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Traditional Chinese medicine for epilepsy.

BACKGROUND
Seizures are poorly controlled in many people with epilepsy, despite current antiepileptic treatments. Some turn to alternative or complementary therapy to treat their condition and the use of traditional Chinese medicinal herbs (TCMH) is increasingly popular. However, it remains unclear whether the existing evidence is rigorous enough to support its use.


OBJECTIVES
To determine the effectiveness and safety of traditional Chinese medicine in people with epilepsy.


SEARCH STRATEGY
Our search included the Cochrane Epilepsy Group's Specialised Register and the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2007, Issue 1), MEDLINE (1950 to 2007) and EMBASE (1974 to 2007).


SELECTION CRITERIA
Randomised controlled trials evaluating traditional Chinese medicine in people of any age with any type of epilepsy, and comparing one formula of TCM with no intervention, placebo or single Western medicine (monotherapy).


DATA COLLECTION AND ANALYSIS
Two review authors independently extracted trial data and assessed quality. We assessed the following outcomes: (a) seizure freedom for at least one year; (b) 50% or greater reduction in seizure frequency; (c) percentage reduction in seizure frequency and duration; and (d) adverse events.


MAIN RESULTS
Five short-term studies involving 1125 participants met the inclusion criteria. All the studies were of poor methodological quality and had a high probability of selection, detection and performance bias.Two studies assessed seizure freedom for one year. One found no difference between Xiaxingci granule and phenytoin for primary generalized tonic-clonic seizures (RR 1.00; 95% CI 0.07 to 14.90).The other study found no difference between Dianxianning pill and valproate (RR 13.00; 95% CI 0.74 to 227.72) for different types of epilepsy.Three studies assessed a 50% or greater reduction in seizure frequency. One found an advantage for Tianmadingxian capsule when compared to phenytoin (RR 1.37; 95% CI 1.23 to 1.53) in different types of epilepsy, the second an advantage for Zhixian I pill when compared to phenytoin (RR 1.31; 95% CI 1.16 to 1.48) in primary generalized tonic-clonic seizure, and the third an advantage for an 'Antiepilepsy capsule' when compared to phenobarbital (RR 1.21; 95% CI 1.02 to 1.43) for primary and secondary generalized tonic-clonic seizure. One study reported the incidence of adverse effects and the Peto odds ratio was 0.04 (99% CI 0.01 to 0.12, P < 0.00001) favouring TCMH compared to phenobarbital.


AUTHORS' CONCLUSIONS
The current evidence is insufficient to support the use of traditional Chinese medicine as a treatment for epilepsy. Much larger, high quality randomised clinical trials are needed to evaluate the effectiveness and safety of traditional Chinese medicinal herbs for treating epilepsy.