very, very slow to adopt what the research has been saying for decades now—that epilepsy is, at it’s root, a problem with the mitochondria in the brain cells. Due to a long list of potential problems and damage that occurs to the mitochondria, the brain cells are no longer able to function in a normal manner.

This lack of energy leads to brain cells firing before they are supposed to fire, creating a seizure. This is a concept that we dance around in treatment while never really addressing. Sadly, medications do not fix this aspect of epilepsy and some even make it worse.

Here’s the rub. The way that brain cells regulate their firing is the exact same way that the heart regulates its rhythm. It makes absolute complete sense that there is a potential for sudden cardiac death in persons with epilepsy, leading to SUDEP.

This study also highlights an additional underlying concern; epileptics need to focus on leading a brain-healthy lifestyle. This same lifestyle is inherently protective against heart disease. And yet, in this study, it seems like the participants with epilepsy actually had worse cardiovascular health than their non-epileptic counterparts.

Not good.

Having Seizures? What are YOU Doing to Protect Your Brain?

June 2, 2015 by James Bogash

There are natural remedies for seizures that have shown strong effectiveness in medical studies; the same types of studies that are used to document the effectiveness of the drugs that are used to treat seizures.

In other words, natural approaches to helping seizures like good sleep, omega 3 fatty acids, vitamin D, the ketogenic diet and exercise have just as much support behind them as do the drugs used to treat epilepsy. But for some reason these approaches take a back seat to medications.

They are used as a last-ditch-backup-plan effort. And even then sometimes only after you ask your neurologist about them. There is this general bias that, if something is not a drug then it’s not really going to be as effective or powerful.

This bias extends throughout all specialties. How many oncologists talk to their patients about dietary changes and exercise? In my experience all too few. And this is despite many studies that find that dietary factors can double survival rate (good choices) or lower life expectancy (bad choices).

Given the many lifestyle choices that can have an active role and benefit in seizure severity, frequency and response to treatment, these are choices that every epileptic should be embracing.

Right?

I mean—it’s your BRAIN we’re talking about here. Not the pinky toe on your left foot or the nail of your index finger.

Which makes the results of this particular study a little bit more disturbing. In it, researchers looked at how many people with seizures where living a lifestyle that includes some of these simple recommendations. Here’s what they found:

About 22% of adults with active epilepsy smoked.
Only 35% of adults with active epilepsy met recommended physical activity guidelines.
Only 40% with active epilepsy reported walking for at least 10 min during the last 7 days.
Only 50% with active epilepsy reported sleeping 7 or 8 hours each day.

These are all brain-healthy behaviors that have been shown to have an impact on either the severity or frequencies of seizures or the response to anti-seizure medications. Despite this, these simple behaviors are performed at a way higher rate than they should be in people with epilepsy. And at a worse rate then the general population who do not experience seizures.

Maybe some of these percentages are due to the seizures themselves. Maybe epileptic patients are sleeping as well because of medications. Maybe they are unable to exercise because of the danger to injuring themselves or because they are too sore from the grand mal they had yesterday. And I’m sure that is the case for some of the people questioned for this study.

But smoking? There’s no excuse to make a distinct effort at quitting a behavior that is literally destroying your brain all by itself, but then is making your epilepsy worse.

There is the chance that this is due a lack of emphasis on the part of the treating physician in regards to how important these choices are for overall brain health, especially in someone who is already challenged in the brain-health department.

If you are epileptic, it is up to YOU to protect your brain in every way possible. It is up to YOU to educate yourself on ways to do so (and, if I may add, checking out my Migraines and Epilepsy book would be a good idea to start you along your way). And most importantly, it’s up to YOU to adopt these brain-healthy behaviors so that you can better control or even eliminate your seizures for a lifetime.

Anti-Seizure Medications: Are You on Too Many?

May 25, 2015 by James Bogash

seizure medication use — Too many seizure meds may create problems

The mainstream approach to treating seizures is to use medications. And it pretty much stops there.

You may get some cursory advice to exercise and watch your stress levels, but the reality is that many neurologists believe that nothing you can do will be as powerful as the anti-seizure medications.

When those medications don’t work at all (which is about 30% of the time) another medication is tried. Most of this is guesswork. There really is no science behind who will benefit from Drug A over Drug B. Much of this is provider experiences—they go with what they know. And they are more likely to try the new fancy drugs over the older ones that have decades of history.

When the list of drugs doesn’t work or doesn’t give adequate seizure control, another drug is added to the mix. At this point, we’re completely out of the realm of double-blind placebo controlled studies and into guesswork.

Every anti-epileptic drug has a list of side effects. Some minor, some life-debilitating. And the more drugs you add in, the longer this list of side effects becomes. And this still does not guarantee that the seizures will be controlled.

Poor controlled seizures are called refractory. In this interesting study, researchers took 962 patients with drug refractory epilepsy and put them in a neurology ward to see what would happen if the number of medications they were on were reduced from an average of 4.24 down to a maximum of three AEDs during their stay in the ward.

Personally, I think 3 meds still sounds like an awful lot of foreign chemicals running through the brain. I’d wonder how many of these patients were also trying natural approaches to seizures that have been shown to be effective like exercise, omega 3 fatty acids, vitamin D and diet.

Here’s what they found after these patients were followed up 6 months later:

After the tapering of the drugs, patients were on an average of 2.65 AEDs.
In 82.7% patients there was either a REDUCTION in seizure frequency or no change at all.

So basically, taking these patients off of some of their drugs led to no change or an actual improvement in seizure frequency. Clearly there is something wrong with the way these patients were managed. For me, this makes it clear that medications are not the only answer and can actually begin to create more problems than they solve.

If you suffer from seizures and the first medication that you take does not adequately control your seizures, it is clear that you can no longer rely on medications alone to help heal your brain.

While it is beyond the scope of this post to outline things that can be done to heal your brain, feel free to check out my Migraines and Epilepsy book by clicking here.

MS, Seizures, Migraines–Can Your Gut Protect Your Brain?

April 18, 2015 by James Bogash

gut bacteria and the brain — fotoliaxrender / Dollar Photo Club

Anyone with a neurological condition, whether anxiety, depression, epilepsy, migraines or MS, will tell you that symptoms wax and wane. But why?

While a common occurrence, it seems that few question why this is so. It is considered more as just a course of the condition. But what if the fluctuations of symptoms are not only explainable, but possibly controllable?

The blood brain barrier (BBB) is a layer of cells that basically separates your brain cells from the rest of your body. Consider it like the Great Wall of China for your brain. And there are very specific gates that restrict access to only what your brain needs. Even immune cells cannot cross this barrier. Luckily, the brain has its own set of immune cells (called the microglia) to fight off anything that threatens to attack the brain cells.

The BBB develops very early in the womb and, as a result, the immune system never really “sees” the cells that make up the central nervous system. In other words, it’s a very sheltered, protected environment due to the presence of the BBB. Or at least it would be if the BBB remain intact.

We know that in certain neurological conditions, like multiple sclerosis (MS), the BBB solidity fluctuates, sometimes doing what it is supposed to be doing and sometimes letting in chemicals, compounds and immune cells that the brain would be better off not being exposed to. This leaky BBB has been linked to symptom flare ups in MS.

What if you could better control your blood brain barrier through lifestyle choices? That’s exactly the question raised by this particular study. In it, researchers looked at two groups of mice. The first were born to mothers who were raised in sterile, germ-free environments. In other words, this group of mice did not have the benefit of being exposed to bacteria from the womb on. The second group was born to mothers who were raised with normal exposures to bacteria.

Here’s what happened:

The germ-free mice had a leaky BBB while the normal mice did not.
The leaky BBB started in the womb and continued through birth and during adulthood.
The mice with leaky BBB had reduced expression of proteins that protect the brain barrier (tight junction proteins occludin and claudin-5).
However, when the gut bacteria from the normal mice were put into the damaged BBB mice, the blood brain barrier stabilized and there was a higher production of tight junction proteins.

This is an animal study and done under controlled conditions, but given how much the gut bacteria have been shown to play a role in other neurological conditions, the results of this study are likely to fit in with what we already know. The relationship between the bacteria in our gut and just about every aspect of health is literally exploding at an exponential rate. It seems like every day we learn more about how it affects our health and risk of chronic disease.

Despite this, I have patients come in time and time and time again given drugs like antibiotics, steroids and NSAIDs that completely disrupt the delicate balance of the bacteria in the gut. This remains a topic that mainstream medicine seems determine to remain oblivious to no matter how much research is published.

Chronic Migraines and Seizures Linked-Does Your Neuro Know?

February 28, 2015 by James Bogash

One of the first reactions to my Migraines and Epilepsy book is that people don’t understand what these two conditions have in common.

At it’s foundation, these two conditions share the same mechanism. I have personally known this for at least a decade, but the information seems to be taking a while to get out there. Which may seem strange because chronic migraine headaches and seizures are both within the realm of neurology. Indeed, over the past few years there has been increasing overlap between anti-seizure drugs being used to treat migraines (Topamax, for example). Taking this even further, anti-seizure medications like Depakote have also been used to treat certain psychological disorders like bipolar disorder.

All in all, if you can take a step back you can see that many of the “brain” conditions overlap. There is a high incidence of depression in those who suffer from seizures. Anxiety disorder is also found in much higher numbers in people with epilepsy. And of course, the aforementioned relationship between seizures and migraines headaches has been demonstrated fairly consistently in clinical studies.

In many cases these relationships are termed “comorbidities” meaning that they occur commonly together. Kind of like curds and whey. You can certainly have curds without whey or whey without curds, and neither choice is really connected together other than at some point someone decided to start a trend of eating them together (most likely Little Miss Muffet…).

In most comorbidities pointed out by mainstream medicine the conclusion almost always recommendations to look for the comorbid condition and throw medications at this problem as well. Need an example? How about high cholesterol and high blood pressure? Two conditions that are frequently seen together and considered comorbidities. And these conditions are given two completely different types of meds for each one.

But these conditions are NOT two separate conditions!!! Ugh! At what point will medicine wake up and realize that, in almost every case, comorbid conditions are two conditions that occur from the same problem. Sticking with the use of analogies, if your car has a severely worn out tire that is flip-flopping and making all kinds of noises as you drive as well as pulling the car to the right would it make ANY sense to adjust the steering so it counteracts the pulling and then turn up the radio so you don’t hear the flip-flopping?

Of course not!! That would be the most asinine thing you could imagine and you’d shoot the mechanic who recommended this two-pronged “fix.”

Welcome to medicine.

When we identify two conditions occurring at a high frequency with one another, never do we step back and ask, “Hey! What on Earth could be wrong with the body to produce both migraines and seizures?”

Nope. We just add on more medications for the second condition.

When it comes to both migraines and seizures there has been evidence for many years now that the underlying mechanism is the same or at least real similar. The underlying problem centers around the ability of the brain cells to generate enough energy for that brain cell to function optimally. Without enough energy the brain cell goes haywire. In some people this produces a migraine, in others a seizure.

Now, it’s not quite that simple, but that’s the basics. This is also why so many things that have been shown to be helpful for migraines are helpful for seizures and vice versa. Exercise, essential fatty acids, antioxidants, magnesium, vitamin D….the list is pretty long.

So what does all of this have to do with this particular study? In it, researchers asked 772 neurologists across 89 hospitals as well as two tertiary epilepsy clinics about whether they thought current headaches are more frequent in people with epilepsy than in the general population. Keep in mind that this relationship has been understood for some time now and I have written about this in past blog posts. In other words, it’s not new news.

Here’s what the researchers found:

Only 1/3 of the neurologists correctly understood that headaches are more common among people with epilepsy.
A mere 8% understood that these headaches are consistent with migraine.
The number of years of experience did not influence knowledge on headaches in epilepsy patients.
However, the interest in epilepsy and the number of epilepsy patients per month seen in the polyclinic did.

I have said time and time again that the vast majority of physicians are decades behind the medical research, specialists included. This article just reinforces the idea that there is a VERY good chance that your neurologist does not really understand the relationship between chronic migraine headaches and seizures. Maybe you could buy him or her a copy of my book for Christmas…