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Chiropractic Care of a Pediatric Patient With Vertebral Subluxations Concomitant with a Seizure Disorder

Abstract

Background: Some fifty million people worldwide, including 2.5 million Americans, have some form of epilepsy. Of the approximately 200,000 new cases of epilepsy each year in the United States, some 75% of these begin in childhood. The seriousness of this disease is such that the US Centers for Disease Control and Prevention has designated childhood epilepsy a major health problem associated with significant developmental disabilities 2.

Impact of the disease on children and their families can be devastating. In addition to the seizures, the child is faced with problems of developmental delays, learning disabilities, and poor social interaction. Studies have demonstrated that the health-related quality of life of children with epilepsy is diminished in both psychosocial and physical domains when compared with healthy controls 3.  Furthermore, extended family members and in particular, the parents of children with epilepsy, are negatively impacted and related to the severity of their child’s epilepsy 4.

Direct treatment costs associated with epilepsy are considerable. The lifetime cost of epilepsy for an estimated 181,000 people with onset in 1995 was projected at $11.1 billion, and the annual cost for the estimated 2.3 million prevalent cases has been estimated at $12.5 billion. Indirect costs account for 85% of the total cost 5.

The consequences to having a seizure disorder are many. Some of these were noted above. Subsequently, not only can these arise from the disease itself but also from the medications used to treat the disorder. Approximately 30% of those managed by anti-epileptic drugs (AEDs) are pharmacoresistant and do not derive any benefit from the use of AEDs 6. Furthermore, many of the marketed AEDs do not have indications for children nor is there information about their pharmacokinetics or their safety 7.  It is well accepted that a child’s brain is developing and how this development is affected by epileptic seizures remains unknown. More importantly, how AED medications affect the developing brain when introduced during this critical period of brain development remains to be fully investigated. In general, adverse reactions to drugs are a major concern to everyone but more so for parents whose children are medically managed with pharmacology such as those with seizure disorders 8. As an example, one need only consider the increase suicide rates among children when given tricyclic medications for clinical depression 9. As such, parents and the general public are looking for safe and effective alternative approaches to the care of their children.

Clinical Features: The patient is a 6-yr-old female with a history of a traumatic fall on her buttocks prior to the onset of seizures. A medical diagnosis of a seizure disorder of the grand mal type was given to her with prescription medication to “manage” her condition. Her response to the medication was worsening of symptoms and following the unsuccessful care of naturopathy, chiropractic care was sought.    

Intervention and Outcome:
The patient was treated with site-specific, low amplitude, high velocity chiropractic adjustments to sites of vertebral subluxations. Following 3 months of care, the patient’s seizure frequency abated to 1 attack per day compared to 20 seizure attacks prior to chiropractic care. 

Conclusion: This case study demonstrates that pediatric patients suffering from seizure disorders may benefit from the clinical framework of adjustments to sites of vertebral subluxations.

References

  1. Freitag CM, May TW, Pfafflin M, Konig S, Rating D. Incidence of epilepsies and epileptic syndromes in children and adolescents: a population-based prospective study in Germany. Epilepsia. 2001;42(8):979-985.
  2. Sheth RD. Challenging Issues in Pediatric Epilepsy. Journal of Child Neurology 2002;17,  (Suppl 2):2S23-2S27.
  3. Miller V, Palermo TM, Grewe S. Health-related quality of life in children with epilepsy. Presented at the 8th Florida Conference on Child Health Psychology, Gainesville, FL, 2001.
  4. Pal DK, Chaudhury G, Das T, Sengupta S. Predictors of parental adjustment to children_s epilepsy in rural India. Child Care Health Dev 2002;28:295–300.
  5. Begley CE, Famulari M, Annegers JF, Lairson DR, Reynolds TF, Coan S, Dubinsky S, Newmark ME, Leibson C, So EL, Rocca WA. The cost of epilepsy in the United States: an estimate from population-based clinical and survey data. Epilepsia. 2000;41(3):342-351.
  6. Leppik IE. Intractable epilepsy in adults. Epilepsy Res Suppl. 1992;5:7-11.
  7. Stables JP, Bertram EH, White HS, Coulter DA, Dichter MA, Jacobs MP, Loscher W, Lowenstein DH, Moshe SL, Noebels JL, Davis M. Models for epilepsy and epileptogenesis: report from the NIH workshop, Bethesda, Maryland. Epilepsia. 2002;43(11):1410-1420.
  8. Fergusson D, Doucette S, Glass KC, Shapiro S, Healy D, Hebert P, Hutton B. Association between suicide attempts and selective serotonin reuptake inhibitors: systematic review of randomised controlled trials. BMJ. 2005;330(7488):396.
  9. Ferrendelli JA. Concerns with Antiepileptic Drug Initiation: Safety, Tolerability, and Efficacy. Epilepsia 2001;42: 28

Joel Alcantara, DC 1 and Van Fotinopoulos, DC 2

  1. Research Director, International Chiropractic Pediatric Association, Media, PA and Private Practice of Chiropractic, San Jose, CA, USA
  2. Private Practice of Chiropractic, Hillsborough, NJ, USA

Presented at ACC-RAC Conference in Las Vegas, NV March 17-20, 2005.