Efficacy and safety of herbal medicine combined with acupuncture in pediatric epilepsy treatment: A meta-analysis of randomized controlled trials

Epilepsy is a serious neurologic condition affecting about 50 million people worldwide, of whom approximately 10.5 million are children younger than 15 years. This disease, characterized by recurrent and unprovoked seizures, is a particular concern when it occurs in childhood, because it can significantly interfere with children's neurologic, cognitive, behavioral, and motor development. In addition to the direct health impacts, pediatric epilepsy can affect school performance, increase the risk of injury, create psychosocial challenges, and compromise long-term life prospects. Although antiepileptic drugs are the standard treatment, they often cause side effects such as fatigue, mood changes, aggressiveness, sleep problems, and cognitive impairments, including memory and attention deficits.

These effects are particularly pronounced when multiple medications are used simultaneously, leading many families to seek complementary treatments that can be integrated with conventional medical care.

This study aimed to evaluate the efficacy and safety of the combination of Chinese herbal medicine with acupuncture in the treatment of pediatric epilepsy. The investigators conducted a systematic review and meta-analysis, searching scientific databases from inception through October 2023 to identify randomized controlled trials comparing combined treatment with herbal medicines and acupuncture versus standard medical care in children with epilepsy. The primary outcome was the risk of treatment failure, defined as a reduction in seizure frequency of less than 50%, lack of improvement or worsening of symptoms, discontinuation due to serious side effects, or persistent seizures without clinical or electroencephalographic improvement. Secondary outcomes included post-treatment electroencephalographic abnormalities and the occurrence of adverse events.

To ensure the robustness of the results, subgroup analyses based on the different herbal formulas used were conducted, as well as meta-regression analyses to examine the influence of patient characteristics such as age, sex, and duration of seizure history.

The analysis included 10 studies involving a total of 882 children, all conducted in China between 2001 and 2019. The results showed that children who received the combined treatment of herbal medicine and acupuncture had a significantly lower risk of treatment failure compared with those who received only standard medical care. Specifically, the intervention group had a 70% lower risk of treatment failure. Subgroup analyses revealed that this therapeutic efficacy was consistent across the different herbal formulas used, including Ding Xian Tang (定癇湯), Ping Gan (平肝), and Xi Feng (熄風), which are traditional Chinese preparations specific for the treatment of seizures.

Meta-regression analysis showed that treatment benefits were not influenced by patient age, proportion of boys, or duration of seizure history, suggesting that the treatment may be effective across different pediatric patient profiles. Although there was no significant difference in post-treatment electroencephalographic abnormalities between groups, a favorable trend was observed in the intervention group. Importantly, the risk of adverse events was significantly lower in the group that received herbal medicine combined with acupuncture.

These findings have important implications for both patients and families and healthcare professionals caring for children with epilepsy. For families, the results suggest that Chinese herbal medicine combined with acupuncture may be a safe and effective therapeutic option that can complement conventional medical treatment, potentially offering better seizure control with fewer side effects. This is particularly relevant given that traditional antiepileptic drugs can cause significant adverse effects in children, including cognitive and behavioral problems that can affect development and quality of life. For healthcare professionals, these findings may encourage a more integrative approach to managing pediatric epilepsy, considering evidence-based complementary therapies as part of the treatment plan.

The consistency of results across different herbal formulas also suggests that the benefit may relate to common therapeutic principles in traditional Chinese medicine rather than being specific to a single formulation.

However, it is important to recognize the significant limitations of this study that must be considered when interpreting the results. The methodologic quality of the included studies raised some concerns, particularly regarding randomization processes, allocation concealment, and blinding, which may introduce bias in the results. In addition, the follow-up periods were relatively short, limiting our understanding of long-term efficacy and seizure recurrence. Many studies also did not evaluate important outcomes such as reduced epilepsy duration and cognitive effects, which are essential for a comprehensive evaluation of treatment efficacy and safety.

The safety profile, although it appears favorable, is based on studies with relatively small samples, which limits our ability to confirm safety for a broader population. Additionally, the research was based primarily on studies conducted in China and published in Chinese, which may limit the applicability of the results to other populations and clinical contexts. The absence of uniform efficacy definitions across studies also represents an important methodologic limitation. Therefore, although the results are promising and suggest that herbal medicine combined with acupuncture may be a valuable clinical approach for the treatment of pediatric epilepsy, additional larger, methodologically rigorous, and multicenter studies are needed to definitively establish the efficacy and safety of this integrative therapeutic approach.