LifeCare Chiropractic

The Best Chiropractic Care in Mesa, Arizona

status epilepticus

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

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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:

  1. 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 .
  2. 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.

 

Can Diet Control the Worst Type of Seizures???

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There is no way that something as simple and uncomplicated as diet can manage the worst-case scenario of epileptic seizures. Not when we have so many powerful drugs to control seizures.

This would seem to be the attitude of most neurologists because diet is usually the absolute last thing they would ever mention, and that is only after every anti-epileptic drug on the planet has not worked. But here’s a scary statistic: In only about 30% of the time does the first anti-seizure medication work to control someone’s seizures. The more medications that are tried, the less likely the next one is going to work. Ultimately, the number of epileptics who do not respond fully to medications may be as high as 40%.

Not good.

Status epilepticus is a state of perpetual seizures that can be fatal and usually needs some type of emergency treatment to control the seizures. In the ER, treatment usually starts with sedatives like benzodiazepine (Valium, Xanax) or, if that doesn’t work, anesthetic agents like propofol (although recent studies suggest that this actually increases the risk of infections and death) are given via IV. But when a seizure cannot be controlled it is called refractory.

Putting this together makes refractory status epilepticus a very dangerous situation with no options. At least, not until someone thought of using diet to control this most dangerous type of seizure. Specifically, the ketogenic diet. The use of the very low carb diet for seizure control is not new and has been shown, in trial after trial after trial, to possess very potent anti-seizure effects. In the case of status epilepticus, after the patient is locked in the seizure state for a certain period of time, feeding usually switches to a feeding tube (enteral), so switching to a ketogenic-based formula is not a problem.

This particular study looked at the treatment of 10 patients who were locked in status epilepticus. Here are the details:

• 7 of the 10 had encephalitis (swelling of the brain due to the severity of the seizures).
• The average time that the patient was in seizure was 21.5 days.
• The average number of antiepileptic medications used before the diet was 7.
• In the 90% that achieved ketosis, seizures ceased in an average of 3 days.
• 3 had minor complications (transient acidosis, hypertriglyceridemia).
• 2 patients ultimately died of causes unrelated to the diet.

While this is a small group of patients, the outcomes achieved for such a safe intervention are more than impressive. They are lifesaving. So I will ask the same question I always ask: WHY is the ketogenic diet the last tool used when the research is so compelling and the safety is so high?

Melatonin Shines Again for the Most Dangerous Seizures

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Seizures are very, very bad for the brain. Status epilepticus is the term for uncontrolled, unstoppable seizures.

Very often, these patients end up in the emergency room pumped full of sedatives just to stop the seizures. The damage to the brain under status epilepticus is even worse than that which occurs with single seizures.

Not to belittle the ongoing damage to is occurring in the brain of epileptics during the interictal (in between seizures) period. Few epileptics are educated on this little tidbit. Most fear the dreaded SUDEP (sudden unexpected death in epilepsy), although the likelihood of any epileptic passing from SUDEP is very small.

The bottom line is that anything that can be done to protect the epileptic brain is a very good thing, whether having seizures or not. This is not to be confused with controlling seizures, since none of the anti-epileptic drugs actually work at protecting and improving brain health.
Which brings us to this particular study. While it is a mouse study, this is not the first time that research has demonstrated that melatonin can help to protect the brain.

In the study, researchers looked to see if melatonin could protect the brain during status epilepticus, arguably the worst-case scenario in an epileptic. Here’s what they found:

  • Melatonin use was able to reduce seizure activity
  • Melatonin reduced the brain cell damage in certain areas of the brain (CA1 area of the hippocampus and piriform cortex).
  • Melatonin decreased the hippocampal serotonin (5-HT) levels.

For something as simple as melatonin, these are some pretty important effects. As a brief primer, the pineal gland deep in the brain releases melatonin once sunlight stops hitting the eyes. Melatonin and serotonin are on the same metabolic pathway derived from the amino acid tryptophan. When sunlight is present, the pathway stops at serotonin. Once darkness arrives (and we are not exposed to blue light) the pathway continues to melatonin.

Interestingly, depression is closely associated with epilepsy. It would not be unreasonable to assume that the tryptophan to serotonin to melatonin pathway is somehow affected, making the supplementation of melatonin a very reasonable recommendation in any epileptic.

In our office, we start with .5 mg, a very small dose. Most patients mistakenly start themselves at much higher dosages.