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Can Ashwagandha And Shatavari Be Taken Along With Keppra?
Question: Hi, my husband uses keppra 750mg for his seizures. We are considering using ashwagandha and shatavari from ayurveda in addition to keppra. Is that ok?
Brief Answer:
The specified products can be taken in addition to keppra.
Detailed Answer:
I read your question and I understand your concern related to his profession.
There is no contraindications to trying the particular products you mentioning. They are not known to cause any negative effects on seizure no particular sedating effect. They are not known to have any interaction to keppra either, so that is ok as well.
In the future though, if any change of therapy is considered, you should inform your neurologist if you are taking these drugs, because ashwagandha is known to have interactions with some antiepileptic drugs like phenobarbital and primidon.
One other consideration, the FDA which is the drug controlling in the US where you appear to be living, has issued a warning regarding ayurveda products in general for two reasons, the first being that that there are no controlled studies on long term use and side effects for many of them and the second because studies have found some of the manufactured products containing quantities of heavy metals which are toxic to the human body. That doesn't mean that all of them are dangerous, but they remain products which are not reviewed by the FDA.
I hope to have been of help.
The specified products can be taken in addition to keppra.
Detailed Answer:
I read your question and I understand your concern related to his profession.
There is no contraindications to trying the particular products you mentioning. They are not known to cause any negative effects on seizure no particular sedating effect. They are not known to have any interaction to keppra either, so that is ok as well.
In the future though, if any change of therapy is considered, you should inform your neurologist if you are taking these drugs, because ashwagandha is known to have interactions with some antiepileptic drugs like phenobarbital and primidon.
One other consideration, the FDA which is the drug controlling in the US where you appear to be living, has issued a warning regarding ayurveda products in general for two reasons, the first being that that there are no controlled studies on long term use and side effects for many of them and the second because studies have found some of the manufactured products containing quantities of heavy metals which are toxic to the human body. That doesn't mean that all of them are dangerous, but they remain products which are not reviewed by the FDA.
I hope to have been of help.
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Hello Dr.Taka,
Thank you very much for your time and the detailed response. We appreciate it a lot!
I have a follow up question - in your practice have you seen seizures being triggered by showers (hot water showers in particular)? My husband has had 6 seizures since 1995 and everytime it's after going through a period of sleeplessness and then a shower triggers the seizure itself. August of this year he had a seizure while driving our 7 yr old to school. Thankfully they both came out unscathed after that incident but as you can imagine it shook me up badly. He had another seizure in Oct (within 6 weeks). In the past his seizures were not this close and so I am worried if Keppra is even helping him. Hence the reason we are looking at alternative medicine. So, in your practice, if you have seen shower induced seizures, do you mind sharing with us what helped to control them?
Many thanks again! XXXXXXX
Thank you very much for your time and the detailed response. We appreciate it a lot!
I have a follow up question - in your practice have you seen seizures being triggered by showers (hot water showers in particular)? My husband has had 6 seizures since 1995 and everytime it's after going through a period of sleeplessness and then a shower triggers the seizure itself. August of this year he had a seizure while driving our 7 yr old to school. Thankfully they both came out unscathed after that incident but as you can imagine it shook me up badly. He had another seizure in Oct (within 6 weeks). In the past his seizures were not this close and so I am worried if Keppra is even helping him. Hence the reason we are looking at alternative medicine. So, in your practice, if you have seen shower induced seizures, do you mind sharing with us what helped to control them?
Many thanks again! XXXXXXX
Brief Answer:
Levetiracetam good first choice, avoid very hot water and lack of sleep
Detailed Answer:
Thank you for your kind appreciative words.
Seizures precipitated by showers belong to what are usually called reflex seizures in which seizures are reproducibly precipitated by an external stimulus. If they were were caused exclusively by showers they are classified as pure reflex epilepsy. You mention a seizure while driving though, which means that he has also non-reflex seizures.
Anyway definitions apart, while I have had patients with other types of reflex seizures (by other stimuluses), I must confess not to have had patients with reflex epilepsy caused by hot water. That is because these types of seizures, apart for being rare in general, are usually encountered in XXXXXXX (25% familial - genetic), not so much in European population and there are no XXXXXXX minorities in my country either. So what I say is derived from literature.
Regarding non drug involving treatment I suppose you have already been told to try lowering the water temperature as much as possible and avoid pouring hot water over the head. Also the use of a cold wet cloth over the head and back of the neck before the shower is helpful.
When it comes to antiepileptic drugs, while most classical antiepileptical drugs seem to work well in hot water seizures, the choice depends also on the seizure phenomenology, EEG changes, drug side effects etc. Levetiracetam (Keppra) is a very solid first choice both for its efficacy as well as its few side effects compared to most antiepileptics. However if you say that seizure frequency is increasing while under treatment switching to another drug or adding a second one should be discussed with your following neurologist as it is a process which is done gradually (the start as well as the tapering) and it involves prescription drugs whose efficacy and side effects should be monitored in follow up visits and tests.
There has been a study indicating a good efficacy of clobazam prophylactically one hour and a half before a hot head shower, but that could be used as sole therapy only if purely reflex seizures, his seizure while driving means he could have non-stimulus seizures as well, so pre-shower treatment alone wouldn't be enough to prevent those other seizures.
You also mention sleepnessness prior to those seizures. Lack of sleep is a proven factor in lowering the seizure threshold so regular sleep is an equally important measure to the ones mentioned above.
I hope to have answered your question.
Levetiracetam good first choice, avoid very hot water and lack of sleep
Detailed Answer:
Thank you for your kind appreciative words.
Seizures precipitated by showers belong to what are usually called reflex seizures in which seizures are reproducibly precipitated by an external stimulus. If they were were caused exclusively by showers they are classified as pure reflex epilepsy. You mention a seizure while driving though, which means that he has also non-reflex seizures.
Anyway definitions apart, while I have had patients with other types of reflex seizures (by other stimuluses), I must confess not to have had patients with reflex epilepsy caused by hot water. That is because these types of seizures, apart for being rare in general, are usually encountered in XXXXXXX (25% familial - genetic), not so much in European population and there are no XXXXXXX minorities in my country either. So what I say is derived from literature.
Regarding non drug involving treatment I suppose you have already been told to try lowering the water temperature as much as possible and avoid pouring hot water over the head. Also the use of a cold wet cloth over the head and back of the neck before the shower is helpful.
When it comes to antiepileptic drugs, while most classical antiepileptical drugs seem to work well in hot water seizures, the choice depends also on the seizure phenomenology, EEG changes, drug side effects etc. Levetiracetam (Keppra) is a very solid first choice both for its efficacy as well as its few side effects compared to most antiepileptics. However if you say that seizure frequency is increasing while under treatment switching to another drug or adding a second one should be discussed with your following neurologist as it is a process which is done gradually (the start as well as the tapering) and it involves prescription drugs whose efficacy and side effects should be monitored in follow up visits and tests.
There has been a study indicating a good efficacy of clobazam prophylactically one hour and a half before a hot head shower, but that could be used as sole therapy only if purely reflex seizures, his seizure while driving means he could have non-stimulus seizures as well, so pre-shower treatment alone wouldn't be enough to prevent those other seizures.
You also mention sleepnessness prior to those seizures. Lack of sleep is a proven factor in lowering the seizure threshold so regular sleep is an equally important measure to the ones mentioned above.
I hope to have answered your question.
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
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