Abstract

Epilepsy is one of the most common chronic neurological disorders, affecting approximately 50 million people worldwide, with nearly one-third of patients experiencing drug-resistant seizures. Although antiepileptic drugs remain the cornerstone of epilepsy management, concerns regarding adverse effects, treatment costs, withdrawal symptoms, and persistent seizures have led many people with epilepsy (PWE) to seek complementary and alternative medicine (CAM). This review aims to summarize the prevalence, types, motivations, information sources, and perceived effects of CAM use among PWE. A literature search of PubMed, Scopus, and ScienceDirect was conducted for studies published between 2015 and 2024 using the keywords “epilepsy”, “complementary and alternative medicine”, “CAM”, “traditional medicine”, “prevalence”, and “motivation”. We included sixteen eligible studies in this narrative review. CAM utilization varied substantially across different countries and was influenced by cultural beliefs, accessibility, affordability, and dissatisfaction with conventional treatment. Herbal medicine, faith-based healing, dietary interventions, and mind-body practices were the most commonly reported CAM modalities. While many patients perceive CAM as beneficial for seizure control, stress reduction, and overall well-being, concerns regarding medication non-adherence, delayed conventional treatment, herb-drug interactions, and misinformation remain significant. Healthcare professionals should encourage open communication regarding CAM use and provide evidence-based guidance to ensure its safe integration into epilepsy management. Further research is warranted to establish the safety and effectiveness of commonly used CAM therapies and to support their appropriate role in comprehensive epilepsy care.

INTRODUCTION

Affecting around 50 million individuals globally, epilepsy is one of the most prevalent neurological disorders and is a chronic illness characterized by recurring, uncontrolled convulsions.¹ Its prevalence is significantly higher in low- and middle-income countries, which account for over 80% of cases and where access to specialized care is generally limited. Advances in antiepileptic drugs (AEDs) have not changed the fact that about 30% of people with epilepsy (PWE) remain drug-resistant, resulting in persistent seizures, cognitive deficits, psychiatric comorbidities, and a lower quality of life.²

Although AEDs are the usual therapy, many PWE seek complementary and alternative medicine (CAM) because of their adverse effects, steep prices, withdrawal symptoms, and possible aggravation of seizures.³ In some areas, stigma, false information, and limited access to medical treatment postpone appropriate care and encourage CAM use.
CAM comprises non-conventional healthcare approaches, including biologically based therapies (herbal medicine and supplements), mind-body interventions (meditation, yoga, and acupuncture), manipulative techniques (massage and chiropractic care), and traditional systems such as Ayurveda, traditional Chinese medicine (TCM), and spiritual healing.^{4, 5} Its use in epilepsy treatment differs among societies and medical systems, thereby affecting its frequency, types, and indications.^{6, 7}

Although scientific evidence of CAM’s efficacy in seizure management is limited, PWE widely utilize it. Studies reveal extensive CAM use in Western countries, often alongside AEDs, while in many African and Asian regions CAM is routinely used as a primary treatment because of cultural beliefs, accessibility, and cost.^8-10 Common practices such as faith healing, herbal medicines, and energy therapies highlight the need for educational programs to encourage evidence-based therapies.¹¹ Additionally, hazards such as herb-drug interactions, toxicity, and delayed access to conventional treatment underscore the significance of studying the role of CAM in epilepsy management.

This review seeks to evaluate the incidence of CAM use among PWE, key motives for use, preferred types, sources of information, and perceived effects of CAM in epilepsy care.

METHODS

This narrative review was conducted in accordance with the Preferred Reporting Items for systematic reviews and meta-analyses (PRISMA) guidelines.¹² A comprehensive search of PubMed, Scopus, and ScienceDirect was performed to identify studies published between 2015 and 2024. The search strategy employed Boolean operators and the following key terms: “epilepsy”, “complementary and alternative medicine (CAM)”, “prevalence”, “motivation”, and “traditional medicine”.

Studies were eligible if they were quantitative research articles published in English and examined CAM use in relation to epilepsy, including prevalence, motivations, types, information sources, and perceived outcomes. Exclusion criteria included review articles, qualitative studies, case reports, and studies not directly assessing CAM in epilepsy. The study selection process is illustrated in the PRISMA flow diagram in Figure 1.

Data extraction focused on sample size, study location, CAM usage prevalence, motivations, types of CAM, information sources, and perceived effects. Findings were synthesized narratively without quantitative meta-analysis. To categorize CAM types, this review adopted the framework of the National Centre for Complementary and Integrative Health, which groups practices into five domains: whole medical systems, mind-body approaches, biologically based practices, manipulative and body-based therapies, and energy therapies.¹³

RESULT

Prevalence and Motivation for CAM Use

The prevalence of CAM use among PWE varies across regions and cultures. In the Middle East, CAM use is ubiquitous, primarily influenced by religious and cultural views. Common approaches include spiritual healing, herbal medicines, and dietary adjustments, which are frequently considered holistic solutions. One study found that 71.0% believed in CAM, while actual usage rates remained uncertain.¹⁴ In Türkiye, CAM prevalence ranged from 20.8% to 82.0% across six studies.^15-20 The reported motivations for CAM use included complementing medical treatment (86.4%), reducing seizure frequency (54.1%), and eliminating seizures (25.0%).¹⁸ Up to 24.1% of participants used CAM on medical advice. However, concerns persist that restricted communication with physicians and faith-based dependence may lead to AED withdrawal.

In Europe, CAM is less common since the emphasis on evidence-based treatments predominates. Nonetheless, it is often used to alleviate stress and to improve well-being. In Germany, CAM use was 13.0%, and 81.0% of parents who used CAM utilized it owing to dissatisfaction with traditional therapies.²¹ Among CAM users, motivations included improving health (31.5%), regulating seizures (25.2%), and managing AED adverse effects (22.1%).²² Unlike users in certain countries, European users often combine CAM with AEDs and consult professionals before use.

In Asia, CAM is widely used, especially in low- and middle-income nations, because of cost, accessibility, and tradition. In Malaysia, prevalence ranged from 25.7% to 58.0%, with 72.5% claiming affordability and accessibility as significant reasons.^23-25 A separate study indicated that 27.5% of caretakers employed CAM; among these, 77.3% cited its natural basis and 55.3% cited seizure control as reasons.²⁶ In South Korea, prevalence reached 77.3%.²⁷ CAM in Asia is commonly used as both a primary and a supplementary therapy, while limited safety regulation raises safety concerns.

In North America, CAM is generally part of holistic care. One study indicated that 30% of caregivers used CAM for children with epilepsy, while 43.0% expressed future interest, frequently citing dissatisfaction with traditional therapy.²⁸ Another indicated that about 27.0% of patients had tried CAM.²⁹ CAM in North America is usually used alongside AEDs. Thus, CAM practices varied across locations according to culture, accessibility, and beliefs. A detailed summary of the prevalence rates and motivations for CAM use is presented in Table 1.

Types and Reasons for CAM Use

Whole Medical Systems include conventional techniques like homeopathy, which is used by 4.7% of Turkish users and 67.0% of users in Germany.^{18, 21} Systems such as Ayurveda, TCM, Malay medicine, and Indian medicine are reported by 6.9%-25.0% of Malaysians.^{23, 25}

Mind-body approaches focus on spiritual and psychological well-being. Prayer and faith healing were extensively employed, with prevalence ranging from 38.4% in Malaysia to 88.0% in the U.S.^{15, 18, 23, 24, 28} Use of yoga for stress alleviation ranged from 19.0% in Germany to 30.6% in Malaysia.^{21, 23} Meditation, hypnosis, and music therapy varied in popularity, with meditation being common among those seeking relaxation.^{18, 26}

Biologically based practices involve herbal medicines, diets, and supplements. Herbal medicine was reported by 25.6% of Turkish users and 67.0% of German users.^{18, 21} Dietary therapy ranged from 18.8% in Iran to 36.1% in Malaysia.^{14, 23} Supplement use, including vitamins and minerals, ranged from 30.0% to 45.0%.^{20, 25}

Manipulative and body-based therapies include physical therapies, such as massage therapy, ranging from 45.3% in Türkiye to 58.3% in Malaysia.^{16, 23} Chiropractic care was used by 10.0%-25.0% of participants, mainly in Germany and Malaysia.^{21, 25} Osteopathy, more widespread in the West, was reported by up to 57.0% of German users.²¹ Other therapies included cupping (18.6%-27.3% in Türkiye) and reflexology.^{16, 23}

Energy therapies involve controlling energy fluxes. Prevalence of acupuncture use ranged from 6.3% in Iran to 47.2% in Malaysia.^{14, 23} Reiki was employed by 27.8% in Malaysia and other energy healing was employed by 31.5% in Poland.²² These categories demonstrate diverse global usage and summary of CAM types and their prevalence is shown in Table 2.

Sources of CAM Information

Most PWE learned about CAM from family and friends, a process influenced by shared experiences and cultural norms.^{15, 28} Trust in social networks typically surpassed trust in expert guidance. Healthcare experts held conflicting views: some endorsed CAM as a supplement, while others highlighted safety concerns.^{18, 23} Online outlets and social media were major information sources, but were prone to misrepresentation.^{22, 24} Traditional healers and religious authorities strongly promoted faith-based approaches, such as prayer and Quranic healing.^{28, 29} Self-experimentation was also reported, particularly among those unsatisfied with traditional therapy.^{19, 25} Social, cultural, and healthcare access issues largely affected CAM decisions.

Perceived Effects of CAM Use

Positive Effects

Some interventions, such as acupuncture, relaxation techniques, and dietary adjustments, were associated with greater seizure control and stress reduction. Among TCM users, acupuncture appeared to reduce seizures.²⁷ Other consumers reported lower anxiety and greater well-being.^{21, 22}

The ketogenic and modified Atkins have demonstrated anticonvulsant potential. Many Malaysian CAM users reported finding it beneficial and regarded it as curative.²⁵ Herbal medicines and spiritual practices were also considered to support emotional well-being.^{18, 23, 28}

Negative Effects

Despite perceived benefits, concerns include delays in therapy or discontinuation of AEDs. Some studies have linked CAM use to poorer seizure control and increased emergency admissions owing to AED withdrawal.^{14, 16, 25} False beliefs that CAM is a sole cure diminished adherence to medications.^{18, 28}

The lack of scientific validation and regulation also poses challenges. Herbal therapies can interact adversely with AEDs, reducing their effectiveness or increasing their side effects.^{15, 23} Studies have reported a decrease in seizure control associated with unsupervised herbal use.²²

Caregivers of children often turned to CAM out of concern about the adverse effects of AEDs, despite insufficient clinical evidence.^{28, 29} Misinformation and limited awareness of the hazards of CAM may delay appropriate medical care when CAM is preferred over conventional treatment.¹⁷ A summary of the perceived effects of CAM use is presented in Table 3.

DISCUSSION

This research highlights the widespread use of CAM among PWE, primarily in response to perceived limitations of conventional epilepsy therapies. Many patients sought CAM because of dissatisfaction with AEDs, concerns about side effects, and cultural or spiritual beliefs. While CAM is typically used alongside AEDs, some individuals accept it as a substitute, raising issues regarding treatment adherence, delays in medical intervention, and patient safety.^{30, 31} The expanding popularity of CAM underscores the need to critically analyse its impact on patient outcomes, physician-patient communication, and health policy.

A particularly striking conclusion was that healthcare providers recommended CAM. This undermines the prevailing notion that clinicians often discourage its use. Instead, it shows a lack of clearly defined clinical criteria, which may cause clinicians to acknowledge CAM without properly evaluating its benefits and risks.¹⁸ Many patients perceived CAM as a more natural and safer alternative to AEDs, making it an attractive option for controlling epilepsy.^{32, 33} Although these views are typically rooted in valid concerns about AED side effects, misconceptions about the safety and effectiveness of CAM may lead to poorly informed treatment decisions, especially when CAM is taken without medical supervision.

Social and cultural forces also play a considerable role in CAM use. Many PWE rely on guidance from family members, religious leaders, or online sources rather than on medical experts.^34-36 In certain communities, epilepsy is regarded as a supernatural or spiritual ailment, leading individuals to seek traditional or faith-based therapies. While these treatments may offer emotional support, they typically lead to delays in seeking medical care, worsen seizure control, and raise the likelihood of poor outcomes. To bridge the gap between traditional practices and evidence-based care, culturally relevant instructional initiatives are needed.

Despite these issues, many patients use CAM in addition to, rather than as a substitute for, traditional therapy. This integrated strategy indicates confidence in the complementary benefits of CAM, especially given perceptions that CAM has fewer adverse effects than AEDs.^{18, 28, 32} Some interventions, such as the ketogenic diet, have demonstrated therapeutic potential; however, many others remain uncontrolled and may pose considerable dangers, including drug interactions and variable dosing.³⁷

A key issue is the delay in initiating conventional therapy among patients who prioritize CAM. Research has indicated that people who postpone AED use in favour of CAM often experience poorer seizure control, increased hospitalization, and avoidable consequences.^{14, 16} In extreme situations, some patients completely discontinue AEDs under the false belief that CAM offers a cure, thereby increasing the risk of seizure recurrence and life-threatening events.^{18, 28} The increased use of herbal medicines further complicates epilepsy care, as unregulated herbal medicines may interfere with AED metabolism, lower therapeutic efficacy, or cause toxicity.^{15, 23} These hazards underscore the importance of physician involvement in discussions about CAM to dispel misconceptions while preserving patient autonomy.

To address these issues, improved physician-patient communication is essential.^{38, 39} Patients must have access to reliable, evidence-based information regarding CAM, and clinicians must be trained to address CAM knowledgeably and respectfully. Public health campaigns should also aim to address CAM-related disinformation, especially on social media platforms, where untested treatments are widely promoted.³⁶ Integrating CAM information into medical training will enhance physicians’ ability to assist patients in making safer, more effective treatment choices.³⁴

Going forward, efforts should focus on strengthening CAM regulation, increasing public understanding, and enhancing healthcare providers’ engagement in CAM-related debates. More rigorous clinical research is necessary to investigate the safety and efficacy of routinely used CAM therapies, particularly when coupled with AEDs. Health authorities must also adopt stringent quality- control standards for herbal and other alternative medicines to limit the hazards associated with self-medication and unregulated products.^{15, 21} Through a coordinated approach incorporating teaching, research, and regulatory supervision, healthcare systems can ensure that CAM is used appropriately and does not impair the quality of epilepsy care.

Study Limitations

This narrative review has several limitations. Limiting the search to three databases (Scopus, ScienceDirect, and PubMed) may have resulted in omission of pertinent studies from other sources. The emphasis on English-language publications may have excluded related studies in other languages, thereby impacting the thoroughness of the conclusions. The review predominantly focuses on the viewpoints of PWE, their parents, and caregivers and excludes comments from healthcare providers, CAM practitioners, and legislators. Understanding these holistic perspectives is crucial for enhancing physician-patient communication, strengthening policies, and incorporating CAM into clinical practice. As qualitative narrative review, our paper synthesises findings descriptively rather than providing quantitative analyses of statistical patterns, therapeutic efficacy, or cost-effectiveness. This review has identified significant gaps and potential avenues for future research, providing essential insights into the motivations, hazards, and obstacles associated with CAM use among patients with epilepsy.

CONCLUSION

The use of CAM among PWE is widespread across various regions, driven by dissatisfaction with AEDs, cultural traditions, and the pursuit of holistic and natural health approaches. Herbal therapies, faith-based healing, mind-body interventions, and dietary modifications were the most commonly utilized CAM modalities. While many patients reported benefits such as stress reduction and perceived seizure control, significant risks, including delayed access to medical care, medication non-adherence, and herb-drug interactions, were identified. These findings underscore the importance of healthcare providers actively engaging in open discussions with patients regarding CAM use to ensure informed decision-making and adherence to evidence-based treatments. Public health initiatives should address the spread of misinformation, promote culturally sensitive education, and advocate for better regulation of CAM products. Future research should focus on rigorous evaluation of the safety and efficacy of commonly used CAM therapies in epilepsy management. By addressing these critical challenges, healthcare systems can support the safer integration of CAM practices without compromising the treatment outcomes in patients with epilepsy.