Aromatherapy for epilepsy

The researchers might be on to something with their scent theory. A few years ago, over at Weird Universe, I posted about a study published in the journal Clinical Neurology and Neurosurgery that looked at whether stinky shoe smell could be an effective treatment for epilepsy. For centuries, it's been part of folk medical practice in India to arrest epileptic seizures by forcing the person having the seizure to smell stinky shoes. The researchers concluded, to their surprise, that the technique worked. They wrote, "strong olfaction applied in the form of 'shoe-smell' did definitely play a suppressive role and thus exerted an inhibitory influence on epilepsy."

http://hoaxes.org/weblog/comments/can_a_bar_of_soap_between_your_sheets_ease_muscle_cramps

I wondered what kind of shoe-smell they were talking about. Apparently it's stinky shoe smell. The stinkier the better. The authors were skeptical that shoe-smell could work, but they end up concluding that it probably did help:

“strong olfaction can aid in halting the progress of an epileptic seizure and/or abort the generalization of a partial seizure especially of temporal origin although more prospective studies are required to establish a clear and firm relation between the two, i.e. strong odor and seizure control. It may not therefore be incorrect to believe that in olden days too, strong olfaction applied in the form of ‘shoe-smell’ did definitely play a suppressive role and thus exerted an inhibitory influence on epilepsy.”

http://www.weirduniverse.net/blog/comments/shoe_smell_and_epilepsy/

Jaseja H. Scientific basis behind traditional practice of application of "shoe-smell" in controlling epileptic seizures in the eastern countries. Clin Neurol Neurosurg. 2008 Jun;110(6):535-8.

Abstract

Epilepsy has been known for thousands of years and has been subjected to various forms of conventional and non-conventional therapies including a non-pharmacological conservative treatment known as aromatherapy, ever since. One commonly practiced form of aromatherapy that persists as an immediate first-aid measure even today in some parts of developing countries in the East is the application of "shoe-smell" during an epileptic attack. The questionable remedial role has intrigued neuro-scientists at least in these parts of the world. This brief paper attempts to provide an insight to the basis of persistence of this practice and to explore a possible scientific logic behind its unscientifically reported remedial effectiveness. The neurophysiology of olfactory stimulation from "shoe-smell" reveals a sound and scientific reasoning for its remedial efficacy in epilepsy; olfactory stimuli in this study have been found to possess significantly effective anti-epileptic influence which could have formed the basis for the use of application of "shoe-smell" in earlier times and also for its persistence even today in those parts of developing regions.

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From the article

Aromatherapy has been tried as a behavioral form of medicinal approach to control epilepsy. Research carried out at the Queen Elizabeth Hospital, Birmingham by Dr. Tim Betts demonstrated that aromatherapy could help in controlling epilepsy. In some people, whose seizures are preceded by an aura, breathing in the scent of the aromatic oils at the start of the warning can reduce the chance, or severity, of an epileptic attack. It has been suggested that smell can act as a countermeasure in epilepsy because of its property of evoking activity in the same cortical region where epileptic potentials arise very often. Efron showed  that odor not only acts as a countermeasure but can also be conditioned easily resulting in formation of smell-memory (odor-memory), which can help inhibit epileptic activity or its spread or both. Further, such memories are not easily de-conditioned or erased. EEG changes during olfactory stimulation have also been observed in several studies .

Some Eastern parts of the world like India have witnessed since time immemorial, a practice of application of “shoe-smelling” in an attempt to arrest the seizures. The practice consisted of bringing the sole of shoe near the nostrils of the patient during the epileptic attack by near-by attendants or passers-by in the event of the attack occurring in a public place. The practice has continued and still remains a form of first-aid treatment in developing countries especially in countryside and rural areas. Although today, this age-old practice of “shoe-smell” may sound ridiculous apart from being most unscientific, its persistence as a remedy does tempt researchers to provide an insight to the reasons and basis for this continuing practice…

Shoe-smell was applied at the time of initiation or warning signs of the attack, even during the full-blown state, as the laymen had no idea of the physiological basis behind an epileptic attack. The application appears to have become a stereotyped immediate first-aid remedial measure irrespective of the phase of the epileptic attack. The author does not intend to state that the application was effective (even to a variable extent) in all the epileptic patients, but does emphasize that it must have been effective in a definite proportion of the epileptic population and this observation has been instrumental in the sustenance of this form of remedy…

Ebert and Loscher have reported that olfactory stimulation with toluene suppressed seizures in most of the kindled rats. Olfactory stimulation with toluene or ammonia was found to increase the epileptic threshold. They also suggest that strong physiological stimulation like olfaction can interfere with ongoing seizure activity in the limbic system…

It has been suggested that olfaction is likely to lead to widespread de-synchronization, akin to vagal nerve stimulation in exercising its seizure-reducing property…

De-synchronization can even arrest the ongoing epileptic activity and thus halt the progress of an epileptic attack, the explanation put forward is the alteration in the level of excitability in the area of epileptic focus that prevents seizure activity .

Thus, the above explanation does indicate that strong olfaction can aid in halting the progress of an epileptic seizure and/or abort the generalization of a partial seizure especially of temporal origin although more prospective studies are required to establish a clear and firm relation between the two, i.e. strong odor and seizure control. It may not therefore be incorrect to believe that in olden days too, strong olfaction applied in the form of “shoe-smell” did definitely play a suppressive role and thus exerted an inhibitory influence on epilepsy especially TLE, which was likely to have been the commonest form of epilepsy as even today.

This short paper is not intended to promote the use of “shoe-smell” as any form of remedy for epilepsy, but has been an endeavor to explore the scientific basis of its apparent remedial effect observed since long.