The use of complementary medicines and alternative practitioners in a cohort of patients with epilepsy
Introduction
Complementary and alternative medicine (CAM) is the term used to describe a heterogeneous group of health-related therapies and disciplines not considered part of orthodox medical care [1]. A study in 1999 found 50,000 CAM practitioners in the United Kingdom, with another 10,000 registered health care professionals offering the service in addition to conventional medicine [1]. Some 5 million people per year are estimated to consult a CAM practitioner in the United Kingdom [1]. Another study reported 20% of the UK population have either visited a CAM therapist or purchased over-the-counter CAM remedies [2]. In the United States, the figure is even higher; one study showed 42% of 2000 people surveyed had used CAM at some point in the previous year [3].
Both in vivo and in vitro studies have demonstrated that herbal remedies exert biological effects. St. John’s wort (hypericum) [4], garlic [5], echinacea, licorice, and Trifolium pratense (wild cherry) inhibit the cytochrome P450 system with the consequent risk of increased antiepileptic drug (AED) levels and toxicity [6]. Shankpushi, an Ayurvedic medicine used for epilepsy, lowers phenytoin levels [7]. Ginkgo biloba, used for memory failure, appears to reduce seizure threshold, as do evening primrose oil and starflower [8]. Conversely, ginseng inhibits epileptiform activity in rat hippocampal slices [9].
As CAM use is common, it is logical to assume that patients with epilepsy may use CAMs either for general health purposes or specifically for their epilepsy. Yet there have been few studies of patients’ attitudes to and use of CAMs.
Section snippets
Objective
The goal of this study was to ascertain the use of complementary medicines and alternative therapies in consecutive patients attending specialist epilepsy clinics attached to a neuroscience center and community-based clinics under general practitioner supervision.
Methods
Four hundred structured questionnaires were distributed to consecutive patients aged 16 years and older attending epilepsy clinics attached to the Greater Manchester Neurosciences Centre. Patients attending Community Awareness and Resources for Epilepsy (CARE) clinics whose epilepsy is supervised in primary care were also included. All patients had a secure diagnosis of epilepsy, and had been taking AEDs for a minimum of 6 months. Each patient was asked to complete the structured questionnaire
Results
Four hundred questionnaires were distributed. Three hundred and seventy-seven returned their questionnaires (165 men, 212 women). There was no significant age difference between the male and female groups (ANOVA, P = 0.8).
One hundred and thirty-eight people (34.6%) had used CAMs at one point. Forty-two of those (11.1%) used it at some time specifically for their epilepsy. At the time of the survey, 70 (17.5%) were using CAMs for symptoms other than seizures, and 7 (1.7%) were using it for their
Discussion
Despite the increasing use of CAMs in Europe and North America, there are few studies of its use in epilepsy. Contrary to many doctors’ expectations, patients do not opt for CAMs because of dissatisfaction with conventional medicine [10]. One postal survey of 1065 Americans found that CAM use was significantly more common in those who had further education, and found that personal commitment to beliefs such as environmentalism, feminism, spirituality, and personal growth psychology was a
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