Archives of Mental Health

EDITORIAL
Year
: 2021  |  Volume : 22  |  Issue : 2  |  Page : 85--86

The use of essential oils may be a trigger for seizures in India: Implications for the practice of sociocultural neuropsychiatry


Chittaranjan Andrade 
 Senior Professor, Department of Clinical Psychopharmacology and Neurotoxicology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India

Correspondence Address:
Dr. Chittaranjan Andrade
Department of Clinical Psychopharmacology and Neurotoxicology, National Institute of Mental Health and Neurosciences, Bengaluru - 560 029, Karnataka
India




How to cite this article:
Andrade C. The use of essential oils may be a trigger for seizures in India: Implications for the practice of sociocultural neuropsychiatry.Arch Ment Health 2021;22:85-86


How to cite this URL:
Andrade C. The use of essential oils may be a trigger for seizures in India: Implications for the practice of sociocultural neuropsychiatry. Arch Ment Health [serial online] 2021 [cited 2022 Jan 17 ];22:85-86
Available from: https://www.amhonline.org/text.asp?2021/22/2/85/331624


Full Text



There is a long list of physiological, pathological, behavioral, chemical, and other risk factors that have been associated with lowering of the seizure threshold. Menstruation is an example of a physiological risk factor, and brain infection, brain tumor, and head injury are examples of pathological risk factors. Examples of behavioral risk factors include missing meals and losing sleep. And, examples of chemical risk factors include the use of drugs such as bupropion, clomipramine, and clozapine. A recent South Indian study, conducted by Mathew et al.,[1] identified the use of essential oils as a possible chemical risk factor.

Essential oils are liquid extracts from plant materials obtained by distillation or by other means. In India, essential oils are frequently used for their aroma. In India, these oils are also common ingredients in certain over-the-counter medicinal preparations that are advertised in the mass media. Such preparations may be topically applied as a counterirritant with the expectation that such use will relieve headache, musculoskeletal pain, or inflammation. Such preparations may also be topically applied on the upper lip or chest, or added to steaming water and inhaled, in the sociocultural belief that their use will result in relief from upper or lower respiratory tract conditions. In the context of such use, Mathew et al.[1] observed that some essential oils may induce or provoke seizures.

These authors[1] described a 4-year prospective study that was conducted in four hospitals in Bangalore, Karnataka. In this study, all patients who presented with seizures were asked about exposure to essential oils. Seizures were classified as induced or provoked. Induced seizures were new-onset seizures, defined as those that occurred soon after exposure to an essential oil in persons with no past history of seizures, and with no recurrence of seizure during at least 6 months of follow-up after stopping the essential oil exposure. Provoked seizures were breakthrough seizures, defined as those that occurred soon after exposure to an essential oil in persons with an already diagnosed seizure disorder who were compliant with antiepileptic medications and who had no other risk factors for breakthrough seizures.

The authors[1] analyzed data obtained from 55 patients who were identified to have had seizures related to essential oil exposure. Of these, 22 had induced seizures and 33 had provoked seizures. The age of these patients ranged from 8 months to 77 years (mean, about 28–29 years). The sample was 53% male. Exposure to essential oil was topical in 42 patients, inhalational in 10 patients, and oral in three. The seizures occurred an average of 4–5 h after exposure. Most seizures (55%) were generalized tonic–clonic seizures. The balms, oils, or liniments responsible for the exposure contained camphor, eucalyptus oil, or both.

In India, as in certain other parts of the world, there is a sociocultural belief that natural substances are harmless, and so, because essential oils are natural substances, they are also considered harmless and even associated with healing properties. The study by Mathew et al.[1] suggests that such beliefs may be dangerous. Camphor and eucalyptus oil are both known to lower the seizure threshold; camphor, in fact, was used by Meduna to induce seizures in schizophrenia patients and was a forerunner of electroconvulsive therapy. A reasonable take-home message from their study, therefore, is that the topical application, inhalation, or ingestion of balms, liniments, or oils that contain camphor or eucalyptus extract may lower the seizure threshold and induce new-onset seizures, or provoke breakthrough seizures in persons with epilepsy.

The study is not without limitations. For example, the authors[1] did not state how many patients they screened; hence, we do not know whether the 55 patients in their study comprised a tiny fraction or a large proportion of patients who presented with seizures. We do not know how often, previously, these 55 patients had been exposed to essential oils uneventfully. Finally, we do not know how many persons who self-expose to essential oils suffer no adverse consequences.[2] All of these are important research questions for further investigation in the field. Answers to these questions will help clarify the cause–effect nature of the relationship between essential oil exposure and seizures as well as the magnitude of the risk in the population. If essential oils are confirmed to be a trigger for seizures, their use should be curtailed. This would require inclusion of the information in preventive and social medicine syllabi, education of the public, and restriction of the use of these substances in over-the-counter medicinal preparations.

References

1Mathew T, John SK, Kamath V, Kumar RS, Jadav R, Swamy S, et al. Essential oil related seizures (EORS): A multi-center prospective study on essential oils and seizures in adults. Epilepsy Res 2021;173:106626.
2Praharaj SK, Narasimha VL, Harshe D, Sharma N, Andrade C. Essential oils as a risk factor for induced or provoked seizures. Epilepsy Res. 2021;106645. doi: 10.1016/j.eplepsyres.2021.106645. Online ahead of print.