Journal of Oriental Neuropsychiatry (동의신경정신과학회지)

The Korean Society of Oriental Neuropsychiatry (대한한방신경정신과학회)
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Herbal Medicine for Pediatric Epilepsy: Clinical Research Trends in Traditional Chinese Medicine

  • Kim, Sang-Ho (Department of Neuropsychiatry of Korean Medicine, Pohang Korean Medicine Hospital, Daegu Haany University) ;
  • Kim, Da-Woon (Department of Neuropsychiatry of Korean Medicine, Pohang Korean Medicine Hospital, Daegu Haany University)
  • Received : 2022.06.04
  • Accepted : 2022.06.23
  • Published : 2022.06.30
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Abstract

Pediatric epilepsy, a chronic, recurrent brain disorder, is the most common neurological disorder in children. Its prevalence is increasing. Early management is very important since 30~40% of cases persist into adulthood. To provide basic data for future clinical research on pediatric epilepsy using Korean medicine treatment and cooperation between Western medicine doctors and Korean medicine doctors, we reviewed recent clinical research in traditional Chinese medicine (TCM) using herbal medicine for pediatric epilepsy. A total of 23 articles (1 clinical practice guideline, 3 systematic reviews, 15 randomized controlled trials (RCTs), and 4 non-RCTs) were reviewed in this study. The authors summarized characteristics of included studies regarding study subjects, diagnostic tools, pattern identification tools, treatment period, evaluation tools, detail of herbal medicines, treatment effects, and adverse events. Combination therapy using both herbal medicine (HM) and anti-epileptic drugs (AEDs) was performed more frequently than herbal medicine alone. Liver-pacifying medicinal, water-draining medicine, and orifice-opening medicine were frequently used. The main single HMs were Cheonma, Boglyeong, Jogudeung, and Seogchangpo. Combined therapy using HM and AEDs had significant benefits in improving total effective rate. It also appeared to be safer than AEDs. However, since the quality of clinical trials was poor and only studies in the last 10 years were included, the clinical evidence was uncertain. Finally, the authors provided limitations of this study and several suggestions for future research based on our analysis results.

Keywords

Acknowledgement

This research was supported by a grant from Daegu Haany University Kylin Foundation in 2021. We thank Professor Chan-young Kwon, Ji-hong Lee PhD, and KMD Bo-ram Lee for reviewing the manuscript.

References

  1. Zack MM KR. National and State Estimates of the Numbers of Adults and Children with Active Epilepsy - United States, 2015. MMWR Morb Mortal Wkly Rep. 2017;66(31):821-5. https://doi.org/10.15585/mmwr.mm6631a1
  2. Jeon J-Y, Lee H, Shin J-Y, Moon H-J, Lee S-Y, Kim J-M. Increasing Trends in the Incidence and Prevalence of Epilepsy in Korea. J Clin Neurol. 2021;17(3):393-9. https://doi.org/10.3988/jcn.2021.17.3.393
  3. Lee S-Y, Chung S-E, Kim DW, Eun S-H, Kang HC, Cho YW, et al. Estimating the Prevalence of Treated Epilepsy Using Administrative Health Data and Its Validity: ESSENCE Study. J Clin Neurol. 2016;12(4):434-40. https://doi.org/10.3988/jcn.2016.12.4.434
  4. Koh HK, Kobau R, Whittemore VH, Mann MY, Johnson JG, Hutter JD, et al. Toward an integrated public health approach for epilepsy in the 21st century. Prev Chronic Dis. 2014;11:E146.
  5. Widjaja E, Guttmann A, Tomlinson G, Snead OC, 3rd, Sander B. Economic burden of epilepsy in children: A population-based matched cohort study in Canada. Epilepsia. 2021;62(1):152-62. https://doi.org/10.1111/epi.16775
  6. Lee S-Y, Jung K-Y, Lee IK, Yi SD, Cho YW, Kim DW, et al. Prevalence of Treated Epilepsy in Korea Based on National Health Insurance Data. J Korean Med Sci. 2012; 27(3):285-90. https://doi.org/10.3346/jkms.2012.27.3.285
  7. Puka K, Tavares TP, Speechley KN. Social outcomes for adults with a history of childhood-onset epilepsy: A systematic review and meta-analysis. Epilepsy & Behavior. 2019;92:297-305. https://doi.org/10.1016/j.yebeh.2019.01.012
  8. Camfield PR, Camfield CS. What Happens to Children With Epilepsy When They Become Adults? Some Facts and Opinions. Pediatric Neurology. 2014;51(1):17-23. https://doi.org/10.1016/j.pediatrneurol.2014.02.020
  9. Kalilani L, Sun X, Pelgrims B, Noack-Rink M, Villanueva V. The epidemiology of drug-resistant epilepsy: A systematic review and meta-analysis. Epilepsia. 2018;59(12): 2179-93. https://doi.org/10.1111/epi.14596
  10. Pellino G, Faggioli R, Madrassi L, Falsaperla R, Suppiej A. Operational diagnosis of epilepsy in children at undetermined risk: A meta-analysis of prognostic factors for seizure recurrence. Epilepsy Behav. 2022;127:108498. https://doi.org/10.1016/j.yebeh.2021.108498
  11. Fisher RS, Acevedo C, Arzimanoglou A, Bogacz A, Cross JH, Elger CE, et al. ILAE official report: a practical clinical definition of epilepsy. Epilepsia. 2014;55(4):475-82. https://doi.org/10.1111/epi.12550
  12. Wieshmann UC, Baker G. Efficacy and tolerability of anti-epileptic drugs-an internet study. Acta Neurol Scand. 2017;135(5):533-9. https://doi.org/10.1111/ane.12698
  13. Mutanana N, Tsvere M, Chiweshe MK. General side effects and challenges associated with anti-epilepsy medication: A review of related literature. Afr J Prim Health Care Fam Med. 2020;12(1):e1-e5.
  14. Wang C, Preisser J, Chung Y, Li K. Complementary and alternative medicine use among children with mental health issues: results from the National Health Interview Survey. BMC Complementary and Alternative Medicine. 2018;18(1):241. https://doi.org/10.1186/s12906-018-2307-5
  15. Lai CWL, Y.H. History of epilepsy in Chinese traditional medicine. Epilepsia. 1991;32(3):299-302. https://doi.org/10.1111/j.1528-1157.1991.tb04655.x
  16. He LY, Hu MB, Li RL, Zhao R, Fan LH, He L, et al. Natural Medicines for the Treatment of Epilepsy: Bioactive Components, Pharmacology and Mechanism. Front Pharmacol. 2021;12:604040. https://doi.org/10.3389/fphar.2021.604040
  17. Xiao F, Yan B, Chen L, Zhou D. Review of the use of botanicals for epilepsy in complementary medical systems--Traditional Chinese Medicine. Epilepsy Behav. 2015;52(Pt B):281-9. https://doi.org/10.1016/j.yebeh.2015.04.050
  18. Auditeau E, Chassagne F, Bourdy G, Bounlu M, Jost J, Luna J, et al. Herbal medicine for epilepsy seizures in Asia, Africa and Latin America: A systematic review. J Ethnopharmacol. 2019;234:119-53. https://doi.org/10.1016/j.jep.2018.12.049
  19. Kakooza-Mwesige A. The importance of botanical treatments in traditional societies and challenges in developing countries. Epilepsy Behav. 2015;52(Pt B):297-307. https://doi.org/10.1016/j.yebeh.2015.06.017
  20. Lee JY CW, Eun SH, Eun BL, Hong YS. Use of herbal medicine in epileptic children. Korean J Pediatr. 2008;51(4): 415-9. https://doi.org/10.3345/kjp.2008.51.4.415
  21. Department of Pediatrics NCoKM. National Korean Medicine University Textbook of Pediatrics 3th Edition. Seoul: Euiseongdang; 2020.
  22. Lee S.H. BJH, Cho Y.S. A Review of Korean Medicine Treatment for Seizure Disease in Children. J Pediatr Korean Med. 2020;34(3):37-54. https://doi.org/10.7778/JPKM.2020.34.3.37
  23. Choi M.K. SGJ, Gwon G.H., Lee H.W , Cho J.Y, Park S.J. . Analysis of Domestic Research Trends in Oriental Medical Clinical Treatment for Epilepsy. Journal of Oriental Neuropsychiatry. 2021;32(3):247-60. https://doi.org/10.7231/JON.2021.32.3.247
  24. Lee J, Son K, Hwang G, Kim M. Effect and Safety of Shihogyejitang for Drug Resistant Childhood Epilepsy. Evid Based Complement Alternat Med. 2016;2016:3410213.
  25. Kang K.H. PEJ. A Literature Study about Childhood Epilepsy - Focused on Chinese Medical Journals -. J Pediatr Korean Med. 2015;29(1):15-26. https://doi.org/10.7778/JPKM.2015.29.1.015
  26. Brouwers MC, Kho ME, Browman GP, Burgers JS, Cluzeau F, Feder G, et al. AGREE II: advancing guideline development, reporting and evaluation in health care. Cmaj. 2010;182(18):E839-42.
  27. Shea BJ, Grimshaw JM, Wells GA, Boers M, Andersson N, Hamel C, et al. Development of AMSTAR: a measurement tool to assess the methodological quality of system - atic reviews. BMC Medical Research Methodology. 2007; 7(1):10. https://doi.org/10.1186/1471-2288-7-10
  28. Higgins J, Altman D. Chapter 8: assessing risk of bias in included studies. In Cochrane handbook for systematic reviews of interventions, version 5.1.0.(eds Higgins, J. P. T. & Green, S.): The Cochrane Collaboration; 2011. 187-241 p.
  29. Kim SY, Park JE, Lee YJ, Seo HJ, Sheen SS, Hahn S, et al. Testing a tool for assessing the risk of bias for nonrandomized studies showed moderate reliability and promising validity. J Clin Epidemiol. 2013;66(4):408-14. https://doi.org/10.1016/j.jclinepi.2012.09.016
  30. Sharif MO, Janjua-Sharif FN, Ali H, Ahmed F. Systematic reviews explained: AMSTAR-how to tell the good from the bad and the ugly. Oral Health Dent Manag. 2013;12(1): 9-16.
  31. R. M, Z.H. L, X.L. Z, L.S. W, B.X. M, Y. W, et al. Guidelines for Clinical Diagnosis and Treatment of Pediatrics in Traditional Chinese Medicine, Pediatric Epilepsy (Revised). Journal of Pediatrics of Traditional Chinese Medicine. 2017;13(06):1-6.
  32. Standardization Office of Traditional Chinese Medicine in Administration of National Traditional Chinese Medicine IoTCMaBM, Chinese Academy of Chinese Medical Sciences General Principles for the Development of TCM Clinical Guideline. In: Medicine AoNTC, editor. 2015.
  33. B.Q. W. Meta-analysis of randomized controlled trials of extinguish wind and suppress convulsion therapy for children with epilepsy [硕士]: Journal of Gansu University of Chinese Medicine; 2016.
  34. W. W. Meta-analysis of the efficacy of traditional Chinese medicine in children with epilepsy. Chinese Journal of Healthy Birth & Child Care. 2014;20(03):204-6.
  35. X.W. L. A systematic review on the intervention of integrated traditional Chinese and western medicine in children with epilepsy [硕士]: Journal of Liaoning University of Traditional Chinese Medicine; 2014.
  36. Y.J. Q, X.Z. Z, C.L. G. Observation of the curative effect of traditional Chinese medicine and western medicine in the treatment of epilepsy in children. China & Foreign Medical Treatment. 2013;32(29):136-7.
  37. C.F. H, X.L. L, Q.S. C. Clinical Analysis and Research on 240 Children with Epilepsy Treated by Integrated Traditional Chinese and Western Medicine. Clinical Journal of Chinese Medicine. 2018;10(01):100-2.
  38. P. R, X.L. Z, R. M, X.M. L, C.P. Y. Clinical study of "Treatment from the kidney" in children with epilepsy. Journal of Tianjin University of Traditional Chinese Medicine. 2012; 31(03):140-3.
  39. M.Y. Q. Effects of Xijing Decoction combined with oxcarbazepine on cognitive function and NPY and NGF in children with epilepsy. Chinese Medicine Modern Distance Education of China. 2021;19(20):144-6.
  40. J.M. C, S.C. W. Treatment of 30 cases of epilepsy in children by sweeping phlegm and settling fright therapy. Henan Traditional Chinese Medicine. 2016;36(04):621-3.
  41. Z.D. Z, X.W. Z. Observation on the curative effect of Crotonis Semen powder paste pill in a small amount for a long time combined with syndrome differentiation formula in the treatment of epilepsy in children. Guangming Journal of Chinese Medicine. 2012;27(02):284-5.
  42. H.J. Z. Discussion on the efficacy of traditional Chinese medicine in the treatment of epilepsy in children. Contemporary Medicine. 2014;20(13):153-4.
  43. X. Y, Y.P. W, J. S. Observation on the curative effect of Anshen Dingxian Decoction in the treatment of absence seizures in children. Guiding Journal of Traditional Chinese Medicine and Pharmacy. 2015;21(15):69-71.
  44. L. Z, C.T. D, S.L. Q, X.H. S, J.J. W, Y.H. L. Clinical observation of Dingxianwan Jiaweifang combined with sodium valproate in the treatment of children with primary epilepsy. Journal of Shanxi University of Chinese Medicine. 2017;18(04):45-6+74.
  45. X.L. H, Y.Q. L, B. Y. Clinical effect of Ditan Decoction on phlegm turbidity blocking orifices type of tonic-clonic epilepsy in children and its effect on immune globulin, peripheral blood Th17 cells, and related factors. Chinese Journal of Experimental Traditional Medical Formulae. 2020;26(12):114-20.
  46. H.Z. X, Q.B. L. Clinical application of Cicadidae Periostracum in the treatment of epilepsy in children. China's Naturopathy. 2018;26(02):39.
  47. G. C, Y.Z. X, R.L. Q, Q. Z. Observation of the effect of traditional Chinese medicine combined with Western medicine in the treatment of epilepsy in children. Contemporary Medicine. 2012;18(15):155.
  48. J.L. K, A.J. S. Analysis of the curative effect of Huazhuojiedu Tiaogan decoction in the adjuvant treatment of epilepsy in children. Jilin Journal of Chinese Medicine. 2013; 33(06):595-6.
  49. Y. Y, X.J. M. Experience of self-made Zhenxian Pills in the combination of traditional Chinese and Western medicine in treating epilepsy in children. Chinese Journal of Woman and Child Health Research. 2014;25(06):1071-3.
  50. X.M. H. Observation on 29 Cases of Childhood Epilepsy Treated by Self-made Ditan Dingxian Decoction. Contemporary Medicine. 2016;22(12):158-9.
  51. J.M. Z, L.Y. Q. Clinical observation of Liujunzi decoction assisted by sodium valproate in the treatment of epilepsy in children. Guangming Journal of Chinese Medicine. 2019;34(03):411-2.
  52. Y.L. K. Clinical efficacy of sodium valproate combined with traditional Chinese medicine in the treatment of children with generalized idiopathic epilepsy. Inner Mongolia Journal of Traditional Chinese Medicine. 2012;31(15): 46-7.
  53. China MoHotPsRo. Guidelines for clinical research of new Chinese medicines. Beijing: People's Health Publishing House; 1993.
  54. F.L. M. Clinical Analysis and Research on 120 Children with Epilepsy Treated by Integrated Traditional Chinese and Western Medicine. Guide of China Medicine. 2012; 10(20):581.
  55. H. T. Clinical efficacy of midazolam combined with sodium valproate and traditional Chinese medicine Angongniuhuang Pill in the treatment of Refractory Status Epilepticus. Clinical Research and Practice. 2018;3(26): 23-4.
  56. T. X , Y.Q. Y. O bservation of the curative effect of Xinshenyuxian decoction combined with Western medicine in the treatment of epilepsy in children. Shaanxi Journal of Traditional Chinese Medicine. 2015;36(10): 1299-300.
  57. The Path Toward Integration of Traditional and Complementary Medicine into Health Systems Globally: The World Health Organization Report on the Implementation of the 2014-2023 Strategy. The Journal of Alternative and Complementary Medicine. 2019;25(9):869-71. https://doi.org/10.1089/acm.2019.29077.jjw
  58. Zhang XLM, R. Rong, P. Yang, X.S. Yan, H.H. Multi-center consistency evaluation of "Traditional Chinese Medicine Pediatric Clinical Diagnosis and Treatment Guidelines Pediatric Epilepsy". Journal of Tianjin University of Traditional Chinese Medicine. 2020;39(5):532-5.
  59. Lu JJX, Z. Li, L. Liu, F.X. Zhang, H.L. Re-evaluation of Systematic review/Meta-analysis of traditional Chinese medicine for epilepsy. Jiangxi Traditional Chinese Medicine. 2021;52(08):41-6.
  60. Yu Y, Yuan C, Gu C. Clinical efficacy and safety of removing blood stasis and removing phlegm in the treatment of epilepsy with cognitive impairment: A protocol for systematic review and meta-analysis. Medicine (Baltimore). 2021;100(47).
  61. Liu LX, YH. FENG, GM. Wang, ZH. Advances in the Research on the Treatment of Qiao Diseases with Kai Qiao Method. Chinese Journal of Ethnomedicine and Ethnopharmacy. 2021;30(12):70-4.
  62. Wang W-j, Zhang T. Integration of traditional Chinese medicine and Western medicine in the era of precision medicine. Journal of Integrative Medicine. 2017;15(1): 1-7. https://doi.org/10.1016/S2095-4964(17)60314-5
  63. XY Zheng YZ, Y. Zheng, X Zheng. Guiding principles for clinical research on new drug of traditional Chinese Medicine: Beijing Ministry of Health of the People's Republic of China; 2002.
  64. Smith SJM. EEG in the diagnosis, classification, and management of patients with epilepsy. Journal of Neurology, Neurosurgery & Psychiatry. 2005;76(suppl 2):ii2-ii7.
  65. Rong P, Fu Q, Zhang X, Liu X, Yang J, Wang X, et al. Chinese herbal compounds containing scorpion in the treatment of epilepsy: A protocol for systematic review and meta-analysis. Medicine (Baltimore). 2021;100(10): e25134-e. https://doi.org/10.1097/MD.0000000000025134
  66. Yip KL, Koon CM, Chen ZY, Chook P, Leung PC, Schachter S, et al. The antiepileptic effect of Gastrodiae Rhizoma through modulating overexpression of mTOR and attenuating astrogliosis in pilocarpine mice model. Epilepsia Open. 2020;5(1):50-60. https://doi.org/10.1002/epi4.12372
  67. Lin C-H, Hsieh C-L. Chinese Herbal Medicine for Treating Epilepsy. Front Neurosci. 2021;15.
  68. Gao Y, Yan H, Jin R, Lei P. Antiepileptic activity of total triterpenes isolated from Poria cocos is mediated by suppression of aspartic and glutamic acids in the brain. Pharm Biol. 2016;54(11):2528-35. https://doi.org/10.3109/13880209.2016.1168853
  69. Farrukh MJ, Makmor-Bakry M, Hatah E, Tan HJ. Use of complementary and alternative medicine and adherence to antiepileptic drug therapy among epilepsy patients: a systematic review. Patient Prefer Adherence. 2018;12: 2111-21. https://doi.org/10.2147/PPA.S179031
  70. Talevi A. Antiseizure medication discovery: Recent and future paradigm shifts. Epilepsia Open.n/a(n/a).
  71. Liu W, Ge T, Pan Z, Leng Y, Lv J, Li B. The effects of herbal medicine on epilepsy. Oncotarget. 2017;8(29):48385-97. https://doi.org/10.18632/oncotarget.16801
  72. Lin C-H, Hsieh C-L. Chinese Herbal Medicine for Treating Epilepsy. Front Neurosci. 2021;15:682821-. https://doi.org/10.3389/fnins.2021.682821
  73. Yip KL, Zhou X, Chook P, Leung PC, Schachter S, Mok VCT, et al. Herb-drug interaction of gastrodiae rhizoma on carbamazepine: A pharmacokinetic study in rats. Epilepsy Res. 2020;165:106376. https://doi.org/10.1016/j.eplepsyres.2020.106376
  74. MEDICINE KIOO. Safety remains the same! Accelerating clinical research to expand the indications of existing herbal medicines Daejeon: KOREA INSTITUTE OF ORIENTAL MEDICINE; 2021 [cited 2022 May 25]. Available from: https://www.kiom.re.kr/brdartcl/boardarticleView.do?menu_nix=9Rwbc7lW&brd_id=BDIDX_N85v0V9e412et159q7XPbi&cont_idx=2406.
  75. Du Y-r, Lin J-h, Mei P-n, Wang L, Wang Y, Shen J-z, et al. Analysis of risk factors for antiepileptic drug-induced adverse psychotropic effects in Chinese outpatients with epilepsy. Journal of Clinical Neuroscience. 2019;63: 37-42. https://doi.org/10.1016/j.jocn.2019.02.011