Epilepsy is one of the most common neurological diseases in the world, affecting over 50 million people worldwide.
In Malaysia, the lifetime prevalence is 7.8 per 1,000.
While this diagnosis is associated with spectacular seizures, it has a long-term impact on the patient’s life in terms of emotional well-being, relationships, learning, work, and of course, daily life itself.
While medical care today has been transformative for epilepsy patients, enabling them to live active and fulfilling lives, there is still a need for a more holistic approach to treatment.
Things like sleep, nutrition, stress, metabolism and other factors that could affect brain health should also be considered.
These supportive practices need to be embedded into the medical system to provide a more comprehensive and compassionate approach for long-term health care.
Understanding epilepsy
At its core, epilepsy is a long-term neurological condition characterised by recurrent unprovoked seizures.
In such cases, a sudden burst of abnormal electrical activity erupts in the brain.
Depending on where that activity starts, a seizure may briefly affect movement, sensation, awareness, behaviour or consciousness.
The causes of epilepsy vary widely.
Seizures can be linked to structural changes in the brain (e.g. stroke, brain tumours, head injuries and infections such as meningitis or encephalitis), genetic causes, metabolic disorders, immune diseases, and/or even sometimes, unknown causes.
No two persons experience epilepsy in the same way.
The symptoms usually depend on which part of the brain is involved.
Some people have generalised seizures involving both sides of the brain.
In some of these cases, it can lead to loss of consciousness, muscle stiffness, shaking and jerking movements.
Others have focal seizures in one part of the brain, which can cause unusual sensations, staring spells, repeated movements or changes in awareness.
Children may experience absence seizures, which may look like brief staring episodes or short lapses in attention.
Besides the seizure itself, people who have epilepsy also suffer from fatigue, memory failure, mood swings, anxiety, depression and poor sleep.
The foundation of treatment
Conventional medical care is still the cornerstone of epilepsy treatment.
Diagnosis usually includes neurological evaluation, electroencephalogram (EEG) assessment, brain imaging like MRI (magnetic resonance imaging) or CT (computed tomography) scan, and blood work, to determine what causes such a condition.
For most people, anti-seizure drugs are the first step in treatment.
Levetiracetam, lamotrigine, valproic acid and carbamazepine have solid clinical evidence showing that they can prevent seizures and reduce the risk of injury and other complications.
If seizures continue to persist despite medication, there are other options.
These might include surgery, vagus nerve stimulation (VNS), responsive neurostimulation (RNS), deep brain stimulation (DBS) or a medically-supervised ketogenic diet, particularly for those with hard-to-control epilepsy.
The functional approach
If traditional treatment is all about controlling seizures, integrative and functional approaches ask: what other factors might be involved in the brain’s vulnerability to epilepsy?
These are not substitutes for standard care.
In fact, they are complementary to the medical care given.
The aim is for the patient to become more resilient, more energy-based and more well- balanced.
Nutrition is one of the most sensible ways to support brain health.
A healthy diet with good nutrition can provide the brain the nutrients it needs.
Any additional supplements should be taken as directed by a healthcare professional.
Magnesium is important for nerve function and low levels may make your nervous system more excitable.
Foods rich in magnesium include pumpkin seeds, almonds, spinach and avocados.
Vitamin B6 is involved in the production of neurotransmitters, and vitamin D is important for the immune system and overall health.
Omega-3 fats are present in foods like salmon, sardines, mackerel and flaxseeds, and may help brain function.
The brain is one of the most energy-hungry organs of the body.
Hence, energy production is the core of the brain.
Some integrative approaches focus on mitochondria, which are the components of cells that produce energy.
Some researchers are also exploring whether coenzyme Q10 or ketogenic therapies might benefit some people.
Inflammation is also a growing topic of interest.
Long-term inflammation in the nervous system (neuroinflammation) may make seizures more likely in some people.
Possible causes include autoimmune disorders, chronic infections, environmental exposure and poor dietary habits.
So, an anti-inflammatory lifestyle is sometimes considered to be a part of a comprehensive care plan for epilepsy.
The gut-brain connection has also become a subject of increasing interest.
Gut bacteria imbalance, food sensitivities and inflammation in the digestive tract can negatively influence communication between the gut and brain.
Supportive strategies might include eating more fibre, adding fermented foods and cutting back on ultra-processed foods, but research is still in its infancy.
Blood sugar balance may matter as well.
Sharp swings in blood sugar can decrease the seizure threshold in some people.
Regular meals that include protein, healthy fats and complex carbohydrates can help maintain stable energy throughout the day.
Some practitioners also consider environmental exposures (e.g. heavy metals, pesticides and industrial chemicals) as part of a broader assessment.
But detox methods are not well established on scientific grounds, so one should be cautious and consult a qualified healthcare professional.
The best place to begin is probably with daily habits.
Small, regular choices can decrease seizure triggers and contribute to overall well-being:
- Sleep is one of the most common seizure triggers.
Regular bedtime routines and good sleep at night, as well as enough rest every night, can make a meaningful difference.
- Find healthy ways to manage stress.
There is no evidence that stress can lead to epilepsy, but it can increase the frequency of seizures in some people.
Helpful ways to manage stress may include meditation, breathing exercises, and counselling or therapy.
- Remain active in a safe way.
Regular physical activity can lift mood, reduce stress, and support thinking and memory.
The key is to choose activities that feel safe and realistic for your situation, and to seek medical advice when needed.
- Learn your own triggers.
Common triggers may include poor sleep, missed medication, high alcohol intake, flashing lights and emotional stress.
Learning patterns from your own experiences will allow you to plan more confidently.
What’s next
Research continues to open new possibilities in epilepsy care.
Precision medicine based on genetic testing, more tailored nutrition strategies, microbiome research, anti-inflammatory approaches and treatments targeting the immune system are all areas of interest.
The development of care plans that are more personalised and responsive to a person’s needs over time will more likely lead to such care plans.
Epilepsy is not a single seizure syndrome.
It is a complex neurological disorder that is determined by the brain, the body, the environment and daily life.
Medication is still needed to control seizures, but supportive interventions could be of help in improving brain health and quality of life.
When evidence-based treatment is coupled with healthy eating, healthy habits and careful attention to possible triggers, people with epilepsy may live better with better seizure control and better well-being.
The future of epilepsy care isn’t about taking one approach over the other; it is about bringing the best of both to the patient.
Datuk Dr Nor Ashikin Mokhtar is a consultant obstetrician and gynaecologist, and a functional medicine practitioner. For further information, email starhealth@thestar.com.my. The information provided is for educational and communication purposes only, and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.
