In a recent study on patterns of CAM use in pediatric patients with common neurologic conditions (headaches, migraines, seizures), pediatric patients with common neurological conditions were found to use CAM significantly more compared to children without these conditions (24% [n=586] vs.13% [n=7,083])⁷⁾. Pediatric patients with neurologic conditions used biological therapies with a similar frequency and mind/body practices with a significantly higher frequency compared to other pediatric patients using CAM. Among mind/body practices, deep breathing was used most commonly (33%), meditation was used in 15%, and progressive relaxation was employed in 10%⁷⁾. In another study in 2010 in North Jordan, 56% of children (n=176) with neurologic illnesses used CAM for their care²⁾. Regarding the most commonly used methods, prayer/reciting the Quran was used in 77%, massage with olive oil in 32%, religious healers in 30%, and consumption of honey products in 29%. Among the reasons provided for the use of CAM, religious beliefs were the most common (68%), and no patients described distrust in conventional medicine²⁾. Other significant factors connected to the use of CAM included belief in its effects, speech delay, father's age greater than 30 years, and mother's education less than high school²⁾. Additionally, parents' experience or hearing of successful cases from acquaintances or mass media was found to be other reasons for using CAM⁸⁾. Side effects were rare⁸⁾. In a study by Soo et al.⁸⁾ regarding the use of CAM in a pediatric neurology clinic, 44% of patients (n=105) were found to use CAM. In regard to the most commonly used CAM modalities, chiropractic manipulation was used in 15%, dietary therapy was used in 12%, and homeopathy, herbal remedies, and prayer healing were each used in 8%. The difference in this study compared to other studies is that the parents' sociodemographic characteristics were not significantly associated with the use of CAM. Pediatric health-related quality of life was also not a significant factor⁸⁾. In total, 59% of patients who used CAM experienced benefits. The total median cost of CAM compared with conventional medicines was not different ($31.70 vs. $50.00 per month)⁸⁾. In a study on CAM use in pediatric neurology, the overall rates of CAM use at two centers were 78% (n=151) and 48% (n=55), respectively⁶⁾. As for the most commonly used CAM products, multivitamins were used in 84%, vitamin C was used in 37%, homeopathic remedies were used in 24%, and fish oil/omega-3s were employed in 22%⁶⁾. Regarding the most commonly used CAM practices, massage was used in 47%, and 37% used chiropractic methods, 18% used faith-healing, and aromatherapy, homeopathy, and relaxation were each used in 16%⁶⁾. Over half of patients disclosed to their physicians their use of CAM in addition to conventional medicine⁶⁾.

In a study examining the use of traditional herbal medicines in Korean elementary school children, 65% (n=905) of children were found to be taking herbal medicines¹²⁾. In a 2008 study in Korea, 65 of 378 children (17%) with epilepsy were found to be taking herbal medicines⁴⁾. In our study in 2014, 19% (n=398) of children with epilepsy used traditional Korean medicine (TKM) (acupuncture, moxibustion, herbal medicine)¹⁰⁾. These results suggest that TKM is not the favored method for attaining seizure control and that patients are careful about using TKM to treat epilepsy. In addition, 60% of children with epilepsy were receiving other types of CAM¹⁰⁾. According to a study by Lee et al.⁴⁾, patients with psychosomatic disorders used herbal medicine significantly more frequently, whereas in a study by Kim et al.¹³⁾, neurologically normal patients used it slightly more frequently; however, the difference did not have statistical significance. In our study, among receivers of combination treatments besides TKM, TKM was used more frequently in those receiving language, music, or art therapy than in those undergoing physiotherapy or other combination therapies¹⁰⁾. This finding suggests that the use of TKM is associated more with the purpose of treatment of cognitive function than motor functions, and parents of children with epilepsy may believe that TKM has an effect on the former rather than the latter¹⁰⁾. Additionally, regarding significant factors, in the group of patients using a greater number of antiepileptic drugs and having low seizure-free rates, the use of TKM was more frequent¹⁰⁾.

Regarding the effect of CAM on epilepsy, inconsistent results had been reported in previous studies. Recent Cochrane reviews show that some studies on the use of acupuncture and Chinese traditional herbal medicine did not succeed in providing clear evidence proving the effects of acupuncture and herbal medicine for epilepsy patients^14,15). According to the study by Lee et al.⁴⁾, 18% of respondents using herbal medicine reported its effectiveness for seizure control, but the rest of the respondents reported no effectiveness or even worsening of symptoms, although many patients (33%) agreed with using herbal medicine. It was also reported that most patients did not feel that CAM was superior to general epilepsy treatments, although 32% of them continued using CAM¹⁶⁾. It is presumed that this persistent usage is due to people's beliefs that herbal medicines are safe (not dangerous) and help to improve health and enhance cognitive function¹⁰⁾. In spite of these beliefs, however, according to the report of Kuan et al.¹⁶⁾, the most frequent adverse effect of CAM was aggravated seizures. It is presumed that this is due to the effects of seizure-inducing materials of herbal medicine or drug-drug interactions. Regarding the frequency of CAM use for epileptic patients in various countries, 49% (n=403) of Taiwanese were found to use CAM, 44% used it in Arizona, 37% (n=265) of Nigerians used CAM, and 32% (n=1,000) in India and 24% (n=92) in Ohio used CAM^{5,16,17,18,19)}. Regarding commonly used forms of CAM for treatment of epileptic patients, prayer and stress relief were used in the West, whereas traditional herbal medicines were employed both in the East and in Africa^{5,16,17,18,19)}. In US, the preferred modalities were biological therapies and mind-body practices⁷⁾.

In Canada, the commonly used methods were chiropractic manipulations, dietary therapy, multivitamins, and massage^6,8). However, in North Jordan, prayer/reciting the Quran was the most commonly used modality²⁾. In Korea, TKM was used commonly by neurologic patients. These differences in use of CAM between countries may be owing to their different cultures, religions, and traditions¹⁰⁾. The characteristics of the use of CAM in children with neurologic diseases are summarized in Table 2.

According to the study by Barnes et al.⁹⁾, almost 40% (n=23,393) of US adults used CAM in 2007 and the most commonly used modalities were natural products (neither vitamin nor mineral) (18%) and deep breathing exercises (13%.). CAM was used more frequently in American adults with common neurological conditions (migraines, regular headaches, strokes, back pain with sciatica, seizures, dementia or memory loss) than in those without such conditions (44% [n=6,587] vs. 33% [n=16,806])²⁰⁾. The frequency of use of each CAM modality was higher in adults with common neurological conditions than in those without²⁰⁾. The most common modalities were mind/body therapies, and the least common were alternative medical systems²⁰⁾. The reasons why those with common neurological conditions used CAM more frequently than those without such conditions included provider's recommendations or little effect achieved with conventional medicine or a cost that was too high²⁰⁾. About 50% of adults with common neurological conditions did not report their use of CAM to their doctors²⁰⁾. Factors that significantly influenced the use of CAM in those with common neurological conditions included higher educational level than high school education, positive history of anxiety, living in a western area, being a former smoker, and drinking alcohol lightly²⁰⁾.

In the previous studies on the use of CAM in various neurologic conditions, the prevalence of use of CAM ranged from 19% to 43%^21,22,23). Compared to the frequency of use of CAM in children with common neurologic diseases, the frequency of use in adults with neurologic diseases was similar^2,6,7,8,10). For Korean adults with other diseases, several studies showed the following findings regarding CAM use: 60%–70% of patients with stroke used CAM, 53% of those with cancer used it and 53% of patients with asthma and 48% of patients with psychiatric disorders used herbal medicines^24,25,26,27).

Preferred modalities of CAM use in children and adults had diverse features, and these results may be influenced by individuals' different cultures and traditions of use of CAM. The factor most commonly related to use of CAM in children with neurologic conditions was parental CAM use, and it could be presumed that the use of CAM in children may be due to such usage running in the family, as well as belief in or experience with the efficacy of CAM. In adults with neurologic conditions, increased educational level was the most common factor associated with use of CAM^20,21,23), and this result may relate to economic level. Characteristics of the use of CAM in adults with neurologic diseases are summarized in Table 3.

In a systematic review on the use of CAM in pediatric cancer patients, the prevalence of use of CAM (since the diagnosis of cancer) ranged from 6% to 91% (n=2,871). The most common CAM modalities were herbal medicines, diets/nutrition, and faith-healing²⁸⁾. The frequent reasons given for the use of CAM were to help cure or fight the child's cancer, relief of symptom, and support of ongoing use of conventional medicine²⁸⁾. There were few factors related to patients' sociodemographic characteristics associated with use of CAM, and this result was different from the results of several other studies²⁸⁾.

According to the study by Barnes et al.⁹⁾, for pediatric patients with specific diseases, the use of CAM was not highly prevalent. The proportions were 2% in insomnia, 3% in attention deficit hyperactivity disorder (ADHD), 5% in other musculoskeletal diseases, 5% in stress or anxiety, 7% in head or chest colds, and 7% in back or neck pain⁹⁾. From these results, it is presumed that patients in these cases use CAM to manage symptoms, to maintain and manage health, or to prevent illness, rather than to treat specific diseases²⁸⁾. Many studies, however, reported a higher frequency of CAM use in pediatric patients with chronic diseases, such as asthma, autism, ADHD, cancer, and sickle cell anemia. Medical symptoms such as nausea and abdominal pain rather than certain medical diagnoses were found to be some of the factors associated with the use of CAM²⁸⁾.

In the study by Oshikoya et al.²⁹⁾, the researchers interviewed parents of children with epilepsy (n=122), asthma (n=78), or sickle cell anemia (n=118). Three hundred three types of CAM were used by 99 patients (31%) (epilepsy, 38%; sickle cell anemia, 36%; asthma, 25%). The most commonly used CAMs were biological products (58%), while alternative medical systems (27%) as well as mind/body interventions (14%) were also employed. Important factors influencing the use of CAM were relatives, friends, and neighbors. Eighty-five parents (86%) were going to report the use of CAM to their physicians, but had not yet done so. In 7% of the patients, adverse reactions were associated with CAM use.

Levy and Hyman³⁰⁾ investigated the use of CAM for children with autistic spectrum disorder (ASD). About 50%–75% (n=50–112) of children with autism were found to use CAM³¹⁾. Patients with comorbid intellectual disability may have a higher frequency of use of CAM. In the study by Levy et al.³²⁾, one-third of children requested for examination of ASD were found to have already used CAM, even before diagnosis. The most frequently used form of CAM for children with ASD were mind/body practices³⁰⁾.

In children with inflammatory bowel disease, adverse effect was the significant predictor of CAM use³³⁾. In cases of children with asthma, the significant predictors of use of CAM were older age and worse control of symptoms. Also, more medications and more medical visits as well as more side effects were significant predictors in using CAM³⁴⁾. A study in Italy showed that the most common reason for the use of CAM was a fear of side effects of conventional therapy for routine illness³⁵⁾. In the study by Hanson et al.³⁶⁾, 75% of parents of children with ASD chose the use of CAM because they felt CAM was perceived to be safe and it did not have side effect or they experienced side effects of conventional therapy previously. The purposes of the use of CAM in children with ASD are treatment of major symptoms of ASD, improvement of attention, enhancement of relaxation, treatment of gastrointestinal symptoms, regulation of sleep and promotion of general health³¹⁾. The characteristics of the use of CAM in children with other chronic diseases are summarized in Table 4.