BEHAVIOR MODIFICATION FOR EPILEPSY: Raising The Seizure Threshold

Everyone has a seizure threshold, a tolerance point beyond which a seizure can be induced. People who develop seizure disorders have a lower threshold for seizures than others. Sleep deprivation, prolonged or acute stress, exhaustion, fear, illness, sudden changes in breathing rates or in blood sugar levels are just a few factors known to lower the seizure threshold.

One of the more debilitating, self-certainty-robbing aspects of seizures is their apparent unpredictability. Seizures can disrupt any function of psyche or soma. Generally, the person in charge of managing seizures is the attending physician, usually a neurologist or family doctor. Losing, or giving full responsibility for treating seizures to a physician can leave an individual feeling powerless to control her body, level of consciousness, or the quality of her daily life. Yet, history shows those of us living with seizures may have a greater ability to influence them than is usually realized.

Since at least the time of ancient Greece, physicians, researchers, and people with seizure disorders have observed seizures are often neither random nor entirely beyond the conscious, willful, control of the person who has them. Reports of behavioral strategies used to stop and sometimes cure seizures, are found throughout the recorded history of western medicine. Hypnosis, progressive relaxation, operant conditioning, auto-suggestion, training in respiration control, and EEG biofeedback training, are among behavioral methods studied and found successful in learning seizure control.

Seizures may only seem to represent chaos in the brain. Writing in the second century A.D., the Greek physician, Galen, found seizures sometimes follow a pattern, beginning in a characteristic way, and then continuing in a predictable manner. One early Greek sufferer described being slapped by a breeze (aura) as the spirit came and seized him. Thus, "aura" became the term used to identify the symptoms preceding seizure onset. Even in those who do not experience an aura, seizures may adhere to some routine, such as only occurring during sleep, or upon waking.

Another early Greek physician, Aretaeus, observed that seizures might begin with a contraction in the hand or foot, then spread to cause a "crash." By intervening at the aura stage, he discovered a seizure can frequently be stopped. Interrupting the seizure, sometimes by binding the limb, was often sufficient to stop the seizure altogether.

A half century after Pavlov trained his famous dog to salivate upon hearing a particular sound, conventional science was still teaching that the activities of the nervous system, heart rate, blood pressure, respiration, etc., cannot be learned and consciously controlled. Because they violated the then current doctrinal assumptions about the nervous system, the findings of Pavlov's studies were disputed.

In the early nineteen sixties, psychologist Neal Miller further eroded the foundations of this doctrine when his research demonstrated supposedly involuntary actions of the nervous system, such as blood pressure and heart rate, can indeed be learned and voluntarily controlled. About the time of Miller's studies, other scientists were realizing that even brain waves can be consciously controlled.

By the late nineteen sixties, the experiments of several scientists, Miller, Tassarini, and Sterman, confirmed seizure activity can be influenced by EEG brain wave training. In 1969 the term "biofeedback" was coined to describe behavioral conditioning taught by using external feedback such as EEG, heart, or blood pressure monitors. Later, "neurofeedback" became the term used for EEG biofeedback.

Dr. M.B. Sterman and his colleague. L. Friar, published the first report of successfully training a woman to control her seizures using neurofeedback in 1972. Several years earlier, Sterman had conditioned a group of cats to produce a particular range of EEG activity, 12-14 Hz, in response to pleasure reward. Because he was training the brain wave activity over the sensory motor cortex, Sterman dubbed this pattern SMR, sensory motor rhythm.
In an unrelated study, Sterman found cats trained to produce the SMR rhythm had developed a higher seizure threshold than untrained cats when exposed to noxious fumes. He then experimented, teaching people with seizures change their brain wave activity to produce more of the SMR frequency.

Sterman's work gave rise to the development of neurofeedback training to teach people to gain conscious control of their seizures. As with the skepticism of Pavlov's and Miller's research, after thousands of studies demonstrating its usefulness, neurofeedback for seizures is still characterized as "fringe" or "experimental." It has been effective in treating seizure disorders for three decades. In some cases its success equals that of drug therapy.

A behavioral approach to treating seizure disorders can be thought of as behavior modification for the nervous system. Discovering, then changing the habits and behaviors that lead to seizures, raises the threshold. In behavioral therapy, the emphasis is on the client acquiring practical, self-help strategies to manage and take responsibility for controlling seizures. Its aim is to restore personal control over one's health and life.

Just prior to it's onset, many people experience the aura, warning of a seizure coming on. These may be unusual sensations such as gut fear, muscle twitching, hallucinatory sounds, smells, tastes, or visual distortions. The most successful behavioral treatments involve learning to identify the aura then interrupting and aborting the seizure at this stage.
Keeping a journal, or seizure log, is a powerful tool for learning to recognize the patterns of seizures and breaking them.

Observing and noting all the events surrounding seizures helps find those symptoms which are the same for most seizures. These are very individual. Did the seizure happen while awake, while standing, or lying down? Was the person hungry, tired, stressed out? Did the seizure start after a meal, a sugar binge, while working, talking, reading, listening to music, when angry, or happy? Witness accounts can also help identify the behaviors that precede seizures. Developing strategies to avoid or change those circumstances leading to seizures is a key to learning to control them on one's own.

According to the Epilepsy Foundation of America's 1999 Report to the Nation, fewer than 25% of the several million Americans diagnosed with seizure disorders gain complete control of their seizures with drugs. Medical reports and research in this field over the past fifty years demonstrate behavioral therapies for seizures can be as successful as drugs in achieving seizure control. David I Mostofsky, Robert Fried, Niels Birbaumer, Joanne Dahl, Donna J. Andrews, and Joel Reiter, are some of the scientists whose research confirms the efficacy of a neurobehavioral approach to treating seizure disorders.

Most major hospitals have specialty centers for treating seizure disorders. Very few of them offer any of the neurobehavioral techniques for self-management of seizures in their treatment approaches. Interest is greater in Europe, where several German medical centers now incorporate neurobehavioral therapy into their seizure treatment programs. The Andrews\Reiter program helps people with seizure disorders learn self-control of seizures using behavior modification.

Sterman's discovery in the 1960s, that neurofeedback training can teach self-regulation of seizure activity, presented new opportunities for learning self-control of seizures. In the 1980s, Sally Fletcher published her account of learning to become seizure free using neurofeedback training, possibly the first book of its kind. Since that time, thousands of studies verify neurofeedback as a practical tool for teaching people techniques to control seizures on their own.

Neurofeedback training often results in a reduction in seizure frequency and a decreased need for medication. For some people, as in Sally Fletcher's case, neurofeedback training eliminates seizures altogether. It is a viable option for seizure management that is free of the risks and side effects of drug therapy.

Advances in EEG monitoring and magnetic resonance imaging are enabling researchers to learn more about the phenomena of seizures and ways to treat them. While the aura is the symptom preceding a seizure, slow cortical potentials (SCPs) represent the activity of the brain's neurons just before a seizure starts. It is now possible to monitor SCPs and teach people to control and alter them, changing the function of their own brain cells. The development of techniques teaching people how to alter the activity of individual groups of their own brain cells adds a potent new tool to the repertoire of behavioral therapies for seizure disorders.

Books on Behavioral Approaches to Treating Seizure Disorders:
" The Neurobehavioral Treatment of Epilepsy; David I Mostofsky and Ingve Loyning, eds; Lawrence Erlbaum Associates;1993; ISBN: 0-8058-1106-0.
" Epilepsy: A New Approach; Adrienne Richard and Joel Reiter, MD; Walker and Company; New York; 1995; ISBN: 0-8027-7465-2
" Epilepsy - a Behavior Medicine Approach to Assessment and Treatment in Children; Joanne Dahl;Paperback(May 1993); Hogrefe & Huber Pub; ISBN:0889371067

Further Information and Resources:
EEG EDUCATION & RESEARCH
" The Andrews\Reiter Epilepsy Research Program

Disclaimer: The information contained in this article is for educational purposes only and should not be used for diagnosis or to guide treatment without the opinion of a health professional. Any reader who is concerned about his or her health should contact a doctor for advice.
@2009-2014

MAYBE IT IS MORNING (Life After my Major Stroke)

It is light when I wake up. Maybe it is morning. It was dark when I went to sleep, it is light now so it must be morning...maybe. How to dress now? I go outside and look around the front yard. There's no snow, so it isn't winter. The trees have no leaves so it isn't summer either. It feels kind of cold. I'll wear a coat and some gloves. But if I dress for winter and it's spring, people will stare and think me weird. If it is winter and I dress for spring, I'll also look strange. 

Since the sun is shining it is a good day to take a walk. I wear jeans, my flannel shirt and...just in case, pack a winter hat, scarf, and gloves in my shoulder bag. About a mile from home is my favorite bookstore and tobacco shop. Perched on a corner across from the campus, it is on the main drag through town. Two doors down is a cafe where I like to go and have my morning coffee while reading a book or newspaper. 

Dressed for all possible seasons, I leave the house and start walking. At the foot of the driveway I turn left, walk two blocks, turn left again and walk about five blocks. The air is cool and crisp. Maybe it is autumn. I reach the corner and am shocked to find there is no bookstore. There is no campus, no main street lined with shops and small cafes. My heart begins to race and I am sweating. There is no Charlottesville. 

I'm standing at the intersection of a busy highway. How did this happen? I don't know where I am or how I got to be here. I cannot remember how I got to this corner, I was home and now am on the corner of a strange highway. 
Where is it? Where am I? I can't remember! I just don't know! It dawns on me I must have had one of those "spells" and gotten lost. My eyes won't focus and the street sign is blurred to my vision. Drawing close, I can read it with my left eye. It says "Colorado Boulevard". 

Impossible. There's no Colorado Boulevard in Charlottesville, Virginia. By now, I know I've had a spell and don't know what to do. The fear is making me nauseated and I don't know where I am or what to do now. Just start walking. Walking and walking, I'm trying to get over the fear, it only makes the confusion worse. 

Walking, breathing deep and slow to quiet my racing heart, I am afraid to walk far from the street sign. It is a marker to give me some sense of where I am in relation to home. Where home is, where I came from, or why I am on this highway, I just don't know. 

Keeping the sign in sight, I walk until I come to a newspaper machine. I'll get a newspaper. It always has the name of the city and the date on it. Reaching for some coins I discover my left arm is paralyzed. I must have forgotten when I had the spell. With my right hand I manage to get some change out of my pocket.  I'm so scared now it isn't possible to figure out what kind of coins they are. I start putting them in the red machine until I succeed in getting a newspaper. 

I want to scream, cry, but something is wrong and all I can do is tremble and try to keep from falling down. I remember I cannot ask anyone for help because my speech is so slurred they will think I am drunk or crazy. I practice some deep breathing and pray my memory will come back and end this terror. 

After calming myself a bit it is possible to recall the brain surgery that leaves me so horribly confused at times. I tap my head. I am wearing the helmet protecting me if I have a seizure and fall--at least I remembered that. Maybe I had a seizure and that's why nothing looks familiar. 

When I feel steady enough, I risk a look at the paper. It is The Denver Post and is published in Denver, Colorado in 1983. Once more a wave of nausea and shock comes over me. 1983? Colorado? But it is 1970 and I'm in Charlottesville, Virginia. Or, I woke up in Charlottesville this morning. 

How can I be in Charlottesville, Virginia in 1970 and be looking at a newspaper from Denver, Colorado in 1983? I try to remember if I'd taken any LSD. No, haven't used drugs for years. What years, how many years? I can't remember. This confusion has happened before. If I just move around and stay calm my memory will come back. For some time I walk along the highway going about one block from the sign and back again. I know it is a landmark, pointing to where I came from this morning. 

After pacing for some time, how long will never be known, my memory slowly returns. I'm in Denver and I live at Joe's house. I think we're married. Nothing looks familiar to me, but Colorado Boulevardmay be near his house. In my wallet I find something with my name and address on it.   Maybe I live there. 

I'm sure I was too scared to cross the highway earlier and begin walking down the long street I think I'd been on when I got so confused. Nothing is familiar. This is not Virginia. After a while I go down another street and finally come across a street that seems a bit familiar. 

I find the address in my wallet. I swear I've never seen this house before.  The house number and street match what's on the card. Maybe it is where I live. I ring the doorbell but no one is at home. The keys in my pocket fit the door so it must be Joe's house.

I let myself in and sit down in the living room. This place is filthy. I'd never live like this. It smells like cat shit. This is not my apartment inCharlottesville. The newspaper reminds me I'm in 1983, in Denver, but place and year have no meaning. I walk around the house and find some things that seem to be mine. There's a book, "The Mind of a Mnemonist," by Luria. I'm reading that book, but where? And when, and why? The address matches, the keys match, and this is my book, so it must also be where I live. If this is Joe's house, he is a filthy pig. Those spells get me so confused. Maybe if I rest my memory will unscramble itself. 

I lay down in one of the two bedrooms and feel a little bit like Goldilocks. I wonder what will happen if the three bears come back while I'm resting. After napping I am a bit more oriented. This is Joe's house in Denver and it must be 1983 if that's what's on the newspaper. 

It is 1981. I live in Denver and write for a small newspaper. Joe's sister and I work together as waitresses in a restaurant on Colfax Avenue. I move to California. 

It is 1982. I am living with friends in Eureka, California and writing a book. I have a stroke and brain surgery. I go into surgery on October 27th. When I wake up it is November 3rd. They tell me I was in a coma and my left side is paralyzed. I cannot remember most of my life from age 18 to 31. 

My roommates and family abandon me at the hospital. I am placed in a nursing home and forced to take drugs that make me more confused. I run away to Ed's in Palo Alto. That afternoon I collapse and he rushes me to Stanford University Hospital. Spinal Meningitis. I nearly die a second time. 

Joe sends me some money and says I can stay at his house in Denver. As soon as I am strong enough I go Joe's. We have dated a few times but he is not my type, too passive. I haven't been there very long when he begins to tell me how expensive it is to feed me, he might have to put me in another state home. He is having trouble making his house payment. If he marries I become his legal dependent and he will get a few hundred dollars a month increase in his Air Force wages for having a dependent. 

Besides, he argues, he really hates sleeping alone, and being the only single guy at the officers' parties. If I will just keep quiet, he will get more money for his house payment, he won't have to sleep alone, and he won't be "forced" to call some authorities and have me taken to a state home like the one in California. 

I hate his guts. I was raped and strangled when I was seventeen, but it is not as sustained and brutal a violence as this. My speech is very slurred, and even if I could talk clearly there is no place to go for help, no one to call. So I marry him under threat of being sent to another nursing home and being force fed drugs that leave me more confused and disoriented. 

It is 1983. I am living in Joe's house. We are married and what happens at night can only be called rape. And I have to pretend I enjoy this, if I don't, he is holding this threat over my head. I must keep up the game until I have the strength to get away from him. 

Still, when I wake up it is morning. A morning like many others. But those other mornings are in 1970, in another state, another time. Somehow I've gotten from 1970 to 1983 and I can't remember how. I do remember I had brain surgery and was in a coma. I do remember my left side is paralyzed and it is hard for me to talk or think clearly. It is light when I wake up. Maybe it is morning. 

@1996, 1999, 2014 by Zoë L. Langley

Originally published in Synapse, Seattle, WA 1996

Gluten Sensitivity Can Affect Mind and Behavior

Reaction to Gluten may Trigger Psychiatric Symptoms

Depressed? Anxious, having trouble concentrating, or with mood control? Before labeling these symptoms as psychiatric, consider testing for sensitivity to gluten.

Gluten intolerance is common, often misdiagnosed. Mood changes, or even psychosis, may be signs of celiac disease (CD) or nonceliac gluten sensitivity (NCGS).
Gluten sensitivity is an inability to properly digest glutens, a type of protein found in wheat, barley, rye and spelt. For those sensitive to it, gluten in the diet can trigger an immune response and inflammatory reaction anywhere in the body. Many people with Celiac Disease, the most recognized form of gluten sensitivity, have or develop psychiatric symptoms. .

Gluten Intolerance Can Injure the Brain

In 2004, an Italian study showed changes in brain blood flow in celiac patients. The researchers found areas of the brain with diminished blood flow in 11 of fifteen patients with untreated celiac disease, but not those who were on a gluten free diet (Addolorato).
In other studies, untreated celiac disease is also associated with the development of lesions and scarring in the white matter of the brain.

Gluten Free Diet Helped Patients with Schizophrenia

Studies linking gluten intolerance to symptoms of mental illness go back decades and were often ignored. Without this information, many may have suffered or continue to suffer psychiatric disorders when a change in diet might improve or reverse their symptoms.
In a 1976 study patients with schizophrenia were placed on a diet free of milk and grains. The patients continued their medications and improved while on the diet. When gluten was reintroduced in to their diets, their symptoms got worse and their progress in recovery was lost.
The authors wrote, "The observed effects seemed to be due to a primary schizophrenia-promoting effect of wheat gluten." (Singh, Kay)
More than thirty years later, research continues to demonstrate a connection between gluten sensitivity and schizophrenia. A Danish study in 2004 shows people with celiac disease are three times more likely to develop schizophrenia. A new study in the UK finds that 30% of those diagnosed with schizophrenia are gluten intolerant.

Cause and Effect

Most people diagnosed with celiac disease have a type of gene that predisposes them to gluten sensitivity. But not everyone who develops celiac disease has this genetic trait. Other factors, such as the age when gluten is introduced into the diet, may trigger the immune reaction to gluten.

Psychiatric Symptoms May Develop Before Celiac Disease

People with celiac disease may have neurological or psychiatric symptoms years before the signs of sensitivity to gluten show up in testing. In Psychosomatics, researchers wrote, "Since unrecognized CD may predispose the sufferer to serious mental disorders and behavioral problems, it should be taken into account in differential diagnosis in all age groups" (Pynnönen).
In 2008, a study in Italy examined the connection between psychiatric disorders and celiac disease. The study authors said, "The available data suggest that screening for CD in patients with affective and/or psychiatric symptoms may be useful since these disorders could be the expression of an organic disease rather than primary psychiatric illnesses" (Addolorato).

Trial Diet May be Advised

Tests are often normal when gluten sensitivity is suspected. If tests for gluten sensitivity are negative, physicians may suggest a trial period on a strictly gluten free diet to see if this improves the symptoms.
Dr. Scot Lewey, a Colorado gastroenterologist, is a passionate educator for increased awareness and understanding of gluten intolerance. He is well known on the internet for his blog, The Food Doc, where he posts articles and resources about gluten sensitivity. Dr. Lewey recommends considering the gluten free diet for anyone who has neurological or psychiatric symptoms.

Disclaimer: The information contained in this article is for educational purposes only and should not be used for diagnosis or to guide treatment without the opinion of a health professional. Any reader who is concerned about his or her health should contact a doctor for advice.

Resource:

Celiac.com

Sources:

Adams, Jefferson; Gluten intolerance tied to schizophrenia; SF Health News Examiner; Apr 30, 2009;www.examiner.com
Addolorato G, et al; Regional Cerebral Hypoperfusion in Patients With Celiac Disease; Am J Med; 2004 Mar 1;116 (5):312-7
Addolorato G, et al; Affective and Psychiatric Disorders in Celiac Disease; Dig. Dis. 2008;26(2): 140-8
Johns Hopkins University Bloomberg School Of Public Health; 2004, February 20; Celiac Disease Is A Risk Factor For Schizophrenia.
Lewey, Scot MD; Gluten Free Diet Should be Considered for Everyone With Neurological and Psychiatric Symptoms
Pynnönen, PA MD, et al; Untreated Celiac Disease and Development of Mental Disorders in Children and Adolescents; Psychosomatics 43:331-334, Aug 2002
Singh MM, Kay SR; Wheat Gluten as a Pathogenic Factor in Schizophrenia; Science 1976 Jan 30; 191(4225):401-2
@2009-2014
Last reviewed: December 14, 2013

ADHD and Dyslexia

A child or adult having difficulty reading or learning to read, following simple verbal instructions, or paying attention, may seem to have ADHD, but in fact dyslexia, a learning disorder involving reading difficulties might be the problem. When these type symptoms arise, a thorough evaluation for dyslexia before considering a label of ADHD might reduce the chances of misdiagnosis. If recognized early, dyslexia can often be overcome with proper therapy and does not require drugs for treatment.

What is Dyslexia

Dyslexia is a language processing and learning disorder. It may be inborn or may be acquired, though the cause is not always clear. The person with dyslexia usually has normal or above-average intelligence. How the brain handles written and spoken language is the main problem. Dyslexia, the most common of children's learning disorders, affects as many as 1 in 10 adults and children in the United States.

In The New Brain: How The Modern Age is Rewiring Your Mind, Richard Restak, MD, notes studies indicating dyslexia, like other reading disorders, may be developmental and can often be overcome with proper treatment.

Restak writes, "In short, remedial programs can successfully reverse dyslexia as long as the programs target the underlying problem-the dyslexic's difficulty in grasping the correspondence between letters and phonemes (individual sounds of speech, such as syllables)."

Signs and Symptoms of Dyslexia

The following are just some of the signs of dyslexia that should not be mistaken for ADD or ADHD:

• Slow reader
• Difficulty learning and pronouncing new words or with rhyming sounds
• Sequencing - may have difficulty with sequencing tasks, such as saying the letters of the alphabet in order
• Auditory processing -difficulty clearly understanding what is being said and following more than one instruction at a time
• Language - cannot follow rapid speech.
• Difficulty with spelling
• Inattentive - it may seem like someone with dyslexia is not paying attention because her or his speed of processing language is slower, especially with spoken language.

Speed of learning is a major factor in dyslexia.

Differences Between ADHD and Dyslexia

Children with ADHD symptoms have difficulty focusing and paying attention in all situations. Those with dyslexia may do more poorly at school or work, where there is less control over the environment than at home. In a home, the pace of activity can be changed to meet an individual's needs.

Difficulty with auditory processing can lead to sensory overload causing confusion, frustration and some of the behaviors which might be mistaken for ADHD.

Writing in The Misdiagnosis of Dyslexia, Fernette and Brock Eide state, "Children with unrecognized dyslexia are often misdiagnosed with ADD or ADHD because if they are underperforming, but have normal or above-average intelligence, ADD or ADHD may be the only other practical alternative on a teacher's, parent's, or physician's list of possibilities."

The Eides, both physicians practicing in Edmonds, Washington, are the authors of The Mislabeled Child, a book on learning disorders and how to treat them.

As Restak writes in The New Brain, with proper training the way the brain works can indeed be changed. According to the CDC, 5% to 8% of all children in the United States are labeled as having ADHD. The number of children and adults with dyslexia who are labeled as ADHD is not known.

Working Memory in ADHD and Dyslexia

Short term memory is the ability to hold information in memory for short periods of time such as remembering a phone number long enough to dial it. Working memory involves being able to hold information in memory long enough to do something with it, to add a group of numbers, put words together to make a clear sentence. Poor working memory is common in those with ADHD and dyslexia. Treatment designed to improve working memory may help those with either disorder.

Pamela Hook, PhD, president of the Massachusetts Branch of the International Dyslexia Association (MABIDA) and associate professor of the Communication Sciences and Disorders Program at the MGH Institute of Health Professions in Boston, advises people to act quickly when symptoms suggesting dyslexia arise. In a recent article in Medical News Today, Hook says, "Early and appropriate intervention is critical and will greatly increase your child's academic success and self-esteem. However, for older individuals with dyslexia it is never too late to learn to read, process, and express information more efficiently."

When symptoms develop that look like ADHD, think dyslexia too.

Resources

Learning Disabilities Association of America

http://www.ldaamerica.org

National Center for Learning Disabilities

http://www.ncld.org

Shaywitz, Sally, MD; Overcoming Dyslexia:A New and Complete Science-Based Program for Reading Problems at Any Level ; Knopf 2003; 0375400125 / 0-375-40012-5

Sources:

Eides Fernette, MD and Brock, MD; The Misdiagnosis of Dyslexia; wellsphere.com, id#469241;Nov. 6, 2008

Hook Pamela, PhD; quoted in "Dyslexia Association Identifies Dyslexia Warning Signs, Facts, and Myths As Part of National Dyslexia Awareness Month;" Medical News Today; article #166210.php; Oct. 5, 2009

Miller, Karen J. MD; "Attention and Learning Problems: When You See One, Look for the Other;" National Center for Learning Disorders (NCLD); March 06 2005

Restak Richard, MD; The New Brain: How the Modern Age is Rewiring Your Mind; Rodale Press; 2004

Disclaimer: The information contained in this article is for educational purposes only and should not be used for diagnosis or to guide treatment without the opinion of a health professional. Any reader who is concerned about his or her health should contact a doctor for advice.

Rickets, Seizures, and Vitamin D

"Rickets on the Rise," "Elderly at Risk of Vitamin D Deficiency." These are just a few headlines making world news about vitamin D Deficiency. Research is now linking the development of many chronic diseases to low levels of vitamin D.

If you take anticonvulsants, this link is significant because anticonvulsants can rob the body of its supply of vitamin D. Low levels of vitamin D can set off psychological, neuromuscular, skeletal, and nervous system disorders. However, research indicates these symptoms may be preventable.





x-ray of a 2 year
old child with rickets



In its active form, vitamin D is calcitriol, a hormone, not a true vitamin. Sunlight reacts with oil in the skin to form vitamin D3. In the liver it is metabolized into calcidiol (25 hydroxy vitamin D) and stored in blood and fat. Throughout the body calcidiol is converted into calcitriol as it is needed. In the early eighteen hundreds, a Polish physician recognized a connection between lack of sunlight, our main source of vitamin D, and the development of rickets, the bone deforming disease of early childhood.
Vitamin D deficiency has been called the enduring epidemic. Widespread throughout the world today, vitamin D deficiency was pervasive a hundred years ago when rickets was endemic. About 80% of children in American cities had rickets in 1900. Some studies of this era in northeastern cities found the rate among Blacks and Italians, people originating from warmer climates, to be 100%.
At that time, it was difficult to find a child in London not suffering from what was called "The English Disease." Rickets was also common among children in Glasgow, Paris, and Berlin. The lifestyles of the world's most industrialized areas included too little sunlight to nurture life and prevent illness.
Smoke and pollution from factories, and too much time spent indoors, contributed to the problem. Rickets and osteomalacia (adult rickets) were common in all age groups, all social classes. Sometimes entire families were afflicted.
Along with bone deformities, other problems are linked to nutritional rickets. Sir William Gowers, a major figure in the history of neurology, saw a strong connection between rickets and the development of seizure disorders more than a century ago. Children suffering from rickets often developed seizure disorders when teething and he thought the two were related.
Everyone has a seizure threshold, a tolerance level for seizures. Anything that increases your risk of having a seizure, such as fevers in children, or metabolic distress lowers the seizure threshold. Whatever raises your seizure threshold reduces your chances of having a seizure. Vitamin D deficiency may trigger mineral and electrolyte imbalances that can lower the seizure threshold.
Gowers conducted a study of 180 young children with seizures in the 1880s. The seizures first occurred in 72 of the cases when the child was teething. Expressing the opinions of his time, Gowers wrote that nearly all cases of convulsions beginning during this period of childhood could be attributed to the "irritability of the nervous system" due to rickets. He made his observations forty years before vitamin D was identified and recognized as crucial to the development of healthy teeth and bones. Cod liver oil, one of the richest food sources of vitamin D, was a common prescription for rickets and seizures in the 1800s and well into the twentieth century.
Public Health and education campaigns beginning in the 1930's promoted food fortification and healthy sunbathing to prevent vitamin D deficiency and rickets. By the 1960s, it appeared rickets had been eradicated. However, neither rickets nor vitamin D deficiency were eliminated and deficiency continues to be widespread.
People who take anti-seizure medications face a greater risk of developing vitamin D deficiency than the rest of the population because these drugs can interfere with the body's metabolism of vitamin D leading to drug induced deficiency. Rickets, osteomalacia, osteopenia (thinning bones) and osteoporosis are the most noted vitamin D related side effects of anticonvulsants.
However, we are just as dependent on vitamin D for a healthy nervous system as for sturdy bones. Fat soluble vitamin D is needed to absorb and metabolize calcium and phosphorus, the two most abundant nutrients in our bodies. As minerals, calcium and phosphorus form hydroxyapatite, the hard crystals which make our bones solid and strong. As electrolytes calcium and phosphorus create nerve and muscle impulses.
If we develop vitamin D deficiency, calcium and phosphorous levels may also fall. Calcium deficiency (hypocalcemia) can cause many health problems. Symptoms may include tingling sensations, nervousness, cardiac arrythmia, muscle spasms and twitching. Neuropsychiatric symptoms include irritability, mental confusion, and behavioral changes.
While too little calcium is associated with bone loss, too little phosphorous (hypophosphatemia) causes soft, weak, and poorly formed bones as well as muscle weakness, confusion, heart problems, and difficulty with speech. Phosphorus is crucial for converting food to energy and needed by all cells in the body. Deficiencies of either calcium or phosphorus lower the seizure threshold.
Sometimes, after years of being seizure free on anticonvulsants, the seizures return. The problem may be the medication. A recent medical report from Kuwait describes how hypocalcemia, a side effect of anti-seizure medication, led to a patient's loss of seizure control after five years of successful drug therapy. His seizures stopped and he regained control following treatment with vitamin D and calcium. The authors concluded loss of seizure control while taking anti-seizure medication is a warning sign to check calcium levels.
By triggering deficiencies of calcium or phosphorus, low levels of vitamin D can be a factor in the development of seizures. But what about preventing seizures? Vitamin D may have a role here as well. A 1984 research study found the seizure threshold of laboratory rats increased when vitamin D3 was injected into their hippocampi, an area of the brain that is very susceptible to seizures.
An exploration of sunlight as vitamin D therapy for seizure patients showed promising results. During the 1982 study, 450 institutionalized patients taking anticonvulsants received sunlight exposure in addition to their medications. The results indicated sunlight therapy may be the reason most of those patients did not develop osteomalacia or rickets from using anticonvulsants.
These and other studies suggest that osteoporosis, mental confusion, and other side effects of anticonvulsants may not be inevitable. The key is maintaining adequate levels of vitamin D, calcium, and other nutrients.
Seizures may be the first noticeable symptom of vitamin D deficiency. Over the last decade physicians from coast to coast have expressed surprise and alarm at discovering children whose seizures are due to vitamin D deficiency rickets. Not all the children appeared to be malnourished, yet they were not receiving enough vitamin D from diet and sunlight to prevent the development of rickets and seizures. Breast fed infants may not receive enough vitamin D from breast milk alone to meet their needs. They must also get vitamin D from sunlight, diet or supplements.
Gowers suspected a nutritional factor at work when children developed seizures while teething. That factor was vitamin D. Today this link may be overlooked in the mistaken belief that vitamin D deficiency is rare. Some of the world's most eminent vitamin D researchers believe up to half the population has below optimum levels of vitamin D. Vitamin D deficiency is common among all age groups in North America.
Vitamin D deficiency is a problem we can fix. The American Academy of Pediatrics revised its recommendations for Vitamin D in 2003. The Academy now recommends 200 IU of vitamin D for children who are not getting adequate vitamin D in their diets or from sunlight.
Speaking out on these concerns is Dr. John Cannell, Executive Director of the Vitamin D Council, whose mission is to raise awareness about vitamin D deficiency. According to Cannell, " A lot of people just won't go into the sun. They just won't; their doctors have told them not to. The Federal Government tells them it causes cancer, which it does. It also prevents cancer. Very little time in the sun is needed for the body to make its own stores of vitamin D."
A quick and easy solution to vitamin D deficiency may be a walk on the sunny side of the street. Writing in "The UV Advantage," Dr. Michael Holick says that just a little sunlight is quite enough to meet our needs. For light skinned people living in the United States, Holick writes, 15-20 minutes skin exposure to sunlight several days a week can produce the as much vitamin D as the body needs from March through October. People with dark pigment will need much longer exposure, up to an hour or more.
Supplements may be the safest means for people who take anticonvulsants to get adequate amounts of vitamin D. Many anti-seizure drugs also cause increased sensitivity to sunlight. If you take anticonvulsants you can check with your pharmacist to see if your medication puts you at risk of becoming sensitive to ultra violet rays from the sun or tanning lights.
Despite decades of reports indicating bone disease is a side effect of using anticonvulsants, most physicians are unaware of the risks or preventive effect of maintaining adequate levels of vitamin D and calcium. A study reported in 2001 found only 7% of adults' neurologists, and 9% of children's' neurologists prescribe calcium and vitamin D to their patients who have seizure disorders. The study concluded more awareness of the problem could improve the bone health of many patients with seizure disorders.
Vitamin D deficiency, and the problems deficiency can initiate, may not be an unavoidable side effect of anticonvulsants. By screening for deficiency and being sure you maintain normal levels of vitamin D and calcium, some of the dreaded side effects of anticonvulsants may never develop. With careful attention to nutrition, some cases of seizures, as Gowers suspected, may indeed be preventable.

Links
• All About Vitamin D
• About vitamin D deficiency• Vitamin D testing• Vitamin D Supplements
• Vitamin D Requirements






Picture: http://en.wikipedia.org/wiki/File:XrayRicketsLegssmall.jpg

Valproate, the Urea Cycle, and Hyperammonemia

This is a technical and "must read" article about how valproate may interfere with the urea cycle and lead to hyperammonemia. If the risk here is recognized, it may be possible to use vitamin supplements along with the medication to avoid the danger and enable the drug to work effectively.
Seizures are one of the symptoms of hyperammonemia.
Link to Article: