Alternative Therapies Improve Seizure Frequency, Quality of Life in Treatment-Refractory Epilepsy
The ketogenic diet is highly effective at reducing seizure frequency in this population.
WASHINGTON, DC – Alternative therapies such as the ketogenic diet (KD), vagus nerve stimulation (VNS), and corpus callosotomy (CC) surgery improve seizure control and quality of life in patients with refractory epilepsy who are not candidates for resective surgery, according to data presented at the 2017 American Epilepsy Society Annual Meeting, December 1-5, 2017 in Washington, DC.
Researchers sought to compare the efficacy of several palliative therapies for patients with epilepsy who have failed treatment with ≥2 antiepileptic medications. They included data from 210 patients who were treated with either KD (n=98), VNS (n=150), or CC (n=44) between January 2010 and November 2015. Parents of the patients participated in a phone interview to assess satisfaction.
Improvements in cognitive and behavioral domains were seen in 33.3-49.3% of patients in the VNS group; 34.7-57.1% of patients in the KD group; and 40.9-59.1% of patients in the CC group. Over 51%, 62%, and 53% of patients in the VNS, KD, and CC groups, respectively, experienced a ≥50% reduction in atonic and/or other generalized seizures, and a ≥50% reduction in focal seizures was observed in nearly 53% of the VNS group; 56% of the KD group; and over 62% in the CC group.
Based on parent surveys, improved quality of life was reported in 43.9% of the VNS group, 48.4% of the KD group, and 62.5% of the CC group. They also reported treatment satisfaction in 80% of the VNS group, 79.6% of the KD group, and 75% of the CC group. Factors that influenced quality of life included improved child behavior, engagement, seizure frequency, and fewer injuring, while factors that influenced treatment satisfaction included engagement, reductions in seizure frequency, and fewer injuries.
Overall, KD appeared to be marginally more successful in reducing both generalized and focal seizures types compared with VNS and CC; however, patients undergoing CC saw an even greater improvement in quality of life.
“Based on the parents' feedback, I would suggest doctors introduce the concept of alternatives after two AEDs fail to control seizures,” said Dave Clarke, MD, MBBS, of Baylor College of Medicine and Texas Children's Hospital in Houston, in a statement. “If a prolonged electroencephalogram (EEG) can identify where the seizures are coming from, surgery to ablate or remove that area of the brain might be an option. If not, doctors really should talk to parents about the diet, VNS, or surgery. If parents think the diet can be tolerated, trying it first may not be a bad option.”
Disclosures: The researchers report financial support from the Anderson Foundation.
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Jackson, M, McCartney M, Moore E, et al. Seizure control and quality of life in children with epilepsy after vagus nerve stimulator placement, corpus callosotomy, or ketogenic diet initiation. Presented at: 2017 American Epilepsy Society Annual Meeting. December 1-5, 2017; Washington, DC. Abstract 3.178.