Acupuncture Treatment of Epilepsy

Epilepsy is one of the commonest brain disorders characterized by recurrent unprovoked seizures that result from the abnormal, excessive, and synchronous activity of clusters of nerve cells in the brain. Epilepsy is very prevalent and has a high incidence. Intensive efforts have been made in the treatment for epilepsy, including medical, surgical, and other treatment strategies such as ketogenic diet and vagus nerve stimulation. However, these treatment options have their own limitations and complications. About one-third of patients show no response to pharmacological treatment. Concern regarding the adverse effects of these treatments has drawn people toward other therapies for treatment of epilepsy. Acupuncture, one of the popular therapeutic techniques in traditional Chinese medicine (TCM), has proven to be safe, efficient, and convenient with minimal side effects. Thus, it has gained popularity in treatment of various diseases, including epilepsy, in the West. However, due to the limited availability of high-quality research papers documented in English and a difference in the understanding of antiepileptic effects of acupuncture between the scientists of East and West, the application of acupuncture in the treatment of epilepsy is limited in Western community. In this chapter, we attempt to summarize the clinical observations on acupuncture in the treatment of epilepsy. Based on the underlying mechanisms of epilepsy and epileptogenesis, we have outlined the probable modes of action of acupuncture antiepilepsy in this chapter. Epileptic seizures and epileptogenesis are complex processes that result from changes in the excitability of neurons and involve synchronous discharges of a population of hyperexcitable neurons propagated through normal or pathological pathways. The increased excitability is ascribed to the changes that occur in both neurons and glial cells. In neurons, it is mainly due to (1) the innate ability of intrinsically bursting neurons in the cortex and hippocampus, (2) alterations in the membrane properties, (3) imbalance between excitatory and inhibitory transmission, and (4) alterations in existing synaptic contacts/circuits and/or establishment of new synaptic contacts/circuits. In glial cells, the most striking change is their impaired ability to maintain glutamate and K+ homeostasis. The most probable mechanism that underlies the antiepileptic effect of acupuncture is normalization of this disrupted neuronal excitability through multiple effects at different levels (from cells to molecules) with different time course (short term vs. long term) and during different stages of epilepsy (early/acute vs. later/chronic). These strategies include the modification of neuronal electrical activity and the activity of therapeutic network, the regulation of the activity of biomediators (e.g., amino acids, neuropeptides, monoamines, NO, Ca2+ and Ca2+-dependent activity, hormones, and humoral factors), the prevention from seizure-induced neuronal injury/loss and the subsequent aberrant neurogenesis and synaptic reorganization/dendritic remodeling in seizure-susceptible areas, and the regulation of ion channel activity.