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Piccicacchi LM, Serino D. A systematic review of the Mozart effect in adult and paediatric cases of drug-resistant epilepsy: A sound approach to epilepsy management. Epilepsy Behav 2024; 154:109743. [PMID: 38636110 DOI: 10.1016/j.yebeh.2024.109743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 02/10/2024] [Accepted: 03/10/2024] [Indexed: 04/20/2024]
Abstract
OBJECTIVES In recent years, adjunctive therapies for epilepsy management are being explored due to considerable side effects carried by antiepileptic drugs (AEDs) and widespread reports of drug-resistant epilepsy. One such approach is non-invasive musical neurostimulation. Within this context, Mozart's sonata K448 has received particular attention following reports of reduced seizure frequency and a decrease in epileptiform discharges during and after music exposure; often described as the 'Mozart effect'. However, controversy exists around the effectiveness of K448 in epilepsy and the strength and quality of the evidence supporting it. Therefore, this study aims to systematically review the available literature around the Mozart effect, in both adult and paediatric cases of epilepsy. METHODS We carried out a literature search on PubMed, Science Direct, Scopus and Web of Science using the query string ALL= (Mozart AND epileps*). Selected clinical studies were classified based on the age of the population studied, as paediatric (0-18 years), adult (19 years or older) or a combination of the two. All the studies were evaluated using the Johns Hopkins Nursing Evidence-Based Practice (JHNEBP) rating scale to determine the strength of the evidence (level) and the quality of the research evidence. RESULTS Out of 538 records, 25 studies were selected, grouped based on the age of the population studied and evaluated using the JHNEBP rating scale. Ten level 1 studies, which represent the strongest evidence, were identified, including six RCTs and three meta-analyses. Nine of these ten studies show a decrease in epileptiform discharges and in seizure frequency following exposure to Mozart's K448. One multiverse analysis reported lack of statistically significant evidence to support the use of K448 in epilepsy or any other medical condition. CONCLUSIONS A growing body of evidence supports the Mozart effect on epilepsy, with notable studies including RCTs and comprehensive meta-analyses. This review identified nine level 1 studies, conducted by research groups worldwide, which endorse the use of Mozart's music to reduce seizures and epileptiform discharges in adult and paediatric epilepsy patients. However, existing research exhibits limitations like varying protocols, small sample sizes and diverse treatment regimens. Additionally, studies that combine adult and paediatric patients fail to take account of developmental differences between these two groups - particularly with regards to brain maturation and neurophysiology - which could negatively impact upon the accuracy of findings by obscuring important age-related differences in response to intervention. Adequately addressing these limitations will be crucial to demonstrating proof of concept; otherwise, a potentially valuable, non-invasive, accessible, and affordable therapeutic option for drug-resistant epilepsy will remain on the medical fringe. Further research with larger samples and stricter protocols, particularly considering patient age and drug regimens, is required.
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Affiliation(s)
| | - Domenico Serino
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK; Paediatric Neurology Department, Royal Aberdeen Children's Hospital, Aberdeen, UK
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Biskupiak Z, Ha VV, Rohaj A, Bulaj G. Digital Therapeutics for Improving Effectiveness of Pharmaceutical Drugs and Biological Products: Preclinical and Clinical Studies Supporting Development of Drug + Digital Combination Therapies for Chronic Diseases. J Clin Med 2024; 13:403. [PMID: 38256537 PMCID: PMC10816409 DOI: 10.3390/jcm13020403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 01/08/2024] [Accepted: 01/09/2024] [Indexed: 01/24/2024] Open
Abstract
Limitations of pharmaceutical drugs and biologics for chronic diseases (e.g., medication non-adherence, adverse effects, toxicity, or inadequate efficacy) can be mitigated by mobile medical apps, known as digital therapeutics (DTx). Authorization of adjunct DTx by the US Food and Drug Administration and draft guidelines on "prescription drug use-related software" illustrate opportunities to create drug + digital combination therapies, ultimately leading towards drug-device combination products (DTx has a status of medical devices). Digital interventions (mobile, web-based, virtual reality, and video game applications) demonstrate clinically meaningful benefits for people living with Alzheimer's disease, dementia, rheumatoid arthritis, cancer, chronic pain, epilepsy, depression, and anxiety. In the respective animal disease models, preclinical studies on environmental enrichment and other non-pharmacological modalities (physical activity, social interactions, learning, and music) as surrogates for DTx "active ingredients" also show improved outcomes. In this narrative review, we discuss how drug + digital combination therapies can impact translational research, drug discovery and development, generic drug repurposing, and gene therapies. Market-driven incentives to create drug-device combination products are illustrated by Humira® (adalimumab) facing a "patent-cliff" competition with cheaper and more effective biosimilars seamlessly integrated with DTx. In conclusion, pharma and biotech companies, patients, and healthcare professionals will benefit from accelerating integration of digital interventions with pharmacotherapies.
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Affiliation(s)
- Zack Biskupiak
- Department of Medicinal Chemistry, College of Pharmacy, University of Utah, Salt Lake City, UT 84112, USA
| | - Victor Vinh Ha
- Department of Medicinal Chemistry, College of Pharmacy, University of Utah, Salt Lake City, UT 84112, USA
| | - Aarushi Rohaj
- Department of Medicinal Chemistry, College of Pharmacy, University of Utah, Salt Lake City, UT 84112, USA
- The Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT 84113, USA
| | - Grzegorz Bulaj
- Department of Medicinal Chemistry, College of Pharmacy, University of Utah, Salt Lake City, UT 84112, USA
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Oberleiter S, Pietschnig J. Unfounded authority, underpowered studies, and non-transparent reporting perpetuate the Mozart effect myth: a multiverse meta-analysis. Sci Rep 2023; 13:3175. [PMID: 36878928 PMCID: PMC9988829 DOI: 10.1038/s41598-023-30206-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 02/17/2023] [Indexed: 03/08/2023] Open
Abstract
In recent years, an ostensible Mozart effect, suggesting beneficial influences of listening to the sonata KV448 on epilepsy, has been extensively covered in popular media outlets. However, the evidential value of such a potential effect seems unclear. Here, we present the first formal meta-analysis on this topic, based on k = 8 studies (N = 207). Further published studies that met our inclusion criteria had to be omitted due to insufficient reporting and author non-responsiveness on data requests. In three independent analyses, we observed non-significant trivial-to-small summary effects for listening to Mozart KV448 or other musical stimuli on epilepsy or other medical conditions (g range: 0.09-0.43). Bias and sensitivity analyses suggested that these effects were likely inflated and non-trivial effects were driven by isolated leverage points. Multiverse analyses conformed to these results, showing inconsistent evidential patterns. Low primary study power and consequently lacking evidential value indicates that there is only little reason to suspect a specific Mozart effect. In all, listening to music, let alone a specific kind of sonata, does not appear to have any beneficial effect on epilepsy. Unfounded authority, underpowered studies, and non-transparent reporting appear to be the main drivers of the Mozart effect myth.
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Affiliation(s)
- Sandra Oberleiter
- Department of Developmental and Educational Psychology, Faculty of Psychology, University of Vienna, 1010, Vienna, Austria.
| | - Jakob Pietschnig
- Department of Developmental and Educational Psychology, Faculty of Psychology, University of Vienna, 1010, Vienna, Austria
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Wired for sound: The effect of sound on the epileptic brain. Seizure 2022; 102:22-31. [PMID: 36179456 DOI: 10.1016/j.seizure.2022.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 09/08/2022] [Accepted: 09/23/2022] [Indexed: 11/22/2022] Open
Abstract
Sound waves are all around us resonating at audible and inaudible frequencies. Our ability to hear is crucial in providing information and enabling interaction with our environment. The human brain generates neural oscillations or brainwaves through synchronised electrical impulses. In epilepsy these brainwaves can change and form rhythmic bursts of abnormal activity outwardly appearing as seizures. When two waveforms meet, they can superimpose onto one another forming constructive, destructive or mixed interference. The effects of audible soundwaves on epileptic brainwaves has been largely explored with music. The Mozart Sonata for Two Pianos in D major, K. 448 has been examined in a number of studies where significant clinical and methodological heterogeneity exists. These studies report variable reductions in seizures and interictal epileptiform discharges. Treatment effects of Mozart Piano Sonata in C Major, K.545 and other composer interventions have been examined with some musical exposures, for example Hayden's Symphony No. 94 appearing pro-epileptic. The underlying anti-epileptic mechanism of Mozart music is currently unknown, but interesting research is moving away from dopamine reward system theories to computational analysis of specific auditory parameters. In the last decade several studies have examined inaudible low intensity focused ultrasound as a neuro-modulatory intervention in focal epilepsy. Whilst acute and chronic epilepsy rodent model studies have consistently demonstrated an anti-epileptic treatment effect this is yet to be reported within large scale human trials. Inaudible infrasound is of concern since at present there are no reported studies on the effects of exposure to infrasound on epilepsy. Understanding the impact of infrasound on epilepsy is critical in an era where sustainable energies are likely to increase exposure.
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Zhao C, Lu L, Liu W, Zhou D, Wu X. Complementary and alternative medicine for treating epilepsy in China: A systematic review. Acta Neurol Scand 2022; 146:775-785. [PMID: 36082744 DOI: 10.1111/ane.13701] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 08/21/2022] [Accepted: 08/22/2022] [Indexed: 11/30/2022]
Abstract
There are about 10 million people with epilepsy (PWE) in China. In addition to therapies approved by the National Medical Products Administration, the use of complementary and alternative medicine (CAM) is prevalent in Chines PWE. These CAM therapies mainly comprise traditional Chinese medicine herbs (TCMHs), acupuncture, and music. A retrospective literature search was performed to summarize the updates of CAM in China in the past ten years, and sixty-two papers were finally included. In this following review, we listed the animal and clinical studies to summarize the antiepileptic mechanisms and clinical efficacy of CAM in Chines PWE. The main mechanisms of TCMHs and acupuncture included regulation of neurotransmitters and receptors, voltage-gated ion channels modulation, expression of apoptosis-related genes, antioxidant response, and anti-inflammation. Although there were enormous clinical studies on them, the current available clinical trials were small, short-term, heterogeneous, and had a high risk of bias. With regard to music, a few studies conducted by Chinese scholars suggested that it was beneficial for PWE as an add-on therapy, which was consistent with the results of foreign studies. Further randomized clinical trials in large populations are required to prove the effectiveness and safety of CAM.
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Affiliation(s)
- Chenyang Zhao
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Lu Lu
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Wenyu Liu
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Dong Zhou
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Xintong Wu
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
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Xu C, Gong Y, Wang Y, Chen Z. New advances in pharmacoresistant epilepsy towards precise management-from prognosis to treatments. Pharmacol Ther 2021; 233:108026. [PMID: 34718071 DOI: 10.1016/j.pharmthera.2021.108026] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 10/15/2021] [Accepted: 10/25/2021] [Indexed: 12/13/2022]
Abstract
Epilepsy, one of the most severe neurological diseases, is characterized by abrupt recurrent seizures. Despite great progress in the development of antiseizure drugs (ASDs) based on diverse molecular targets, more than one third of epilepsy patients still show resistance to ASDs, a condition termed pharmacoresistant epilepsy. The management of pharmacoresistant epilepsy involves serious challenges. In the past decade, promising advances have been made in the use of interdisciplinary techniques involving biophysics, bioinformatics, biomaterials and biochemistry, which allow more precise prognosis and development of drug target for pharmacoresistant epilepsy. Notably, novel experimental tools such as viral vector gene delivery, optogenetics and chemogenetics have provided a framework for promising approaches to the precise treatment of pharmacoresistant epilepsy. In this review, historical achievements especially recent advances of the past decade in the prognosis and treatment of pharmacoresistant epilepsy from both clinical and laboratory settings are presented and summarized. We propose that the further development of novel experimental tools at cellular or molecular levels with both temporal and spatial precision are necessary to make improve the management and drug development for pharmacoresistant epilepsy in the clinical arena.
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Affiliation(s)
- Cenglin Xu
- Key Laboratory of Neuropharmacology and Translational Medicine of Zhejiang Province, School of Pharmaceutical Sciences, Zhejiang Chinese Medical University, Hangzhou, China
| | - Yiwei Gong
- Institute of Pharmacology & Toxicology, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China
| | - Yi Wang
- Key Laboratory of Neuropharmacology and Translational Medicine of Zhejiang Province, School of Pharmaceutical Sciences, Zhejiang Chinese Medical University, Hangzhou, China; Institute of Pharmacology & Toxicology, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China
| | - Zhong Chen
- Key Laboratory of Neuropharmacology and Translational Medicine of Zhejiang Province, School of Pharmaceutical Sciences, Zhejiang Chinese Medical University, Hangzhou, China; Institute of Pharmacology & Toxicology, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China; Epilepsy Center, Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
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Musical components important for the Mozart K448 effect in epilepsy. Sci Rep 2021; 11:16490. [PMID: 34531410 PMCID: PMC8446029 DOI: 10.1038/s41598-021-95922-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 07/28/2021] [Indexed: 11/08/2022] Open
Abstract
There is growing evidence for the efficacy of music, specifically Mozart’s Sonata for Two Pianos in D Major (K448), at reducing ictal and interictal epileptiform activity. Nonetheless, little is known about the mechanism underlying this beneficial “Mozart K448 effect” for persons with epilepsy. Here, we measured the influence that K448 had on intracranial interictal epileptiform discharges (IEDs) in sixteen subjects undergoing intracranial monitoring for refractory focal epilepsy. We found reduced IEDs during the original version of K448 after at least 30-s of exposure. Nonsignificant IED rate reductions were witnessed in all brain regions apart from the bilateral frontal cortices, where we observed increased frontal theta power during transitions from prolonged musical segments. All other presented musical stimuli were associated with nonsignificant IED alterations. These results suggest that the “Mozart K448 effect” is dependent on the duration of exposure and may preferentially modulate activity in frontal emotional networks, providing insight into the mechanism underlying this response. Our findings encourage the continued evaluation of Mozart’s K448 as a noninvasive, non-pharmacological intervention for refractory epilepsy.
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Rafiee M, Istasy M, Valiante TA. Music in epilepsy: Predicting the effects of the unpredictable. Epilepsy Behav 2021; 122:108164. [PMID: 34256336 DOI: 10.1016/j.yebeh.2021.108164] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 06/07/2021] [Accepted: 06/08/2021] [Indexed: 01/08/2023]
Abstract
Epilepsy is the most common serious neurological disorder in the world. Despite medical and surgical treatment, many individuals continue to have seizures, suggesting adjunctive management strategies are required. Promising effects of daily listening to Mozart K.448 on reducing seizure frequency in individuals with epilepsy have been demonstrated. In our recent randomized control study, we reported the positive effect of daily listening to Mozart K.448 on reducing seizures compared to daily listening to a control piece with an identical power spectrum to the Mozart piece yet devoid of rhythmic structure. Despite the promising effect of listening to Mozart K.448 on reducing seizure in individuals with epilepsy, the mechanism(s) underlying such an effect is largely unknown. In this paper, we specifically review how auditory stimulation alters brain dynamics, in addition to computational approaches to define the structural features of classical music, to then propose a plausible mechanism for the underlying anti-convulsant effects of listening to Mozart K.448. We review the evidence demonstrating that some Mozart pieces in addition to compositions from other composers such as Joplin contain less predictable rhythmic structure in comparison with other composers such as Beethoven. We propose through both entrainment and 1/f resonance mechanisms that listening to musical pieces containing the least predictable rhythmic structure, might reduce the self similarity of brain activity which in turn modulates low frequency power, situating the brain in a more "noise like" state and away from brain dynamics that can lead to seizures.
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Affiliation(s)
| | - Marco Istasy
- Krembil Brain Institute, Toronto, ON, Canada; Department of Human Biology, Faculty of Arts and Science, University of Toronto, ON, Canada
| | - Taufik A Valiante
- Krembil Brain Institute, Toronto, ON, Canada; Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto ON, Canada; Institute Biomedical Engineering, and Electrical and Computer Engineering, University of Toronto, Toronto, ON, Canada; Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
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Bulaj G, Clark J, Ebrahimi M, Bald E. From Precision Metapharmacology to Patient Empowerment: Delivery of Self-Care Practices for Epilepsy, Pain, Depression and Cancer Using Digital Health Technologies. Front Pharmacol 2021; 12:612602. [PMID: 33972825 PMCID: PMC8105510 DOI: 10.3389/fphar.2021.612602] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 02/22/2021] [Indexed: 12/15/2022] Open
Abstract
To improve long-term outcomes of therapies for chronic diseases, health promotion and lifestyle modifications are the most promising and sustainable strategies. In addition, advances in digital technologies provide new opportunities to address limitations of drug-based treatments, such as medication non-adherence, adverse effects, toxicity, drug resistance, drug shortages, affordability, and accessibility. Pharmaceutical drugs and biologics can be combined with digital health technologies, including mobile medical apps (digital therapeutics), which offer additional clinical benefits and cost-effectiveness. Promises of drug+digital combination therapies are recognized by pharmaceutical and digital health companies, opening opportunities for integrating pharmacotherapies with non-pharmacological interventions (metapharmacology). Herein we present unique features of digital health technologies which can deliver personalized self-care modalities such as breathing exercises, mindfulness meditation, yoga, physical activity, adequate sleep, listening to preferred music, forgiveness and gratitude. Clinical studies reveal how aforementioned complimentary practices may support treatments of epilepsy, chronic pain, depression, cancer, and other chronic diseases. This article also describes how digital therapies delivering “medicinal” self-care and other non-pharmacological interventions can also be personalized by accounting for: 1) genetic risks for comorbidities, 2) adverse childhood experiences, 3) increased risks for viral infections such as seasonal influenza, or COVID-19, and 4) just-in-time stressful and traumatic circumstances. Development and implementation of personalized pharmacological-behavioral combination therapies (precision metapharmacology) require aligning priorities of key stakeholders including patients, research communities, healthcare industry, regulatory and funding agencies. In conclusion, digital technologies enable integration of pharmacotherapies with self-care, lifestyle interventions and patient empowerment, while concurrently advancing patient-centered care, integrative medicine and digital health ecosystems.
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Affiliation(s)
- Grzegorz Bulaj
- Department of Medicinal Chemistry, Skaggs Pharmacy Institute, University of Utah, Salt Lake City, UT, United States
| | - Jacqueline Clark
- College of Pharmacy, University of Utah, Salt Lake City, UT, United States
| | - Maryam Ebrahimi
- College of Pharmacy, University of Utah, Salt Lake City, UT, United States
| | - Elizabeth Bald
- Department of Pharmacotherapy, Skaggs Pharmacy Institute, University of Utah, Salt Lake City, UT, United States
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Asadi-Pooya AA, Brigo F, Lattanzi S, Karakis I, Asadollahi M, Trinka E, Talaat El Ghoneimy L, Pretorius C, Contreras G, Daza-Restrepo A, Valente K, D'Alessio L, Turuspekova ST, Aljandeel G, Khachatryan S, Ashkanani A, Tomson T, Kutlubaev M, Guekht A, Alsaadi T, Calle-Lopez Y, Mesraoua B, Ríos-Pohl L, Al-Asmi A, Villanueva V, Igwe SC, Kissani N, Jusupova A. Complementary and alternative medicine in epilepsy: A global survey of physicians' opinions. Epilepsy Behav 2021; 117:107835. [PMID: 33611098 DOI: 10.1016/j.yebeh.2021.107835] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 12/25/2020] [Accepted: 01/30/2021] [Indexed: 12/12/2022]
Abstract
PURPOSE To investigate the opinions of physicians on the use of complementary and alternative medicine (CAM) in patients with epilepsy (PWE) worldwide. METHODS Online survey addressed to neurologists and psychiatrists from different countries. RESULTS Totally, 1112 physicians from 25 countries (different world region: Europe, North America, South America, Middle-East, Africa, Former Soviet Union Republics) participated; 804 (72.3%) believed that CAM might be helpful in PWE. The most commonly endorsed CAM included meditation (41%) and yoga (39%). Female sex, psychiatry specialization, and working in North and South America were associated with the belief that CAM is helpful in PWE. Two-hundred and forty five out of 1098 participants (22.3%) used/prescribed CAM to PWE; among them, 174 (71%) people perceived CAM to be less effective and 114 (46.5%) people found CAM to be safer than conventional antiseizure medications (ASMs). The most common reasons to prescribe CAM for PWE were: to satisfy the patient (49.9%), dissatisfaction with the efficacy (35.6%), and dissatisfaction with the adverse effects (31.2%) of conventional therapies. CONCLUSION Although the evidence supporting the use of CAM for the treatment of epilepsy is extremely sparse, most physicians worldwide believe that it could be integrated with the use of conventional ASMs, at least in some patients. High-quality controlled trials are warranted to provide robust evidence on the usefulness of CAM options in PWE.
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Affiliation(s)
- Ali A Asadi-Pooya
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA.
| | - Francesco Brigo
- Department of Neurology, Hospital of Merano (SABES-ASDAA), Merano-Meran, Italy
| | - Simona Lattanzi
- Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy
| | - Ioannis Karakis
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | | | - Eugen Trinka
- Department of Neurology, Christian-Doppler Medical Centre, Paracelsus Medical University, 5020 Salzburg, Austria; Institute of Nursing Science and Practice, Paracelsus Medical University, 5020 Salzburg, Austria; Centre for Cognitive Neuroscience, 5020 Salzburg, Austria, Associated Member of the European Reference Network EpiCARE
| | | | - Chrisma Pretorius
- Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
| | - Guilca Contreras
- Department of Pediatric Neurology, Hospital Metropolitano, Quito, Ecuador
| | | | - Kette Valente
- Laboratory of Clinical Neurophysiology, Deparment of Psychiatry, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, Brazil
| | - Luciana D'Alessio
- Buenos Aires University, Epilepsy Center, Ramos Mejía and El Cruce Hospitals, IBCN-CONICET, Buenos Aires, Argentina
| | - Saule T Turuspekova
- Department of Nervous Diseases with a Course of Neurosurgery, Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
| | - Ghaieb Aljandeel
- Iraqi Council for Medical Specializations, Faculty of Epileptology, Medical City, Baghdad, Iraq
| | - Samson Khachatryan
- Department of Neurology and Neurosurgery, National Institute of Health, Yerevan, Armenia
| | | | - Torbjörn Tomson
- Department of Clinical Nueroscience, Karolinska institutet, Stockholm, Sweden
| | - Mansur Kutlubaev
- Department of Neurology, Bashkir State Medical University, Ufa, Russia
| | - Alla Guekht
- Moscow Research and Clinical Center for Neurospychiatry; Department of Neurology, Nerosurgery and Medical Genetics, Pirogov Russian National Research Medical University, Moscow, Russia
| | - Taoufik Alsaadi
- Deptartment of Neurology, American Center for Psychiatry and Neurology, Dubai, United Arab Emirates
| | - Yamile Calle-Lopez
- Neurology Section, University of Antioquia, Fundación Clínica del Norte-Neuroclínica, Medellín, Colombia
| | - Boulenouar Mesraoua
- Neurosciences Department, Hamad Medical Corporation and Weill Cornell Medical College, Doha, Qatar
| | | | - Abdullah Al-Asmi
- Neurology Unit, Department of Medicine, College of Medicine and Health Sceinces, Sultan Qaboos University, Oman
| | - Vicente Villanueva
- Refractory Epilepsy Unit, Neurology Service, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Stanley C Igwe
- Department of NeuroPsychiatry, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Nigeria
| | - Najib Kissani
- Laboratory of Clinical and Experimental Neuroscience, Faculty of Medicine, Cadi Ayyad University, Marrakech, Morocco; Department of Neurology, Teaching Hospital Mohammed VI, Marrakesh, Morocco
| | - Asel Jusupova
- Kyrgyz State Medical Academy, Neurology and Clinical Genetics Department, Bishkek, Kyrgyzstan
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