Dr. Tim Betts, Consultant Neuropsychiatrist at the Birmingham University Seizure Clinic, has written a number of papers concerning aromatherapy and epilepsy. With his kind permission, International Therapist takes a look at some of the key issues Dr. Betts has tackled in his work ...

One question we are commonly asked at the Birmingham University Seizure Clinic is "Can aromatherapy be used by people who have epilepsy?" The short answer is "yes". Unfortunately, there are many myths surrounding epilepsy and aromatherapy. This is because much of the accepted knowledge about the properties of essential oils is not based on experimentation with the oils themselves, but rather on the clinical experience of herbalists using the powdered plant by mouth.

As a consequence, many therapists are frightened of epilepsy and become paralysed by the fear that aromatherapy (or similar techniques, such as Swedish massage) might make the condition worse. They forget, or do not realise, that epilepsy is a condition that fluctuates for its own good reasons, and the only way of telling whether or not aromatherapy will make epilepsy worse is to try it, rather than finding theoretical reasons why it might make the epilepsy worse and. therefore, banning its use - an attitude very commonly found in senior nurses or administrators in hospitals.

The observations made about safety in this article are based on our own clinical experience of treating over 200 people with epilepsy with aromatherapy. Some gained great benefit, some gained a little benefit, and some seemed to gain no benefit - but in only two patients did we see an increase in seizure activity following treatment.

Massage and seizure frequency

Very rarely, some people with epilepsy may have an increased seizure frequency if they become very relaxed, but this is an extremely uncommon response. This does not mean that massage is therefore unsafe for the majority of people with epilepsy. In almost all people with epilepsy, relaxation reduces seizure frequency.

However, many therapists fear that the person might have a seizure whilst the massage is taking place. Extensive experience of massage in our clinic in people with epilepsy over several years suggests that the danger of a patient having a seizure during massage is very low and, in fact, only one of our patients has ever had (a very minor) seizure during treatment. Obviously, if someone is having frequent seizures, this may happen, but no more than by coincidence. Providing that the therapist knows the appropriate First Aid, there is no danger. (We advocate the use of a couch which can be lowered swiftly to the floor, and that the towels covering the couch and client are used to gently restrain movement until the seizure is over. In patients who have very frequent seizures, it may be safer to massage them on the floor).

Oils that should be avoided

Oils containing large amounts of camphor should be avoided, as this particular chemical can cause convulsions. Rosemary, an oil often used in aromatherapy, contains camphor, and we have one recorded incidence where its use seemingly increased a patient's seizure frequency, and we therefore suggest that this oil is not used. Other oils that contain camphor and should perhaps be avoided include: Hyssop; Sweet Fennel; and Sage.

Oils that may be beneficial

Jasmine in particular may have a direct, beneficial effect on a person's epilepsy, with possible anti-convulsant properties. At present, the evidence for this is tenuous and further research is required - but it is an interesting observation, nonetheless.
(Indeed, in a study conducted by Efron in 1957, it was shown that the aroma of Jasmine could be used as a counter measure to prevent oncoming seizures.)

Other oils that have proved useful to our patients include Ylang Ylang, Camomile and Lavender. It is our experience that many patients with epilepsy who have had a series of aromatherapy massages with these oils will often see a decline in seizure frequency during, and for some time after, treatment. A few patients, providing they continue to have treatments every two to four weeks, may remain seizure free. (The oils most likely to achieve this, in our experience, are Ylang Ylang and Jasmine.) However, we would like to emphasise that this is not true for everybody with epilepsy.

First hundred patients followed for a year after treatment

Aromatherapy & epilepsy

Oils as a counter measure

Some people with epilepsy can develop control mechanisms for their seizures, and if they can impose a counter measure at the time they feel a seizure coming on, the seizure will often stop, or they can at least delay the onset of their seizure until a safer time. As aromas can be used as a counter measure, I wondered if essential oils could be used in the same way ...

And so I decided to introduce hypnosis to our aromatherapy trials at the Clinic. During hypnosis, patients - who did not receive any aromatherapy massages -were asked to associate the smell of a particular essential oil with a deep sense of relaxation. By then smelling the same oil when a seizure was imminent, it was hoped that the patient would be able to relax, and thus reduce the likelihood of the seizure occurring, or delay its onset -if the counter measure proved successful. (Using a single essential oil as opposed to a blend means that the same aroma can be easily reproduced and used both during and after treatments for effect.)

Indeed, this method did produce some positive results. (However, a third method - using both aromatherapy massage and hypnosis - seemed to be more beneficial: see Table I on the page opposite for comparative results.)

It is important to note here that using essential oils as a counter measure is only successful under certain conditions or circumstances. Firstly, patients need to know when they are likely to have a seizure, which will depend on the type of epilepsy they have, and how well they recognise the triggers/ warning signs. The success of such a technique also depends on how dedicated the patient is, and whether they can afford (or make time to have) the relevant treatments.

Areas of caution or concern

While we feel there is no reason why people with epilepsy should not try aromatherapy, patients do need to disclose their condition to the qualified aromatherapist, along with any medication they are taking. [Also refer to Please bear in mind section in next column.]

Remember that smell can awaken memories, and it is possible (though rare) for someone to associate the smell of an essential oil with actually having a seizure. For this reason, it is best not to test or introduce essential oils to the patient until a time when they are relaxed and least likely to have a seizure.

On conclusion

Our experience is that some people with epilepsy can use aromatherapy as a means of controlling their seizures. We must emphasise, however, that aromatherapy is not a panacea, and one treatment is not going to "cure" anybody. Aromatherapy only works for some forms of epilepsy, and usually only in people who have sufficient warning. Having said that, aromatherapy can be helpful for people who have seizures that only occur in their sleep as these particular seizures are associated with broken or unsatisfactory sleep - which can be greatly improved with the use of aromatherapy.

Our experience also suggests that 'top up' aromatherapy treatments are required from time to time, in order for the patent to benefit on a more long-term basis.

With thanks to Dr. Tim Betts,
Birmingham University Seizure Clinic

Please bear in mind ...

Epilepsy is a contra-indication
In the case of most physical therapies, epilepsy is considered to be a contraindication. A contra — indication does not necessarily mean that a treatment cannot go ahead. It does, however, indicate that the therapist needs to proceed with caution. GP permission MUST be obtained prior to treating someone who is considered to have epilepsy - particularly if the client has regular seizures, or is taking anti-epileptic drugs/ medication.

Learn about epilepsy
If you are considering treating someone with epilepsy, it is vital that you have a basic understanding of the condition. You need to know: the different types of epilepsy; how the condition affects the various body systems; and what the common symptoms are. Obviously, learning the underpinning facts about a condition will not make you a medical expert, but it will help you to decide whether treatment is appropriate in this instance. For further information, contact the British Epilepsy Association ('Epilepsy Action') on Tel: 0808 800 5050, or visit their website: www.epilepsy.org.uk

Further Reading/ References

• Betts, Dr Tim. (Birmingham University Seizure Clinic.) 2002. Aromatherapy and people with epilepsy.
• Betts, Dr Tim. (Birmingham University Seizure Clinic.) 2002. Sniffing the breeze.
• Betts, Dr Tim. (Birmingham University Seizure Clinic.) 2003. Aromatherapy (with or without hypnosis) in the treatment of intractable epilepsy - a two year follow-up study. For a copy of this paper, email: t.a.betts@bham.ac.uk

Efron, R. 1957. The conditioned inhibition of uncinate fits. Brain; 80: 251 -261.

Our thanks to International Therapist Magazine for allowing us to share past articles