Nonpharmacologic care for patients with Lennox-Gastautsyndrome: Ketogenic diets and vagus nerve stimulation
Kossoff EH, Shields WD.
Epilepsia. 2014 Sep;55 Suppl 4:29-33.
https://doi.org/10.1111/epi.12546.
Let’s continue with our theme - Lennox-Gastaut syndrome (#LGS) and vagus nerve stimulation (#VNS). This review by Kossoff et al. (Dec. 2014) discussed clinical studies using ketogenic diet (#KD) or VNS as#nonpharmacological treatments for LGS patients.
Both treatments have around a 50% responder rate* for LGS patients. Reported treatment outcomes by KD in LGS patients included: 1) significant seizure reduction (p=0.003)[1] and 2) reduced antiseizure medications (#ASMs)[2]. Unfortunately, specific studies examining the use of KD in LGS patients were quite limited. Most of the evidence was based on short-term (≤1y), retrospective studies in pediatric patients, where LGS patients were only part of a larger patient group.
Numerous studies have reported the treatment outcome of VNS in LGS patients. Outcomes included: 1) decreased drop-attacks[3] and atypical absence seizures[3], 2) reduced atonic seizures (p=0.005), tonic seizures (p=0.002), and disabling seizures[4], 3) decreased seizure severity[5], 4) fewer hospitalizations from status epilepticus episodes[5], and 5) improved #alertness[3]. Noteworthy, compared to the ASMs’ rapid but gradually decreased efficiency, most of the VNS responders achieved sustained improvement during long-term follow-up[5].
When considering the effectiveness of the KD and VNS Therapy, future studies focusing on the combination of both treatments for LGS patients might be promising.
*Defined as a ≥50% seizure frequency reduction.
Ref.
[1].https://onlinelibrary.wiley.com/doi/epdf/10.1111/j.1528-1167.2008.01740.x
[2]. https://onlinelibrary.wiley.com/doi/epdf/10.1111/j.1469-8749.2012.04233.x
[3]. https://onlinelibrary.wiley.com/doi/epdf/10.1046/j.1528-1157.2001.23900.x
[4]. https://www.epilepsybehavior.com/article/S1525-5050(09)00428-4/fulltext
[5]. https://onlinelibrary.wiley.com/doi/epdf/10.1111/j.1528-1167.2008.01940.x
