Epilepsy & Acupuncture

A common neurologic disease in humans, epilepsy is typically treated with antiepileptic drugs, most of which have adverse effects and long-term consequences. Other treatments (eg, peripheral or central neuromodulation) can be invasive and produce variable results. Acupuncture, particularly electroacupuncture at specific points, has been shown to produce favorable results in some types of epilepsy (eg, absence seizures, febrile convulsions, generalized tonic-clonic, seizures, status epilepticus). Therapeutic effects have been documented in improvements of the electroencephalogram (eg, reduction of spike wave, desynchronization) and in clinical signs (eg, seizure frequency, length of episodes, functional recovery, life quality). As compared with conventional antiepileptic drugs, surgical interventions, and neurostimulation procedures, acupuncture may provide a less complicated, safer, and less invasive complementary therapy. 

The thalamus, which plays a critical role in epilepsy, is regarded as a gateway and switchboard of sensory information transmission to the cerebral cortex. The thalamus has been shown important in mediating acupuncture effects in the brain. Many studies have evaluated changes in diagnostic imagery (eg, positron emission tomography studies, functional MRI), blood flow, and quantification of various activating responses in the thalamus after stimulation of various acupuncture points. Afferent inputs by acupuncture could evoke sufficient inhibition to modulate or interrupt electrical impulses that oscillate between the thalamus and cortex during a seizure. Additionally, there is evidence suggesting that chronic effects of acupuncture may result from repetitive stimulation that causes modulation of synaptic plasticity, neurotransmitter metabolism, or even neural reconstruction.

Commentary

Although this paper was a review of the human literature, epilepsy is also common in veterinary medicine and, in severe cases, fraught with the same treatment challenges. Using acupuncture in patients refractory to typical antiepileptic medications is becoming increasingly popular. Although evidence from double-blinded, placebo- controlled studies does not exist in the human or veterinary arena, there is support for use of the technique in these populations. The techniques are not painful and do not require lengthy or expensive treatments. Most animals tolerate the procedure well, and points can even be described to the family for at-home stimulation. Future acceptance of this technique will depend upon a willingness to continue to understand how and why acupuncture works.—Heather Troyer, DVM, DABVP, CVA