- Email: [email protected]
Herbal Medicines and Epilepsy
199
Letters to the Editor
used protocol of the Medical College of Georgia, will be important. It would be interesting to know whether conventional neuropsychological verbal memory testing showed a similar association with duration of epilepsy or seizure load in this sample, or whether the Wada test appears to provide a unique window into this effect.
REFERENCE 1.
Blum D. Decline in verbal memory associated with duration of epilepsy: an intracarotid amobarbital study. Epilepsy Behav 2001;2:448 –53.
Bruce Hermann, Ph.D.
Department of Neurology University of Wisconsin–Madison 600 Highland Avenue Madison, Wisconsin 53792
doi:10.1006/ebeh.2002.0331
Reply To the Editor: I appreciate Dr. Hermann’s comments. I agree completely with him that site–site variability in ICAT protocols complicates the interpretation of a study performed at a single center, and I also agree that similar analysis from other centers would be useful. Conventional neuropsychological testing did not show a significant relationship with duration of epilepsy; however, turnover in neuropsychological personnel at the Barrow Neurological Institute (where the study was done) and resultant change in the manner of data collection precluded a robust analysis. The largest such review (1) showed at best a modest correlation between early age of onset and cognitive impairment, with no clear independent contribution from epilepsy duration.
REFERENCE 1.
Strauss E, Loring D, Chelune G, et al. Predicting cognitive impairment in epilepsy: findings from the Bozeman epilepsy consortium. J Clin Exp Neuropsychol 1995;17:909 –17.
David Blum, M.D.
Glaxo SmithKline 5 Moore Drive Research Triangle Park, NC 27709 doi:10.1006/ebeh.2002.0334
Herbal Medicines and Epilepsy To the Editor: We read with interest the recent review article by Dr. Spinella on herbal medicines and epilepsy (1). We think the author has provided an excellent summary of what is known about this important, yet largely understudied area. It is clear from our recent study (2) and ongoing clinical practice that many patients with epilepsy are consuming complementary and alternative medicines (CAMs) and, in many cases, not telling their health care providers. A conference was held on this very subject in November 2001 in New York City that was mainly directed to patients and their families and caregivers (http://www.epilepsyfoundation.
org/epusa/altconference.html). It is our understanding from the conference coordinators that a portion of the presentations will be compiled and available soon. We, as many others do, get inquiries from epilepsy patients about the exact risks and benefits of CAMs. Unfortunately, as Dr. Spinella pointed out, there are no prospective studies examining the benefits, risks, and/or potential drug interactions of CAMs in patients with epilepsy. With so many questions remaining unanswered, there is a huge and very present need to study this area. The National Center for Complementary and Alternative Medicine (NCCAM) at the NIH was established in 1998 and is “dedicated to exploring comple©
2002 Elsevier Science (USA) All rights reserved.
200 mentary and alternative medical (CAM) practices in the context of rigorous science; training CAM researchers and disseminating authoritative information.” A check of its clinical trial sections (http://nccam.nih.gov/ne/ clinical-trial/) failed to discover any clinical trials recruiting patients with epilepsy. It is our practice during a medication history to specifically inquire about not only over-the-counter medicine use, but also use of CAMs by patients. We believe that there is a need to educate the public about the importance of telling their health care professionals about CAM use and for health care professionals to ask patients about their use. Prospective studies regarding the effects of the most commonly used CAMs are overdue.
Letters to the Editor 2.
Peebles CT, McAuley JW, Roach J, Moore JL, Reeves AL. Alternative medicine use by patients with epilepsy. Epilepsy Behav 2000;1:74 –7.
James W. McAuley, Ph.D. 1 Ohio State University College of Pharmacy 500 West 12th Avenue Columbus, Ohio 43210 James Layne Moore, M.D. Ohio State University University Hospitals Columbus, Ohio 43210 doi:10.1006/ebeh.2002.0325
REFERENCES 1.
Spinella M. Herbal medicines and epilepsy: the potential for benefit and adverse effects. Epilepsy Behav 2001;2:524 –32.
To the Editor: Two recent articles in Epilepsy & Behavior highlight a major concern for all of us involved in the care of patients with epilepsy, namely, the concomitant use of alternative medicine (1, 2). The articles stress two major points: (1) the high frequency of use of alternative medicine, and (2) the potential problems specifically associated with herbal medications. I think that the estimates made in the Peebles et al. article regarding the frequency of total use of alternative medicine may be lower than is actually the case, although their estimate of the extent to which patients inform their neurologists seems accurate. In a recent survey performed in our epilepsy clinic, a pharmacist sought to acquire comparable information. The patient population was similar to that in the Peebles et al. study. In their study, the survey was self-administered by the patient; in ours, either a pharmacist or an epilepsy nurse (but not the treating physician) collected the information. We used a questionnaire adapted from a recent multicenter study (3). In our patient population, 80% of the patients were currently using or had recently used at least one alternative therapy; and 68% were continuing to use alterna2002 Elsevier Science (USA) All rights reserved.
©
1 To whom correspondence should be addressed. Fax: (614) 2921335. E-mail: [email protected].
tive medicine. General health promotion and disease prevention were the most common stated reasons for this. More than half of our patients (52%) had not discussed these therapies with their health care providers. Only 39% said that their physician was aware of their alternative medicine usage. These latter findings are comparable to previous observations (1, 3). In light of all the potential problems raised in the Spinella article, these observations should be of concern to us all. The differences in usage of alternative medications may, in part, be a function of geographic factors. Our institution, for example, is well known for promoting alternative therapies. Our region is very tolerant of, and in fact welcomes, this approach to care. Alternatively, the fact that our patients were interviewed to gather this information rather than providing it via self-report could account for some difference. In and of itself, this is not the issue. Rather, we as health care providers must learn of the potential interactions between commonly used alternative medicines and our “standard” epilepsy treatments. Further, we must improve communication with our patients so that we may learn about any alternative treatments they are using (typically without our prior knowledge).
Letters to the Editor
used protocol of the Medical College of Georgia, will be important. It would be interesting to know whether conventional neuropsychological verbal memory testing showed a similar association with duration of epilepsy or seizure load in this sample, or whether the Wada test appears to provide a unique window into this effect.
REFERENCE 1.
Blum D. Decline in verbal memory associated with duration of epilepsy: an intracarotid amobarbital study. Epilepsy Behav 2001;2:448 –53.
Bruce Hermann, Ph.D.
Department of Neurology University of Wisconsin–Madison 600 Highland Avenue Madison, Wisconsin 53792
doi:10.1006/ebeh.2002.0331
Reply To the Editor: I appreciate Dr. Hermann’s comments. I agree completely with him that site–site variability in ICAT protocols complicates the interpretation of a study performed at a single center, and I also agree that similar analysis from other centers would be useful. Conventional neuropsychological testing did not show a significant relationship with duration of epilepsy; however, turnover in neuropsychological personnel at the Barrow Neurological Institute (where the study was done) and resultant change in the manner of data collection precluded a robust analysis. The largest such review (1) showed at best a modest correlation between early age of onset and cognitive impairment, with no clear independent contribution from epilepsy duration.
REFERENCE 1.
Strauss E, Loring D, Chelune G, et al. Predicting cognitive impairment in epilepsy: findings from the Bozeman epilepsy consortium. J Clin Exp Neuropsychol 1995;17:909 –17.
David Blum, M.D.
Glaxo SmithKline 5 Moore Drive Research Triangle Park, NC 27709 doi:10.1006/ebeh.2002.0334
Herbal Medicines and Epilepsy To the Editor: We read with interest the recent review article by Dr. Spinella on herbal medicines and epilepsy (1). We think the author has provided an excellent summary of what is known about this important, yet largely understudied area. It is clear from our recent study (2) and ongoing clinical practice that many patients with epilepsy are consuming complementary and alternative medicines (CAMs) and, in many cases, not telling their health care providers. A conference was held on this very subject in November 2001 in New York City that was mainly directed to patients and their families and caregivers (http://www.epilepsyfoundation.
org/epusa/altconference.html). It is our understanding from the conference coordinators that a portion of the presentations will be compiled and available soon. We, as many others do, get inquiries from epilepsy patients about the exact risks and benefits of CAMs. Unfortunately, as Dr. Spinella pointed out, there are no prospective studies examining the benefits, risks, and/or potential drug interactions of CAMs in patients with epilepsy. With so many questions remaining unanswered, there is a huge and very present need to study this area. The National Center for Complementary and Alternative Medicine (NCCAM) at the NIH was established in 1998 and is “dedicated to exploring comple©
2002 Elsevier Science (USA) All rights reserved.
200 mentary and alternative medical (CAM) practices in the context of rigorous science; training CAM researchers and disseminating authoritative information.” A check of its clinical trial sections (http://nccam.nih.gov/ne/ clinical-trial/) failed to discover any clinical trials recruiting patients with epilepsy. It is our practice during a medication history to specifically inquire about not only over-the-counter medicine use, but also use of CAMs by patients. We believe that there is a need to educate the public about the importance of telling their health care professionals about CAM use and for health care professionals to ask patients about their use. Prospective studies regarding the effects of the most commonly used CAMs are overdue.
Letters to the Editor 2.
Peebles CT, McAuley JW, Roach J, Moore JL, Reeves AL. Alternative medicine use by patients with epilepsy. Epilepsy Behav 2000;1:74 –7.
James W. McAuley, Ph.D. 1 Ohio State University College of Pharmacy 500 West 12th Avenue Columbus, Ohio 43210 James Layne Moore, M.D. Ohio State University University Hospitals Columbus, Ohio 43210 doi:10.1006/ebeh.2002.0325
REFERENCES 1.
Spinella M. Herbal medicines and epilepsy: the potential for benefit and adverse effects. Epilepsy Behav 2001;2:524 –32.
To the Editor: Two recent articles in Epilepsy & Behavior highlight a major concern for all of us involved in the care of patients with epilepsy, namely, the concomitant use of alternative medicine (1, 2). The articles stress two major points: (1) the high frequency of use of alternative medicine, and (2) the potential problems specifically associated with herbal medications. I think that the estimates made in the Peebles et al. article regarding the frequency of total use of alternative medicine may be lower than is actually the case, although their estimate of the extent to which patients inform their neurologists seems accurate. In a recent survey performed in our epilepsy clinic, a pharmacist sought to acquire comparable information. The patient population was similar to that in the Peebles et al. study. In their study, the survey was self-administered by the patient; in ours, either a pharmacist or an epilepsy nurse (but not the treating physician) collected the information. We used a questionnaire adapted from a recent multicenter study (3). In our patient population, 80% of the patients were currently using or had recently used at least one alternative therapy; and 68% were continuing to use alterna2002 Elsevier Science (USA) All rights reserved.
©
1 To whom correspondence should be addressed. Fax: (614) 2921335. E-mail: [email protected].
tive medicine. General health promotion and disease prevention were the most common stated reasons for this. More than half of our patients (52%) had not discussed these therapies with their health care providers. Only 39% said that their physician was aware of their alternative medicine usage. These latter findings are comparable to previous observations (1, 3). In light of all the potential problems raised in the Spinella article, these observations should be of concern to us all. The differences in usage of alternative medications may, in part, be a function of geographic factors. Our institution, for example, is well known for promoting alternative therapies. Our region is very tolerant of, and in fact welcomes, this approach to care. Alternatively, the fact that our patients were interviewed to gather this information rather than providing it via self-report could account for some difference. In and of itself, this is not the issue. Rather, we as health care providers must learn of the potential interactions between commonly used alternative medicines and our “standard” epilepsy treatments. Further, we must improve communication with our patients so that we may learn about any alternative treatments they are using (typically without our prior knowledge).