New evidence shows that vaccines, allergies or nutritional deficiencies may bring on epileptic seizures, and certain simple dietary changes may control them without drugs.

Epilepsy is surrounded by a great deal of ignorance. As recently as 1978, two priests in Switzerland were asked to perform an exorcism on a 22-year-old woman whose family thought she was possessed by the devil. Just nine years ago, it was reported that a British child was told not to play with a classmate who suffered from epilepsy “because she was a witch.”

The British charity, Epilepsy and the Young Adult (EYA), says epilepsy affects about one in 200 UK adults. According to Dr Harris L Coulter, the celebrated medical researcher and writer, the number of recorded cases of epilepsy in the US has increased threefold since 1940 when there were 2.7 cases per 1,000 inhabitants. In 1990, this had become 10 cases per 1,000: “No one knows whether this is due to the treatment, or the condition itself,” he declares.

Anyone can have an epileptic fit, or seizure (the word “epilepsy” comes from the Greek “epi lambano” meaning “a taking hold of”), which happens when the brain’s chemical balance is upset and the nerve cells fire off signals in all directions. It’s rather like an electrical storm in your brain, and it can take many forms. Idiopathic epilepsy can be caused by a range of circumstances some genetic, some congenital. Symptomatic epilepsy occurs when a specific part of the brain has been damaged by an injury, infection or a tumour.

According to Coulter, epilepsy is very much associated with violent behaviour in the modern society: “Violent criminals tend to have a very high incidence of seizure,” he says.

His 1975 study of three US jails found that 5 per cent of prisoners had a history of seizures or epilepsy about 10 times higher than in the population at large.

Current research into epilepsy’s various causes has also begun to

focus on the link between epilepsy and vaccination (see box, p 2).

Recent British government research shows that the DTP (diphtheria tetanus pertussis) and MMR (measles mumps rubella) vaccines can increase the risk of seizure five-fold. Even though the American government has been busy reassuring the country that the measles vaccine is perfectly safe, its Public Health Laboratory Service Statistics Unit has found that the combined two produced seizures three times more than was previousley reported, and that DTP schedule is responsible for a four-fold increase in seizures (see WDDTY vol 1, no 8).

It appears extraordinary that the British government is not rethinking its action in the light of the US evidence which shows that DTP vaccine caused convulsions in infants less than a year old, usually three days after they’d been given the dose. The MMR vaccine took longer to cause convulsions between 15 and 35 days afterwards.

This study, by the US Centers for Disease Control and Prevention in Atlanta, is based on the most complete data yet compiled and monitors the progress of 500,000 children, by far the most ever observed by a single piece of research.

The seizure rate was found to be three times the norm for children receiving the DTP shot. The rate rose 2.7 times within four to seven days for children being given the MMR shot and this increased to 3.3 times within eight to 14 days. Nevertheless, the evidence was never made public, and WDDTY only got hold of the evidence via one of the cluster of scientists present at the meeting.

The US medical authorities have been unwilling to contemplate the possibility that vaccinations cause epilepsy because they have a government programme promoting vaccinations, with another studying the causes of epilepsy: “One is not going to try the other,” continues Coulter.

“But it’s as plain as your nose on your face; vaccines cause neurological disabilities. It’s just that nobody wants to admit it, that’s all,” said Coulter.

Rather than attempting to isolate the cause, doctors commonly prescribe drugs to control the condition, and a lot of people are kept on drugs for a lifetime only because they’ve had a minor fit during childhood.

Most doctors believe that, until suppressed by drugs, seizures will recur and that drug treatment can affect the course of the disease, reducing the risk that early epilepsy will develop into an intractible disorder.

According to a review paper by EH Reynolds, Consultant Neurologist at the Centre of Epilepsy, Maudsley Hospital, London (BMJ January 21, 1995), several studies show that the more seizures, the worse the prognosis (Epilepsia, 1989; 30: 648), and that patients with single seizures did better, in the medium term, when they got drugs, compared to those who’d been given placebo, or had treatment delayed (Clin Neurol Neurosurg 1992; 94 [Suppl]: S61-3; and Neurology 1993; 432: 478-83).

Anti-convulsants are supposed to work by preventing epileptic fits without affecting the brain. But this is a delicate balancing act. The doctor needs to be highly conversant with the various anti-convulsant drugs, understand how different seizures affect particular patients, regularly monitor the patient to record the seizures and how the drug they’ve prescribed is behaving inside the patient.

And treatment varies from doctor to doctor. Some feel their patients should take anti-epileptic drugs for the rest of their lives; others feel daily doses can be slowly reduced by steps every few weeks in patients who have remained free from seizures for two years. They may even be taken off drugs altogether.

David Chadwick, Professor of Neurology at the Walton Centre for Neurology and Neurosurgery, presents a strong argument against the early use of drugs in the same January 21 edition of the BMJ and recommends that treatment should be held off. He argues that epilepsy is an umbrella term which refers to a group of disorders, and not a single, homogenous disease. In some clearcut cases of epilepsy, such as benign rolandic epilepsy in children (where seizures affecting the face, throat and arm occur during sleep), there is strong evidence that the seizures stop by themselves by mid-adolescence.

Furthermore, preliminary data suggesting that people are better off getting drugs after early treatment is far from definitive because untreated epileptics are difficult to find.

Studies that are performed suggest that drugs make virtually no difference. “This makes it all the more important that reliable data is obtained,” says Peter Rubin, Professor of Therapeutics at Nottingham University (BMJ, January 21, 1995; 310: 178).

None of the thousand patients participating in the Medical Research Council’s anti-convulsant withdrawal study group had a fit in two years (The Lancet, May 18, 1991). The study concluded that the chances of remaining seizure free were directly related to the length of time since the last fit. Those with the poorest reaction to drug withdrawal were patients who’d been taking more than one anti-epileptic drug, or had a history of neonatal seizures.

However, one WDDTY reader further maintains that the underlying cause of her seizures are anti-convulsants prescribed to control epilepsy in the first place. They also induce a number of side effects, the most common being drowsiness and confusion.

The most widely used anti-convulsants are sodium valproate (Epilim) and carbamazepine (Tegretol), both of which can control generalized and partial seizures.

Phenytoin (Epanutin, Dilatin) is used for generalized fits, but you must have your blood checked regularly since a small increase in dose may create toxins (poisons) in the blood. It can also increase the frequency of the fits. A 1994 study shows epileptic women receiving phenytoin are inherently more likely to bear malformed children (JAMA, September 21, 1994).

The Physician’s Desk Reference says that all epileptic drugs can cause birth defects. Specifically, it says valproic acid “may produce teratogenic effects in the offspring of human females receiving the drug during pregnancy. . .Therefore, anti-epileptic drugs should be administered to women of childbearing potential only if they are clearly shown to be essential in the management of their seizures.”

Congenital malformations are two to three times more frequent in babies born to women with epilepsy, and it’s now accepted that part of the reason is the ability of anti-convulsants to cause birth defects. In fact, these birth defects have now been labelled as “fetal valproate syndrome” characterized by distinctive facial features and possibly including spina bifida, heart disease, cleft lip or palate, limb defects and genital malformations (J Med Genetics, 1995; 32: 724-7).

The Centers for Disease Control estimates the risk of valproic-exposed-women having children with spina bifida to be approximately 1 to 2 per cent, a risk similar to that for non-epileptic women who have had children with neural tube defects.

In the past, doctors have blamed the well documented increase in frequency of reproductive disorders seen in epileptics on the condition itself. However, a Finnish study of 238 women aged between 18 to 45 taking anti-epilepsy drugs for an average of nine years suggests that conditions such as polycystic ovarian disease (which causes ovarian cysts) plus raised levels of testosterone (the male hormone) and menstrual problems may be a result of the treatment, rather than the disease (N Eng J Med, November 4, 1993).

Ethosuximide controls “absences” (when you look blank and stare, the eyelids twitch, flutter or blink it’s a condition that lasts just for a few seconds), but can make other kinds of epilepsy worse and so is only given in certain circumstances.

Phenobarbitone, a barbiturate, is also sometimes prescribed, but this also carries a host of serious risks, which include Parkinsonian effects (involuntary movements), impaired judgement, drowsiness, allergic reactions and depressed breathing.

In the last four years, two new drugs have been introduced in the UK. Vigabatrin, or Lamictal, supposedly causes fewer side effects than carmazepine (more commonly prescribed, but whose side effects include rashes and sleepiness), although this is currently being debated (The Lancet, May 20, 1995) and may result in a clash of two evils.

There have also been deaths following the use of the drug. Wellcome Medical Division, which manufactures Lamotrigine, states in the Data Sheet Compendium that: “During clinical trials in over 4,000 patients receiving multiple anti-epileptic therapy, including Lamotrigine, there have been, rarely, deaths following rapidly progressive illnesses with

status epilepticus (continuous seizures without recovery of consciousness between attacks), multi-organ dysfunction and Disseminated Intravascular Coagulation or DIC. The contribution of Lamotrigine to these events remains to be established”.

However, a case of Stevens-Johnson Syndrome has been associated with Lamotrigine as well as three cases of multi-organ failure through its use in recent years (The Lancet, August 13, 1994).

Liver damage has also been linked with Epilim, particularly in children and those with mental retardation, and although this is rare, these drugs become more dangerous if used together. The 35-year-old, mentally handicapped son of one WDDTY reader used to take Epilim, Tegretol and folic acid every day, but died after he’d been prescribed a daily 50mg tablet of Lamictal.

!AClive Couldwell

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