Non pharmacologic management of epilepsy

This is a timely learning material

1. Non Pharmacologic Management of Epilepsy By Tilahun Belete Mossie ( BSc , MSc ) College of H ealth Sciences Mekelle University Ethiopia October 2016

2. Non Pharmacologic Management of Epilepsy Dietary Measure : High fat and low carbohydrate diet that mimics the effect of starvation is called a Ketogenic diet. This name is given because of its ability to forms ketone in the blood. It has been implicated in the treatment of epilepsy for a long period of time [1]. By restoring energy to the central nervous system, it can treat different forms of seizure in infants and children [2 - 6].

3. I. Dietary measure… There is evidence that ketogenic diets can treat or at least minimize seizure frequency in refractory seizers to anticonvulsants [7, 8]. NB : Ketogenic diet is rich in fat, has low carbohydrate and normal protein. Other vitamins and calcium should also be supplemented. Usually there is a restriction in calories and fluids. Moreover, it must be monitored by physicians

4. 2. Yoga/Meditation : Yoga is known for its relaxation and stress reduction effect. It can bring changes in metabolism, blood flow, and oxygen levels in the brain by improving circulation, respiration, and concentration . These in turn result in relaxation state and reduced level of stress [9, 10].

5. 2. Yoga/Meditation… Now this day Yoga has been found effective in reducing seizure attacks in people who used anticonvulsants. However , its efficacy in uncontrolled seizure is not yet determined [11]. Also a meditation practice for 20 minutes a day has been found effective in reducing seizure frequency [12, 13].

6. 3. Surgery This has been performed in refractory/drug resistant seizures. It might take curative form that includes temporal and extra temporal resection, hemispherectomy and radio surgery. Collasotomy and multiple transections are considered as palliative measures [14]. About 50% to 60% people who were treated with brain surgery became seizure free; as well 60% to 85% had a reduction in the frequency of seizure [14 , 15].

7. 4. Vagal Nerve Stimulation t is a neuromodulary treatment carried out by stimulating the vagus nerve through a programmable pulse generator. This appears to b effective treatment for those with refractory seizure resulting in at seizure reduction in 50% of people who got this treatment [16 , 17 ].

8. Conclusion Moreover common non pharmacologic measures to manage seizure include: ketogenic diets, yoga/meditation, surgery and vagal nerve stimulation

9. References 1. Bailey EE, Pfeifer HH, Thiele EA. The use of diet in the treatment of epilepsy. Epilepsy Behav.2005;6:4–8 . [ PubMed ] 2. Wang D, Pascual JM, Yang H, et al. Glut-1 deficiency syndrome: clinical, genetic, and therapeutic aspects. Ann Neurol. 2005;57:111–118. [ PubMed ] 3. Wexler ID, Hemalatha SG, McConnell J, et al. Outcome of pyruvate dehydrogenase deficiency treated with ketogenic diets. Studies in patients with identical mutations . Neurology. 1997;49:1655–1661.[ PubMed ] 4. Kossoff EH, Hedderick EF, Turner Z, Freeman JM. A case-control evaluation of the ketogenic diet versus ACTH for new-onset infantile spasms. Epilepsia . 2008 Apr 10 ; ( Epub ahead of print) [ PubMed ] 5. Caraballo RH, Cersosimo RO, Sakr D, et al. Ketogenic diet in patients with myoclonic - astatic epilepsy.Epileptic Disord . 2006;8:151–155. [PubMed] 6. Korff C, Laux L, Kelley K, et al. Dravet syndrome (severe myoclonic epilepsy in infancy ): a retrospective study of 16 patients. J Child Neurol. 2007;22:185–194 . [PubMed]

10. References… 7. Oguni H, Tanaka T, Hayashi K, et al. Treatment and long-term prognosis of myoclonic - astatic epilepsy of early childhood. Neuropediatrics . 2002;33:122–132. [ PubMed ] 8. Hemingway C, Freeman JM, Pillas DJ, Pyzik PL. The ketogenic diet: a 3- to 6-year follow up of 150 children enrolled prospectively. Pediatrics. 2001;108:898– 905 . [ PubMed ] 9. Usha Panjwani , W. Selvamurthy , S.H. Singh, H.L. Gupta, L.Thakur & U.C. Rai ; " Effect of Sahaja Yoga on Seizure Control and EEG Changes in Patients of Epilepsy"; Indian Journal of Medical Research, 103, March 1996, pp165-172 10. Yardi , Nandan ; "Yoga For the Control of Epilepsy"; Seizure 2001: 10: 7-12 11. Panebianco M, Sridharan K, Ramaratnam S. Yoga for epilepsy. Cochrane Database Syst Rev . 2015 May 2;(5):CD001524. doi : 10.1002/14651858.CD001524.pub2 .

11. References… 12. Deepak KK, Manchanda SK, Maheshwari MC; "Meditation Improves Clinicoelectroencephalographic measures in Drug-resistant Epileptics"; Biofeedback and Self-Regulation , Vol. 19, No. 1, 1994, pp 25-40 13. Lansky EP, St Louis EK. Transcendental meditation: a double-edged sword in epilepsy? Epilepsy Behav . 2006 Nov; 9(3):394-400. Epub 2006 Aug 23. 14. Guénot M. [Surgical treatment of epilepsy: outcome of various surgical procedures in adults and children]. Rev Neurol (Paris).2004 Jun; 160 Spec No 1:5S241-50. 15. Téllez-Zenteno JF, Dhar R, Wiebe S. Long-term seizure outcomes following epilepsy surgery : a systematic review and meta-analysis. Brain. 2005 May;128(Pt 5):1188-98. Epub 2005 Mar 9. 16. Jennum P, Sabers A, Christensen J, Ibsen R, Kjellberg J. Socioeconomic evaluation of vagus stimulation: A controlled national study. Seizure. 2016 Sep 13;42:15-19. doi : 10.1016/j.seizure.2016.08.011 17. Panebianco M, Rigby A, Weston J, Marson AG. Vagus nerve stimulation for partial seizures . Cochrane Database Syst Rev. 2015 Apr 3;(4):CD002896. doi : 10.1002/14651858.CD002896.pub2.