This Case Study was prepared by Dr. Eric Karchmer, MD (China), Phd, LAC and DAO Labs Co-Founder & Chief Doctor of Traditional Chinese Medicine as a "Conference Poster" for 21^st International Congress of International Society of Ethnopharmacology.  It is not intended to treat, mitigate or cure any disease, but was created for research purpose.  The current research is in "Draft Form" and is not to be cited without permission of the Author.

Infantile spasms is a form of catastrophic childhood epilepsy, that presents with clusters of head and arm jerks. It has a very poor prognosis in 80-90% of cases (Kosoff 2010). In two recent cases, children who had failed multiple pharmaceutical therapies had positive responses to traditional Chinese herbal therapies that used centipedes (Scolopendra subspinipes mutilans L. Koch.). One patient achieved total seizure control and the second has had a 90% reduction in seizure frequency. This poster will discuss both case histories, the Chinese medicine principles for centipede use, and pharmacological evidence for a possible mechanism in treating epilepsy.

Case Study One - An Overview

In case #1, the child was diagnosed with infantile spasms at 5 ½ months at Wake Forest Medical Center (North Carolina, USA). No causative etiology was determined for this case. Seizures were initially controlled with a month-long course of high-dose prednisolone, but they reappeared at 14 months. Seizures worsened despite treatment with Keppra and Klonopin, so the child was put on the ketogenic diet at 22 months. In the ensuing months, parents observed some positive developmental achievements, such as steadier walking and the beginnings of language acquisition. Seizure frequency also seemed plateaued at 8-9 episodes per month. With more refinements of the ketogenic diet and a switch to treatment with Onfi alone, seizure frequency fell to 6 episodes per month. At 3 ½ years, the parents began using a cannabidiol (CBD) supplement, and seizure frequency improved to one episode per week or less.

Due to behavioral issues in school, the parents decided to taper the child off Onfi entirely, when the child was roughly six years old. Seizure frequency did not worsen without Onfi, but head and arm jerks intensified considerably, and clusters increased in length from 10 minutes to 30 minutes. At 6 ½ years, four months after stopping Onfi, the parents began giving the child a Chinese herbal therapy that contained centipedes (Scolopendra subspinipes mutilans L. Koch.). The parents had administered Chinese herbal therapies previously but without much clear success. Adding centipedes to the previous formula seemed to result in immediate improvements. The child was soon seizure free and has remained so for over 3 ½ three years. The parents gradually stopped all other therapies (CBD and the ketogenic diet). For the past year and a half, the child has only received Chinese herbal therapies, including centipedes.

Case #1 Graph of Seizure Frequency

Case Study Two - An Overview

In case #2, the child was diagnosed with infantile spasms at 5 months at Chung Shan Medical Center (Taichung, Taiwan). Because of the child’s poor response to conventional anti-seizure medications, the family sought out Chinese medicine therapies at China Medical University when he was 2 years 11 months. At the time, the child was already taking Trileptal, Depakine, Decone, Sabril, Topamax, Rivotril, and Keppra; he had also been on the ketogenic diet since he was 12 months old. Developmentally, the child struggled to walk without falling, had no language, and did not seem to recognize his family members. He was averaging 12 seizures per day, in clusters that lasted on average 3 minutes. After beginning Chinese herbal therapy (roughly 16 herbs in total) that included centipedes, there was a gradual improvement in the frequency of spasms and the length of the clusters over three months and then a marked improvement in the fourth month.

During this time, the child’s pediatric neurologist tapered him off several anti-seizure medications, continuing only with Trileptal, Depakine, and Keppra, but adding Inovelon. The family also started giving the child a CBD supplement. The child’s awareness of his surroundings improved significantly. He was able to walk without falling, ascend and descend stairs unassisted, and clearly recognized family members. During the first four months of treatment, the Chinese herbal formula was gradually modified, increasing the dose of centipedes from than 0.2g per day to 1.7g per day. After four months of treatment, the child’s seizure frequency declined rapidly, averaging 0.5 seizures per day in months five and six of treatment, before increasing to 2 seizure per day in the seventh month of treatment. Treatment is ongoing with this case.

 Case #2 Graph of Seizure Frequency

Traditional Chinese Medicine Principles

According to classic principles in Chinese medicine, seizures are caused in part by an “internal wind,” and centipedes can be used to “extinguish wind.” The famous early 20^th century physician, Zhang Xichun, can help us further understand the role of centipedes in treating seizures. He argued that seizures were caused by “original yang seizing qi and blood and rushing upwards to disturb the brain.” He further explained: “To treat the branch of this condition, nothing is better than centipedes. Branch-treating medicinals should be used to relieve the emergency… and root-treating medicinals to clear the source (Zhang Xichun 2015 (1918), II: 352-353).”

Supporting Research

The pharmacological study of centipedes is still in its infancy (Hakim, Yang, and Lai 2015). Studies on animal models have suggested that centipede extract can protect against neurodegeneration in the hippocampus and produce anti-neuroinflammatory effects in the treatment of amyotrophic lateral sclerosis. (Cai, Choi, Song, et al. 2013; Seo, Ang, Moon, et al. 2019)

Discussion

The two cases above suggest centipede-based Chinese herbal formulas may contribute to control of refractory infantile spasms. Case #1 provides the strongest evidence. This child had already stopped treatment with all pharmaceuticals when centipedes were added to his herbal regimen. Moreover, in the four months since stopping his pharmaceutical therapies, his head and arms jerks has become noticeably more intense, and the length of the clusters had tripled from 10 minutes to 30 minutes. The evidence from case #2 is more complex. The benefits of the Chinese herbal therapy seemed quite modest at first, and a clear reduction in seizure frequency only happened four months later. This could be due to several complicating factors: a) the patient was simultaneously tapered off several pharmaceuticals during this time; b) the initial dose of centipedes may have been too small, beginning at approximately 0.2g per day gradually increasing to 1.7g per day. In addition, it should be recognized that other therapies were initiated or modified during this time, including the use of Inovelon, refinements of the ketogenic diet regimen, the use of acupuncture therapies, and the initiation of a CDB supplement. Current clinical evidence suggests that these therapies were unlikely to produce such a dramatic improvement in seizure control for refractory infantile spasms (Coppola et al. 2014, Hussain et al. 2020). In addition to the above caveats, it is important to remember that doctors of Chinese medicine assert that the combination of ingredients in a Chinese herbal therapy produce a synergistic effect. Centipedes may be a key ingredient in the two cases above, but the role of the additional medicinals in each formula should not be underestimated.

Conclusion

In this poster, we have examined two cases of refractory infantile spasms, where both patients had dramatic improvements. Centipede-based Chinese herbal therapies seemed play an important, perhaps even pivotal role, in these clinical results. Further study of centipedes and other Chinese herbal medicinals for the treatment of epilepsy may yield interesting findings.

References

Cai, MuDan, Sun-Mi Choi, Bong Keun Song, Ilhong Son, Sungchul Kim, and Eun Jin Yang. "Scolopendra Subspinipes Mutilans Attenutates Neuroinflammation in Symptomatic Hsod1^G93A Mice." Journal of Neuroinflammation 10, no. 131 (2013).

Coppola, Giangennaro, Frank Besag, Raffaella Cusmai, Olivier Dulac, Gerhard Kluger, Romina Moavero, Rima Nabbout, Marina Nikanorova, Francesco Pisani, Alberto Verrotti, Celina von Stülpnagel, and Paolo Curatolo. 2014. "Current role of rufinamide in the treatment of childhood epilepsy: Literature review and treatment guidelines." European Journal of Paediatric Neurology 18 (6): 685-690.

Hakim, Md Abdul, Shilong Yang, and Ren Lai. 2015. "Centipede Venoms and Their Components: Resources for Potential Therapeutic Applications." Toxins 7: 4832-4851.

Hussain, Shaun A., Dennis J. Dlugos, M. Roberta Cilio, Neha Parikh, Alex Oh, and Raman Sankar. 2020. "Synthetic pharmaceutical grade cannabidiol for treatment of refractory infantile spasms: A multicenter phase-2 study." Epilepsy & Behavior 102.

Kosoff, Eric. 2010. "Infantile Spasms." The Neurologist 16 (2): 69-75.

Seo, Yun-Soo, Mary Jasmin Ang, Byeong Cheol Moon, Hyo Seon Kim, Goya Choi, Hye-Sun Lim, Sohi Kang, et al. 2019. "Protective Effects of Scolopendra Water Extract on Trimethyltin-Induced Hippocampal Neurodegeneration and Seizures in Mice." Brain Sciences 9, no. 369

Zhang Xichun. 2015 (1918). Medical Records Cherishing China and Referencing the West 醫學衷中參西錄. edited by Li Zhengyu 李政育. New Taipei City: Yuen Chi Jai Press.

Dr. Eric Karchmer is a practicing Chinese medical doctor, medical anthropologist, and co-founder and Chief Doctor of Chinese Medicine for DAO Labs. From 1995-2000, Eric studied at the Beijing University of Chinese Medicine and today is both a licensed acupuncturist and professor at Appalachian State University. Eric can be reached at drkarchmer@mydaolabs.com.