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poster
presentation
ACUPUNCTURE
TREATMENT OF PEDIATRIC STATUS EPILEPTICUS
Yuan-Chi Lin, MD
Gene G. Hong, MD
OBJECTIVE
To describe the use of acupuncture for
a pediatric patient with intractable seizures.
PROBLEM
A 7-year-old female patient in the pediatric
intensive care unit with intractable seizures for 6 weeks.
HISTORY OF PRESENT ILLNESS
A previously
healthy 7-year-old Venezuelan female had seizures at school and was
admitted for a week to the local hospital's intensive care unit. On
average, she experienced 4 status epileptic episodes a day lasting a
few minutes each. She required pentobarbital infusion, phenytoin sodium
(Dilantin), carbamazepine (Tegretol), and phenobarbital for seizure
control. Due to peripheral cyanosis and significant desaturation, tracheal
intubation was required for airway protection. She was then transferred
by med-flight from Venezuela to Children's Hospital Pediatric Intensive
Care Unit (PICU) in Boston, Massachusetts for further management.
The patient continued
to have complex partial seizures in the PICU. Despite appropriate therapeutic
levels of pentobarbital, phenytoin sodium, and carbamazepine, rhythmic
spike and wave activity was seen on the electroencephalogram (EEG) in
both right and left temporal lobes. Findings from brain magnetic resonance
imaging (MRI) and single-photon emission computed tomography (SPECT)
were inconclusive. Several attempts at tapering pentobarbital failed.
The patient underwent craniotomy for brain biopsy and no abnormality
was noted. The internist expected a grim prognosis. Acupuncture treatment
was requested by the ICU care team and the family for possibly controlling
seizures.
Past History
Her
past medical history was unremarkable.
Family/Social History
Family
history was notable for adult-onset seizure in a maternal
aunt. Her father is American and works in Venezuela.
Allergies
The
patient had no history of drug allergy.
Physical Examination
The
child was afebrile with a heart rate of 90/min. Her respiration rate
was 16 to 18/min, and she was breathing spontaneously above the ventilator.
The ventilator was delivered via a tracheotomy. Blood pressure was 110/60
min Hg on dopamine drip, and oxygen saturation was 98%. She was edematous
with protrusion of her tongue. She
was noted to have intermittent seizure activity with rapid movement
of the eyes. Her chest moved bilaterally with equal breath sound and
heart auscultated with regular rate and rhythm. The patient's abdomen
was soft. Her extremities were cold with adequate perfusion, and her
pulses were thin and weak throughout, especially at Yin positions.
DIAGNOSIS
Status
epilepticus.
TREATMENT
Traditional
Chinese Medicine (TCM), 3 treatments for the first week, then 2 times
weekly for 4 weeks. The treatment was 10 minutes long, and electrical
stimulation was performed at low frequency. After the second treatment,
the EEG showed moderate generalized cortical dysfunction with no electrographic
seizures, and no overt seizure activity was noted.
Points included
GB 20 (Feng Chi), PC 6 (Nei Guan), and SP 6 (San Yin Jiao), 10 minutes
each. ITO No. 3 (0.2 x 40) acupuncture needles were used for acupuncture.
ITO CE electroacupuncture (IC- 1107) unit with leads wired to SP6 points
were used to provide continuous, low-frequency electrostimulation for
10 minutes in each session.
Outcome
Before
the acupuncture treatment, the EEG showed periods of burst suppression
alternating with periods of continuous seizure activity. After the second
acupuncture treatment, the EEG showed moderate generalized cortical
dysfunction with no electrographic seizures, and no overt seizure activity
was noted; more obvious change at the second treatment. The patient
was then weaned off pentobarbital drip and was transferred to the regular
ward. Following decannulation of her tracheotomy tube, she was transferred
to a rehabilitation facility.
Complications
None.
DISCUSSION
Seizure is viewed in TCM as I of the 4
major disorders affecting children.1
The term Yang Dian Shian denotes epilepsy in TCM. The first known documentation
of epilepsy appeared in the Yellow Emperor's Classic of Internal Medicine
(Huang Di Nei Jing, 700-221 B.C.).2
The treatment is based on "Yin Yang Wu Xing" (Yin-Yang and Five Elements).
In animal studies, peripheral electrical acupuncture
stimulation changes the seizure thresholds in rats,3
which is related to a deficiency state of the cholecystokinin level
in the central nervous system. Previous reports support the efficacy
of acupuncture for epilepsy.4-6
This case report further demonstrates that acupuncture can
be an effective complementary and alternative medical therapy for
pediatric patients with intractable status epilepticus.
ACKNOWLEDGMENT
We wish
to thank Dr Tom Wen for providing valuable advice.
REFERENCES
1. Scott J.
Acupuncture in the Treatment of Children. Seattle, Wash: Eastland
Press; 1991.
2. Lai CW, Lai YH. History of epilepsy in Chinese
traditional medicine. Epilepsia. 1991;32:299-302.
3. Zhang LX, Li XL, Wang L, Han JS. Rats with decreased
brain cholecystokinin levels show increased responsiveness to peripheral
electrical sti m u lation- induced analgesia. Brain Res. 1997;245:158-164.
4. Chen KY, Chen GP, Feng X. Observation of immediate
effect of acupuncture on electroencephalograms in epileptic patients.
J Tradit Chin Med. 1983;3:121-124
5. Shi ZY, Gong BT, Jia YW, Huo ZX. The efficacy of
electro-acupuncture on 98 cases of epilepsy., J Tradit Chin Med.
1987;7:21-22.
6. Wang Q. Advances in treatment of epilepsy with
traditional Chinese medicine. J Tradit Chin Med. 1996; 16:230-237.
AUTHORS' INFORMATION
Dr Yuan-Chi
Lin is a Pediatrician and Anesthesiologist. He is the Director of the
Pediatric Pain Management Service at Lucile Packard Children's Hospital
at Stanford University, Stanford, California; and Associate Professor
of Anesthesia and Pediatrics, Stanford University School of Medicine.
Dr Lin is a visiting scholar at the Department of Anesthesia, Children's
Hospital at Harvard Medical School, Boston, Massachusetts.
Yuan-Chi Lin, MD, MPH
Dept of Anesthesia
Stanford University School of Medicine
Stanford, CA 94305
Phone: 650-725-8064
E-mail: Yclin@leland.stanford.edu
Dr Gene G.
Hong is in private practice, specializing in Medical Acupuncture/Internal
Medicine in Portland, Oregon. Dr Hong studied acupuncture in Beijing
and Taiwan, and is a Board member of the American Academy of Medical
Acupuncture (AAMA), the Oregon Academy of Medical Acupuncture, and Oregon
College of Oriental Medicine.
Gene G. Hong, MD
10273 NE Hancock Street, Suite 218
Portland, OR 97220
Phone: 503-408-0865
E-mail: Gghong@aol.com
Editor'sNote: Poster presentation as originally
presented at the 1999AAMA Symposium in Chicago, Illinois. Reproduced
in its entirety with minor editing.
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