In 1971, The Institutes for the Achievement of Human Potential presented to The World Organization for Human Potential a cautionary note to the medical world and to the parents of brain-injured children regarding the widespread and sometimes indiscriminate use of anticonvulsant drugs. Since that time, we have regularly and successfully removed such drugs from many children and young adults. This practice has become an integral part of our treatment of brain injury.
In addition to our desire to avoid adverse effects of the drugs, our rationale is also based on our strong belief that seizures serve a physiological function, as do the many other defense mechanisms of the body. Coughing, vomiting, diarrhea, fainting, and fever could also be viewed as dysfunctions, but we know that they are designed to protect the organism. So also are seizures. A seizure is an activity of great metabolic activity of the brain, and during its presence cerebral blood flow increases, providing more oxygen and glucose and increasing excitatory amino acids necessary for establishing the neuronal wiring and function.
A mature and well-organized central nervous system has less need for seizure activity since other options are more available to provide its needs. The seizure control we seek is to develop a more mature cortex and to provide for the physiological needs that have produced the seizure state. This is a more rational and more successful approach than the use of drugs, which dull the senses, inhibit motor activity, and interfere with growth and metabolism.
Our comprehensive treatment of brain-injured children is a very intensive program applied by the parents at home, after careful teaching by the staff during the course of five days every six months. Close telephone and mail contacts are maintained. This contact is also vital to the successful management of a detoxification program, as it provides great reassurance for parents who have been made terrified of seizures by the medical profession.
Medication is tapered very gradually at a rate appropriate for each child and their seizure situation. It is not unusual for the process to take one to two years to accomplish withdrawal. There are times when it must be suspended or a temporary return to medication may be indicated, but this is rare. Generally, status epilepticus must be interrupted because of prolonged marked motor activity in order to avoid acidosis, hyperthermia, and hypoxia. It is important, at all times, to seek the precipitating cause of the seizure and to correct adverse internal or external environmental factors.
Great attention must be paid to supporting the body's physiological processes if detoxification is to be successful. Most important is the overall improvement of brain function. Therefore, the total neurological program designed to gain for each child normal function in all areas is of paramount importance. A mature, well-organized cortex reduces the need for seizures.
Additional measures are:
I. Optimize respiratory function to increase oxygen availability.
II. Masking--a procedure of rebreathing for short periods to gain CO2 enrichment resulting in a favorable acid base balance and to increase cerebral circulation. This technique is useful to shorten individual seizures as well.
III. Restriction of sodium and liquids to prevent fluid retention and increased intracranial pressure.
IV. Excellent nutrition to maintain good health and structures and to provide for energy and all needed vitamins, minerals, and neurotransmitter precursors.
V. Magnesium and calcium supplements to promote central nervous system membrane stability.
VI. Pyridoxine to support GABA and to increase the efficient use of oxygen by the brain.
VII. Control the environment: Pollution, toxins, hyperthermia, reduced oxygen availability.
VIII. Maintain excellent health--avoidance of infections, etc.
We have kept very careful records of the results of medication reduction and elimination and have reported overall statistics periodically. The figures are remarkably stable from 1971 through 1996. Included are the specifics for a typical year, 1993.
Detoxification Results: 1993
Total of Children on The Institutes Intensive Treatment Program: 629
- Children with positive seizure history: 332 (52.78%)
- Children with seizures current to first visit: 233 (37.04%)
- Children taking anticonvulsants at first visit: 197 (31.32%)
- Children who completed detoxification: 132 (67.00%)
Of the 132 children who completed detoxification, the following seizure activity was recorded:
- No seizures for a minimum of 6 months post detoxification: 63 (47.72%)
- Fewer seizures for a minimum of 6 months post detoxification: 45 (34.09%)
- Same number of seizures as before detoxification: l (0.76%)
- More seizures than before detoxification: 13 (9.85%)
- Replaced on medication before the study was completed: 5 (3.79%)
- Contact lost during the follow-up: 5 (3.79%)
Conclusion:
Of the children from whom all medication was gradually eliminated, 81.81% had an improved seizure picture while receiving a program of neurological organization and intensive physiological support.
