WEANING FROM ANTI-CONVULSANT MEDICATION IN AN AUTISTIC EPILEPTIC CHILD Chanchal Cabrera MSc MNIMH, AHG
Andrew was 4 ½ years old when his mother brought him to see me the first time in April
1996. He had been diagnosed in December 1995 with mild (high functioning) autism and was attending a pre-school for developmentally challenged children. In the office he was bright, cheerful and chatty although his conversation was unintelligible and his movements erratic and uncoordinated. His pediatrician was considering a concurrent diagnosis of attention-deficit-hyperactivity-disorder.
In October 1995 he had a febrile seizure which was followed by a cluster of non-febrile
seizures in January and February of 1996. Each was a grand mal type with full tonic and clonic phases. There was no evidence of petit mal seizures.
There was some difficulty in establishing appropriate medication types and doses. Initial
medication was Dilantin but this was considered too strong for a small child so it was soon changed to Clobazam. This caused extreme abdominal bloating, belching, flatulence and bowel looseness. In March 1996 his medication was switched to Lamotrigine which reduced the digestive disturbance but after 10 days he experienced another cluster of febrile seizures with a temperature of 400 C which lasted several days. Following this he was put back on Clobazam alongside the Lamotrigine. This caused a recurrence of the digestive disturbance and he also developed a severe and widespread skin rash. When he presented in my clinic he had been switched to Tegretol at 350 mg and had been stable for a month. He was having no more bowel disturbance and had no seizures.
The major side effect though, which made his mother understandably concerned, was that the
medication was making him very drowsy and his autistic symptoms were much exaggerated. He was weepy and clingy, afraid to be alone, very introverted, his speech and his socializing skills had regressed and he was experiencing day time and night time enuresis which he had not done for over a year previously. His doctors were suggesting that he should stay on Tegretol for many years, at least through puberty, and his mother was concerned that this would impair his ability to learn to cope with autism. Thus our therapeutic aim was to wean him off the Tegretol and keep him seizure free.
My first action was to refer him to a neurologist that specialized in seizure disorders of
children and that was very sympathetic to alternative and complementary health care. I felt it was necessary to do this before attempting to reduce the Tegretol so that we could have adequate monitoring of the situation. I also recommended that he undergo extensive food and environmental allergy testing by the Vega (electrodermal screening) method as well as hair element analysis.
Vega testing revealed significant sensitivity to many foods, most notably wheat, nuts, milk,
lactose and all dairy products, aspartame, MSG, strawberries, pork and all pig products, shellfish, chocolate, cocoa and alcohol as well as to dust mites, molds, sulphites, phenolic resins and fluoride.
Hair analysis revealed very low levels of calcium, magnesium, chromium, cobalt, lithium,
manganese, molybdenum, vanadium and germanium, slightly low levels of selenium and zinc and a very elevated copper level.
With the information gained from these tests we made some significant adjustments to his
diet. All allergenic foods were completely eliminated and he was given a liquid nutritional supplement with balanced minerals and vitamins. I was especially concerned to raise the calcium and magnesium levels because calcium is intimately involved in the transmission of nervous
impulses and low levels have been suggested as a causative factor in seizure disorders. The high copper was also a concern because it may cause nervousness, depression, irritability, behavior problems and learning disabilities in children.1 It was also important to maintain adequate levels of vitamin B6 because repeated studies have shown its benefits in stabilizing brain wave patterns and improving cognitive development in autistic children.2 Murray notes that B6 supplementation is more effective when taken with magnesium. 3
Because of Andrew’s sensitivity to alcohol, and because of his age, I decided not to use
tinctures in this case but to work with simple herbal teas. The plan was to get him established with the herbal formula and dietary adjustments then to slowly wean him off the Tegretol, monitoring him closely and working with the full cooperation of the neurologist. We planned to reduce the dose of medication by 25 mg every 4 - 8 weeks after he had been on the herbs for at least 4 months. Tea blend Avena
Hypericum perforatum (St. John’s Wort)
The dose was 3 teaspoons of the blend steeped in 2 cups of boiling water, to be sipped throughout the day. Rationale
The primary herb in this blend was the Avena. This is considered a powerful amphoteric
(balancing and normalizing agent) to the nervous system, being both a stimulant tonic and a sedative as required. In this case we wanted to sedate the over activity leading to seizures without reducing his mental alertness or causing him to be more drowsy - a contradiction well suited to the use of Avena. Bartram suggests that it is a nerve tonic, restorative, antidepressant and tranquillizer as well as being a rich source of minerals with a nutritive specificity for the brain.4 Weiss mentions the presence of an indole alkaloid called gramine which is not unlike the harmine group found to be sedative and hypnotic in Passionflower.5 Ellingwood recommends it especially for epilepsy nervous depression, and in particular with Cimicifuga and Scutalleria for trembling, spasms and twitching.6
Hypericum, likewise, is traditionally considered an amphoteric and a tonic restorative to the
brain, being sedative and anti-depressant and useful for balancing and regulating all brain function. It has entered popular usage as a powerful but safe anti-depressant akin to but milder than the selective serotonin re-uptake inhibitors such as Prozac, Paxil and Zoloft. Multiple studies have found this to be an effective treatment for mild to moderate depression although it may take up to 3 weeks for it to be clinically effective.7 Weiss also mentions a specific action of Hypericum against enuresis.8
The Chamomilla, Scutalleria, Valeriana are all sedative or hypnotic agents with pronounced
relaxing and anti-spasmodic activity. Newall et al report that Valeriana has a pronounced inhibitory effect on the enzymes responsible for the degradation of GABA (gamma amino butyric acid - an
inhibitory neurotransmitter) and this causes depression of CNS activity. It also exhibits a direct action on smooth muscle receptors to inhibit muscle activity.9 Bartram recommends Valeriana specifically for nervous tension, excitability, convulsions, irritability and mental confusion.10 Scutalleria may be usefully employed wherever there is over excitability of the nervous system. Ellingwood recommends it for nervous irritability and restlessness as well as nervous disorders characterized by irregular muscular activity, twitching, tremors, restlessness and incoordination.11 The British Herbal Compendium lists it as a sedative, relaxant and spasmolytic.12 Tisserand states that the volatile oil of Valerian contains valeranone, valerenic acid and valeranal all of which are sedative and have a depressant action on the CNS.13 Chamomile is a traditional remedy for anxiety, restlessness and hysteria. Willard says that the bitter principle (anthemic acid) is responsible for the relaxing nervine properties and tiglic acid, apigenin glycoside and chamazulene in the volatile oil are responsible for the anti-spasmodic effect.14 Chamomile also contains a bitter element which acts as gentle digestive stimulant and normalizer.
Cimicifuga and Lobelia were included specifically for their anti-spasmodic actions. Lobelia
contains many alkaloids, chief among which is lobeline. This has an depressant action on the CNS and is antispasmodic.15 Ellingwood recommends Lobelia as a powerful anti-convulsant specific for childhood epilepsy.16 Bartram recommends Cimicifuga as a relaxing nervine, sedative, spasmolytic and vaso-dilator, a regulator of the autonomic nervous functions and as a specific for hysteria and nervous depression.17
Verbena was included both as a nervine and a stomachic. It is quite bitter and stimulates
appetite, production of digestive enzymes, mucus and hydrochloric acid, hepatic and biliary activity and the absorption of nutrients and elimination of wastes. Additionally is has long been considered the best tonic nervine, being stimulating and relaxing at the same time.18 It is traditionally used for epilepsy and convulsions. It has been shown to stimulate both sympathetic and parasympathetic tone, which herbalists believe points to the herb’s intrinsically balancing or regulating effect upon the nervous system.
Centella was included in this formula for it energizing tonic effect upon brain tissue. Newall
et al describe animal studies in which the terpenoids brahmoside and brahminoside were demonstrated to decrease motor activity of the CNS via a cholinergic mechanism, and a human study in which another terpenoid called asiaticoside improved the general ability and behavioral patterns of 30 mentally retarded children when given over a period of 12 weeks.19 Bartram lists it as an adaptogen, alterative, bitter digestive tonic and relaxant to the nervous system and he recommends it for overcoming stress, fatigue and mental confusion.20 Clinical outcome
Andrew’s family was very committed to helping him so they followed the dietary restrictions
diligently. He took the nutritional supplements and herbal tea quite happily. After three months of following this regime his mother reported that he was generally calmer and less frenetic. His speech had improved significantly and she attributed this in part to the fact that he was now sitting quietly and paying attention. He had no seizures.
Over the next several months I continued to see Andrew’s mother periodically. Each time she
reported that he was doing better and better. His social skills were improving, he was happier and better behaved in school and at home. His motor coordination also improved and could dress himself for the first time. His family moved house and he began a new behavior modification program with intensive one-on-one coaching, and despite all these changes and stresses he had no seizures. He had
a bad cold and high fever (39.50C) on one occasion but remained seizure free.
6 months after commencing the herbal treatment Andrew’s mother felt confident to try
reducing the dose of Tegretol. She reduced the dose by 25 mg per month over a period a year. Throughout this time, and continuing to the present, she maintained the dietary restrictions and the supplements. After 14 months he was drug free and he has remained stable for over a year now. He has had no epileptic episodes and his autism continues to improve. He remains in the intensive behavior modification program and is doing very well. He continues to drink the tea and will do so until he passes puberty (the highest risk age for seizure disorders). We have retested his allergies twice and they remain the same. We discussed the possibility of desensitization but decided that he was doing quite well on the diet and we should make only one major change at a time. This may be something to return to in the future. I also later prescribed evening primrose oil and fish oil to provide essential fatty acids for brain development. Conclusion
This case is a nice example of the tonic action of herbs working over extended periods of
time. Andrew’s mother was cautious and patient. She was satisfied that he was doing better behaviorally, at least, before embarking on the drug reduction protocol. It also helped immensely that she was so committed to making the dietary changes. Clearly the underlying autism will never be cured but this should never stop a practitioner from attempting to improve the situation. The safe and nutritive attributes of herbs make them ideally suited to this tonic approach. The anti-spasmodics in the tea will help to keep him seizure free, but we hope that the Avena and Hypericum will also nourish the brain and improve overall brain function. 1. Correspondence with Omegatech Medical Laboratory, Cleveland, Ohio
2. Information from The Autism Research Institute, San Diego, CA
3. Michael Murray, Encyclopedia of Nutritional Supplements, Prima Publishing, 1996, p.103
4. Thomas Bartram, Encyclopedia of Herbal Medicine, Grace Publishers, 1995, p. 315
5. Rudolph Weiss MD, Herbal Medicine, Beaconsfield Publishers, 1988, p 287
6. Finley Ellingwood MD, American Materia Medica, Therapeutics and Pharmacognosy, Eclectic Medical Publications 1994 (first published 1919), p. 204
7. C. Newall, L. Anderson & D. Phillipson, Herbal Medicines - A Guide for Health Care Professionals, The Pharmaceutical Press, 1996, p.250
9. C. Newall, L. Anderson & D. Phillipson, ibid, p.260
11. Finley Ellingwood, ibid, p.123
12. Ed. Peter Bradley The British Herbal Compendium, The British Herbal Medicine Association, 1992, p. 214
13. Robert Tisserand & Tony Balacs, Essential Oil Safety, Churchill Livingstone, 1995, p.73
14. Terry Willard, The Wild Rose Scientific Herbal, Wild Rose Publications, 1991, p.74
15. C. Newall, L. Anderson & D. Phillipson, ibid, p.187
16. Finley Ellingwood, ibid, p.240
19. C. Newall, L. Anderson & D. Phillipson, ibid, p. 170
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