What natural supplements can help with seizures?

Natural Supplements for Seizures: Evidence-Based Recommendations

Primary Recommendation

There is no clear evidence that dietary supplementation with vitamins, minerals, herbs, or spices can improve outcomes in people with epilepsy who do not have underlying deficiencies, and they are not generally recommended for seizure control. 1

Critical Safety Concerns

Supplements That May Worsen Seizures

• Kratom must be discontinued immediately - chronic use can lead to neurologic effects including seizures, and the FDA warns against its use 1
• Folate supplementation can occasionally cause seizures in people with epilepsy and marginal folate status who are receiving anticonvulsants 1
• Herbal stimulants containing ephedrine (ephedra, ma huang) and caffeine (guarana, cola) can exacerbate seizures, especially when taken in combination 2
• Ginkgo and ginseng may exacerbate seizures based on anecdotal evidence 2
• Essential oils of many plants contain epileptogenic compounds and should be avoided 2

Supplements With Problematic Drug Interactions

• St. John's wort should be discontinued at least 2 weeks before any procedure due to multiple drug interactions, including with antiepileptic medications through CYP3A4 induction 1, 3
• Kava may act additively with antiepileptic medications causing excessive sedation and should be held 2 weeks preoperatively 1
• Valerian, chamomile, and passionflower may potentiate sedative effects of antiepileptic medications, increasing cognitive impairment 2

When Supplementation IS Indicated

Electrolyte Correction (Primary Treatment)

Correct underlying electrolyte disturbances as the primary treatment for seizures caused by metabolic abnormalities, rather than adding antiepileptic drugs: 4, 5

• Potassium supplementation when levels fall below 3.0 mmol/L, particularly in elderly patients on diuretics 4
• Magnesium supplementation if hypomagnesemia is present, as this commonly coexists with hypocalcemia 4, 5
• Calcium and vitamin D supplementation for hypocalcemia-induced seizures, especially in velocardiofacial syndrome or hypoparathyroidism 5

Vitamin Deficiency Correction

Supplementation is appropriate only when documented deficiencies exist: 1, 6

• Vitamin B6 (pyridoxine) for pyridoxine-dependent or pyridoxine-responsive epilepsies - these are specific genetic conditions requiring high-dose supplementation 6
• Vitamin D when deficiency is documented, as certain antiepileptic medications (phenytoin, carbamazepine, phenobarbital) can lower vitamin D levels 6
• Folate when deficiency is documented, though monitor carefully as supplementation can occasionally worsen seizures in those on anticonvulsants 1
• Vitamin B12 when deficiency is documented, particularly in patients on long-term antiepileptic therapy 6

Supplements With Insufficient Evidence

Despite animal studies or theoretical mechanisms, the following lack clinical evidence for seizure control: 7, 8, 9, 6

• Melatonin - while safe perioperatively for anxiety, efficacy for seizure control is unproven 1, 8
• Omega-3 fatty acids - animal data exists but clinical trials are lacking 9
• Zinc - no established role in epilepsy management 1
• Chromium - benefit not conclusively demonstrated 1
• Curcumin - small studies showed no cognitive benefit 1
• Alpha lipoic acid, N-acetyl-cysteine, acetyl-L-carnitine - insufficient evidence 1

Clinical Algorithm for Supplement Use in Epilepsy

1. First, identify and correct any electrolyte abnormalities (potassium, magnesium, calcium) - this is primary treatment, not adjunctive 4, 5

2. Screen for vitamin deficiencies in patients on long-term antiepileptic medications, particularly vitamin D, B12, and folate 6

3. Supplement only documented deficiencies with appropriate monitoring 1, 6

4. Discontinue all potentially harmful supplements including kratom, ephedra-containing products, St. John's wort, and essential oils 1, 2

5. Continue standard antiepileptic drug therapy - do not replace with unproven supplements 8, 2

Common Pitfalls to Avoid

• Do not assume "natural" means safe - many herbal products can worsen seizures or interact with antiepileptic medications 8, 2
• Do not overlook electrolyte disturbances as treatable causes of seizures, even in patients with known epilepsy 4, 5
• Do not use herbal sedatives as seizure prevention - efficacy is unestablished and they may increase medication side effects 2
• Always inquire about supplement use as patients may not volunteer this information 8
• Monitor for overcorrection when supplementing calcium/vitamin D, which can cause hypercalcemia and renal complications 5