Dear Editor:
With great interest we read the article entitled “Perspective: Therapeutic Potential of Flavonoids as Alternative Medicines in Epilepsy” by Kwon et al. (1). This article provides a comprehensive overview of the flavonoids and epilepsy. However, there are some concerns about the conclusion of the authors, particularly in the clinical aspect.
The authors concluded, “Flavonoids, which are more effective but impose fewer adverse effects than conventional AEDs, could be used in the treatment of epilepsy.” All the supporting evidence of the article is limited to the findings of in vivo studies. To our knowledge, to date, no clinical study compared the efficacy of flavonoids and antiepileptic drugs (AEDs) in patients with epilepsy; therefore, how can we conclude that flavonoids are more effective than AEDs in a clinical setting?
The authors mentioned that we should be looking for an alternative treatment for patients with epilepsy because 30% of the patients with epilepsy do not respond to AEDs. According to the findings of the cited studies of the article, all of the mentioned flavonoids reduced seizure frequency but did not cease seizures. Therefore, if we prescribe flavonoids in a clinical setting, we will expect reducing seizures, not stopping the seizure. Still, 30% of the patients will have seizures. Hence, what will be the benefit of flavonoids over AEDs?
The length of efficacy is another factor that needs to be considered. All the cited studies investigated the efficacy of flavonoids in an animal setting for a short period. However, patients with epilepsy require long-term treatment (2). Will flavonoids be effective in controlling the seizures in long-term treatment? Without answering this question, how can we suggest flavonoids as an alternative treatment for epilepsy? For illustration, there have been reports of patients responding well to the AEDs or other treatments such as a ketogenic diet in a short-term treatment, who experienced a reoccurrence of seizures a few months later (2).
The authors mentioned that flavonoids impose fewer adverse effects than conventional AEDs. We did not find any references in the article that the authors cited to prove their claim. To our knowledge, no studies compared the adverse effects of flavonoids with AEDs in patients with epilepsy.
The authors stated that AEDs are the only currently available epilepsy treatment; however, this is not correct. AEDs are commonly the first treatment in the management of seizures; however, they are not the sole treatment for epilepsy. Other treatments are surgery, ketogenic diet, and vagus nerve stimulation (2).
Notes
SR had the idea and drafted the letter; MH revised the letter and supervised the clinical aspect of it.
The authors report no funding received for this letter.
Author disclosures: The authors report no conflicts of interest.
References
- 1. Kwon JY, Jeon M-T, Jung UJ, Kim DW, Moon GJ, Kim SR. Perspective: therapeutic potential of flavonoids as alternative medicines in epilepsy. Adv Nutr. 2019;10(5):778–90. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2. Rezaei S, Abdurahman AA, Saghazadeh A, Badv RS, Mahmoudi M. Short-term and long-term efficacy of classical ketogenic diet and modified Atkins diet in children and adolescents with epilepsy: a systematic review and meta-analysis. Nutr Neurosci. 2019;22(5):317–34. [DOI] [PubMed] [Google Scholar]