Treatment-resistant Epilepsy – consider LDN

Because we had a case of treatment-resistant epilepsy for neuromodulation here today, here’s a tip for colleagues:

Low-Dose Naltrexone – LDN – potential efficacy also in epilepsy

We have been using LDN in our practice since 2011, primarily as an adjuvant tool for cancer and autoimmune diseases. The study landscape is sufficiently reliable and convincing; I’ve researched it extensively and written many articles, and I especially love the interview with Dr. Bihari, the “inventor” and first user of LDN.

Mechanism of action

LDN has a “hormetic” effect: a low dose of a drug has a paradoxical “inverse” effect, like taking a cold shower that trains the body to fight off colds.

Enkephalins and Endorphins

As these substances are “master hormones” of the immune system, they correct pathological abnormalities on many levels,

reduce inflammation, activate regeneration, and are good for chronic pain, against microglial inflammation (brain inflammation), against degenerative processes, neurodegeneration, multiple sclerosis, dementia, Parkinson’s, all kinds of inflammatory diseases and acts via its own receptor in cancer cell growth and against chemoresistance (this is also the effect of methadone, which activates this receptor can)

for cancer and LDN – there are already 24,000 entries on this in Scholar

New areas of application

Autism – definitely, the kids are getting better, it’s definitely also an immune-triggered neuroinflammation

ME/CFS – for me, probably the most important therapy because it reduces the autoimmune disorder. I have to start with very low doses (0.1 mg per day) and give it in the morning, slowly increasing to the target dose of 3-4.5 mg per day. Today, another ME/CFS patient was here who came back to life with nicotine, LDA, and LDN and is now at 40% energy and has almost no PEM.

LDN is also effective in epilepsy

At least 8,000 entries on Scholar for LDN. Most studies are preclinical in animal models, but there are also some “human studies.” The best is the CASE series from Egypt, which I had summarized here by the AI:

Effect of low-dose naltrexone in Egyptian children with difficult-to-treat epilepsy: A case series study

Here is the link to the 2021 original article

Background: Epilepsy is a chronic neurological disorder affecting 50 million patients worldwide and requiring continuous treatment, with 30% of them failing to respond to treatment. Intractable epilepsy, especially in children, represents a social burden in developing countries.

LDN has been proposed as an immunomodulator in various diseases and has been shown to be particularly useful in conditions involving immune dysregulation. Naltrexon is an opioid antagonist. LDN, at a dosage of 1 to 5 mg/day, has a different mechanism of action than high-dose naltrexone.

It has been shown to be beneficial in many diseases, particularly in conditions of chronic inflammation and immune dysregulation, such as Crohn’s disease, multiple sclerosis, and chronic pain. There is evidence for the role of neuroinflammation and immune modulation in the process of epileptogenesis.

Aim of the study: The aim of this study was to demonstrate the effect of LDN in the treatment of children with intractable epilepsy (i.e., completely treatment-resistant epilepsy) and to discuss its potential role in the process of epileptogenesis.

Methods: ….. The study included five children with intractable epilepsy, …..

Results: The administration of LDN to children with severely treatable epilepsy showed a significant improvement based on its mechanism of action as an immunomodulator. The addition of LDN to the treatment of patients with intractable epilepsy resulted in a significant improvement, even in symptomatic epilepsy. This improvement was observed both clinically and in follow-up electroencephalogram (EEG). Specific improvements in the five cases after three months of LDN administration included freedom from seizures in two children and a significant reduction in seizure frequency in the others, with one case even allowing other antiepileptic medications to be reduced.

Follow-up EEGs also showed improvements in the examinations conducted, such as the disappearance or reduction of epileptiform discharges.

Discussion: ….. LDN’s mechanism of action through the suppression of neuroinflammation and immunomodulation could contribute to reducing seizure frequency in … LDN acts as an antagonist of Toll-like receptors 4 (TLR4), leading to a reduction in the pro-inflammatory profile of activated microglial cells.

Conclusion: The study observed a significant improvement in children with intractable epilepsy after the addition of LDN, both clinically and electrophysiologically. This finding may open up a new avenue for drug treatment in cases of intractable epilepsy.

Limitations: The authors point out that the evidence is of low certainty due to the case series design. Of course, LDN costs practically nothing! That’s why something like this can’t prevail.

Conclusion

As I already wrote about ME/CFS, everyone here is very happy to receive a prescription for LDN.

Unfortunately, the general medical profession and especially pharmacists don’t know anything about it yet. I regularly hear feedback like, “My pharmacist threw up his hands.”

So please share this with your colleagues!