Non-pharmacological treatments for pediatric refractory epilepsies

ABSTRACT

Introduction

Antiseizure medications (ASMs) are the primary treatment option for epilepsies of wide etiologies, however, about 10–20% of children do not gain sustained seizure control and in this case, it is worth investigating ‘alternative’ therapeutic approaches aside from ASMs. Nowadays, non-pharmacological strategies for epilepsy treatment encompass dietary interventions, neurostimulation-based techniques, and biobehavioral approaches.

Areas covered

A search on PubMed database was conducted. Experimental and clinical studies, as well as meta-analysis and structured reviews on the latest non-pharmacological treatments for drug-resistant epilepsy (DRE) in children, were included. Special attention is given to the efficacy and tolerability outcomes, trying to infer the role novel approaches may have in the future.

Expert opinion

The large heterogeneity of primary clinical outcomes and the unavoidable subjective response of each patient to treatments prevents Researchers from the identification of a single, reliable, approach to treat DRE. The understanding of fine pathophysiologic processes is giving the way to the use of alternative therapies, such as the well-known ketogenic diet, in a ‘personalized’ view of treatment. The goal is to apply the non-pharmacological treatment most suitable for the patient<apos;>s sake.

KEYWORDS:

• Epilepsy
• ketogenic diet
• neurostimulation
• non-pharmacological
• pediatric epilepsy
• treatments

Article highlights

• Drug-resistant epilepsy (DRE) affects up to 20% of children with epilepsy.

• The ketogenic diet (KD) may be effective in etiologically heterogeneous DRE.

• Neurostimulation-based approaches may be a palliative treatment option for highly DRE.

• Biobehavioral approaches or homeopathy may indeed be effective in some cases.

Acknowledgments

This work was developed within the framework of the DINOGMI Department of Excellence of MIUR 2018-2022 (legge 232 del 2016).

Disclosure statement

No potential conflict of interest was reported by the author(s).

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.