TCVM for Challenging Illnesses – Part 1: Seizures
The rapidly increasing prevalence of chronic illness in pets has irrevocably altered veterinary care. Much of conventional medicine struggles to care for growing numbers of patients with ongoing and challenging health problems. Meanwhile, the use of integrative or complementary medicine in the treatment of chronic diseases has increased in popularity over the last few decades.
Traditional Chinese Veterinary Medicine (TCVM) has become one of the most frequently requested integrative therapies to be used by itself or in conjunction with conventional medicine or other treatments to treat a variety of challenging illnesses, including pain, seizures, Cushing’s disease, skin problems, and cancer. Practitioners of TCVM use many different modalities, including acupuncture, Chinese herbal medicine, moxibustion, Tui na massage, and dietary therapy to treat or prevent health problems, improve outcomes, and enhance quality of life.1
CONTROLLING SEIZURES IN PETS
Seizure disorder or epilepsy is one of the most challenging neurological conditions affecting pets, and represents a significant number of referrals to veterinary neurologists. It is estimated that 1% of the canine population has some form of seizure disorder.2 The incidence of idiopathic (inherited) epilepsy in certain breeds of dog can be as high as 15% to 20%.2
To date, there is no cure nor ideal treatment for epilepsy. While antiepileptic drugs (AEDs), such as phenobarbital and potassium bromide (KBr), can be very helpful in the control of seizure activity, they reduce the clinical signs but do not treat the cause,2 and not all treatments provide absolute control. Approximately 20% to 40% of epileptic dogs may become refractory to phenobarbital and KBr.3 In addition, some animals are less tolerant of their side effects, which include lethargy, polyuria/polydipsia, polyphagia, vomiting, sedation, and weight gain (phenobarbital).4
Regardless of the causes of epilepsy, TCVM is an effective treatment to help complement current medications and improve seizure management. Indications for TCVM therapies include side effects caused by AEDs, refractory seizures, and quality of life of the patient.
- A number of published studies demonstrate the antiepileptic effects of acupuncture as an adjunctive treatment for seizures in animal models and humans.5-13 Different modalities of acupuncture have been used to treat seizures, including needle insertion,5,10 electrostimulation,14 scalp acupuncture,12 auricular acupuncture,6,7,15, and gold bead/ wire implants on acupuncture points.8,11 Accumulating data have showed that acupuncture may have an effect on epilepsy by increasing the release of inhibitory neurotransmitters, such as serotonin, GABA, nitric oxide, or opioid peptides.15
- Herbal medicine is another major component of TCVM and has been advocated as an adjunctive therapy in seizure control, usually in conjunction with acupuncture.16 TCVM practitioners usually prescribe combinations of herbal medicines. The most frequently used Chinese herbal medicine in the management of seizures is Di Tan Tang (Chinese herbal equivalent of phenobarbital). It contains Uncaria, Arisaemi, Acorus, Poria and Glycyrrhiza, which have been shown to possess anti-epileptic activity in animal models.17 Nux vomica, Illicium henryi, betelnut and mulberry are only a few herbals that should be avoided as they have been found to induce seizures.18
Soothe Liver and calm Liver Yang
BL-18 – Backshu association point for the liver
BL-19 – Backshu association point for the gallbladder
LIV-3 – Shu -stream (earth) of the LIV channel; subdues Liver Yang
TH-5 – Subdues Liver Yang
Er-jian – Clears Heat and subdues Yang; hemoacupuncture this point
GV-14 – Extinguishes interior Wind
GV-16 – Extinguishes both interior and exterior Wind, especially when the Wind affects the brain
GB-20 – Extinguishes Wind and subdues Yang
BL-17 – Influential point for Blood; activates Blood to dispel Wind
SP-10 – Sea of Blood; activates Blood to dispel Wind
Da-feng-men – Classical point for Wind pattern
Calm the Shen
GV-20 – Calms the Mind, extinguishes interior Wind, and subdues Liver Yang
HT-7 – Calms the Mind and opens the Mind’s orifices
An-shen – Classical point for calming the Mind
Nao-shu – Brain association point for calming the brain
ST-40 – Resolves Phlegm and opens the Mind’s orifi ces
GV-1 – Opens the Mind’s orifices and extinguishes interior Wind
GV-26 – Opens the Mind’s orifices, extinguishes interior Wind, and promotes consciousness
Notes: Additional acupoints based on pattern diagnoses as follows:
1) Wind-Phlegm: BL-20, BL-21, ST-36
2) Phlegm-Fire: LIV-2, ST-36, Wei-jian
3) Blood Stagnation: LI-4, GB-41
4) Yin-Blood Defi ciency: BL-23, LIV-8, SP-6, KID-3
THE TCVM PHILOSOPHY OF SEIZURES
The philosophy of disease treatment in TCVM differs from that of Western medicine. TCVM treats the individual, not the disease. From the TCVM standpoint, seizure is caused by “internal Wind” invading the channels of Liver due to Heat generated by the Liver (known as Liver Yang rising). The metaphor of “Wind” implies the shaking of tree leaves in a strong breeze, which resembles seizure activity. The Heart and Kidneys are also involved in seizures. The Kidney, in TCVM, is Water. Water nourishes Wood (Liver) and hinders Fire (Heart), so if the Kidneys are out of balance, it could influence the Liver or Heart imbalances that trigger seizures.
TCVM treatment for seizures involves calming the Liver, eliminating Wind, calming the Mind, clearing Phlegm, and restoring consciousness (see table above).1 It is also important to balance the Qi, Blood, Yin and Yang if they are involved.
Acupuncture can be given once every two to four weeks for five to eight sessions initially, along with Chinese herbal medicine. After that, the treatments can be spaced out to once every three to six months for maintenance. Once the seizures are under control, you can gradually reduce the dosage of phenobarbital, potassium bromide, or other AEDs to the lowest effective dose (one at a time). Gold bead or wire implant can be considered for refractory epilepsy as a last resort. In one study, nine of 15 dogs had at least a 50% reduction in seizure frequency after gold wire implantation in acupoints.8 Acupuncture and herbal medicine should be tried before permanent materials are implanted, since metal implants may interfere with future MRI testing.
- S -adenosyl methionine (SAMe) or milk thistle (Silybum marianum) provide hepatocellular protection by stabilizing hepatic cell membranes. The author uses SAMe (15 to 20 mg/kg q24h) and/or milk thistle extract (5 to10 mg/ kg q24h) or silybin (1 to 2 mg/kg q24h) to prevent liver damage from medications.
- Hemp-based cannabidiol (CBD) is an extract from industrial hemp plants that contains mainly non-psychoactive CBD with minimal to no psychoactive THC. Emerging data support its use as a therapeutic option for refractory epilepsy in humans.19 The author may add hemp-based CBD (2.5 to 10 mg/kg q12h) for refractory seizure patients that do not respond well to TCVM and conventional treatment. The regulations of CBD can be varied in each state, so veterinarians should consult their state veterinary association before prescribing it.
- Huperzine A is a compound isolated from Chinese club moss Huperzia serrata, and is available as an over-the-counter supplement to enhance memory. It has been shown to have anti-seizure action in animal models.20 Huperzine A is given orally (1 µg/kg q8-12h) and was associated with no major side effects in a canine case report.21
- Other nutraceuticals advocated as an adjunctive therapy for epilepsy in humans include dimethylglycine (DMG), taurine, betaine HCl, proanthocyanidin complex, pyridoxine (vitamin B6), folic acid (vitamin B9), magnesium, manganese, zinc and choline.22 The author commonly supplements with pyridoxine (25 to 50mg q24h) and folic acid (400 to 800µg q24h) for epileptic patients. High dose pyridoxine may decrease phenobarbital serum levels.
TCVM may prove to be an excellent adjuvant to conventional therapy in the treatment of seizures in animals, especially those with poorly controlled seizures. In mild cases, TCVM can be used on its own to help prevent and minimize the occurrence of further seizures. It may reduce the requirement for anti-epileptic medication.
Nevertheless, there is a need for evidence-based research in the study of acupuncture or herbal medicine for managing seizures in animals. A pet owner looking at TCVM and acupuncture for epilepsy should ensure their pet is treated only by a certified veterinary acupuncturist in addition to having the animal evaluated by their primary veterinarian or a veterinary neurologist.
A five-year-old male neutered Weimaraner presented with a four-year history of grand mal seizures due to idiopathic epilepsy. The seizures were not well controlled by increased doses of KBr and phenobarbital therapy, and were continuing to occur once every five to seven days. Since being put on increased doses of phenobarbital and KBr, he had also been restless, ataxic, and had no stamina. He often panted and looked for cool places to lie. His tongue was red and wet. His pulses were fast, slippery and bounding. The hair coat was dry with small dandruff.
The TCVM diagnosis was Phlegm-Fire and Yin deficiency. Therapies included acupuncture once every two weeks for five sessions, and daily herbal therapy with Ding Xian Wan and Tian Ma Plus II (JingTang). Two weeks later, the owner reported that the dog had only one minor seizure. After five sessions, he had seizures only once every six to eight weeks and the owner noticed that he had better activity levels and less restlessness. Phenobarbital dosage was reduced by 25%.
The dog continues receiving acupuncture and herbal therapy once monthly. The goal is to minimize the frequency of seizure to once every six to 12 months.
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