Abstracts

The U.S. Food and Drug Administration (FDA) has prohibited the sale of ephedra (often referred to as ma huang) containing dietary supplements as of April 12, 2004. This was based on review of available clinical evidence regarding safety and efficacy of ephedra in weight loss and performance enhancement (RAND Corporation report 2/2003). Despite published warnings to the public since the RAND report, the sale of herbal stimulants has grown exponentially. Ephedra continues to be advertised, sold and widely used. Supposedly [ldquo]safer[rdquo] alternatives have been substituted. These stimulants are [ldquo]standardized[rdquo] for common ephedra doses and often mixed with other stimulants. In the past year we have seen 6 patients in our out patient clinics who appeared to have seizures directly linked with taking this type of dietary supplement. Patients were gleaned from clinic visits on the basis of history at intake. History of supplement use was elicited through standard history taking techniques. All of the patients had routine laboratory work, an EEG, and either CT or MRI of the brain. Follow up in clinic in each case was carried out to track seizure freedom off of supplements A total of 6 patients were identified. Ages were between 21 [ndash] 49 years. Only one patient had a prior history of seizures and significant medical illness. He had been seizure free, on monotherapy for more than one year prior to use of the supplement. Each subject used a different supplement. Only one contained the actual ephedra alkaloid. The others were [ldquo]ephedra free[rdquo]. All subjects had witnessed generalized tonic-clonic convulsions. None of the subjects have had recurrent seizures following discontinuation of the supplement (4 [ndash] 12 months follow up). In spite of FDA prohibition, patients continue to obtain and use ephedra and ephedra like compounds. Utilizing a Web search engine yields over one million responses from a query on ephedra. Many are informational with appropriate warnings and many offer the substance for sale. It is estimated in surveys that up to 42% of patients¹ will use some form of [ldquo]alternative medicine[rdquo] and that fewer than 35% will report² this use to their physician. It is important therefore, to actively seek a history of use in order to properly assess the need for initiation of anti-epileptic drug (AED) therapy in the case of new onset seizures, and to confirm the need for alterations in AED doses in patients who may be experiencing exacerbation of seizures solely on the basis of the use of ephedra compounds. Eliciting history of alternative therapies is paramount and physicians must maintain a high index of suspicion regarding the use of these in their patient population.
1. Eisenberg et al. JAMA 1998; 280: 1569-1575.
2. Peebles et al. Ep [amp] Beh 2000; 1: 74-77.