WASHINGTON, DC—Many patients with pharmacoresistant epilepsy may benefit from nondrug treatments, including vagus nerve stimulation (VNS), the ketogenic diet, and corpus callosotomy, according to a study presented at the 71st Annual Meeting of the American Epilepsy Society. The treatments may reduce generalized and focal seizures, and most parents whose children underwent these procedures would opt for the same treatment under similar circumstances, the researchers said.
About 20% to 30% of patients have pharmacoresistant epilepsy. The ketogenic diet, corpus callosotomy, and VNS have been studied as alternatives to antiepileptic drugs (AEDs) for these patients, but few studies have compared the modalities.
Dave F. Clarke, MD, MBBS, Professor of Pediatric Neurology at the Baylor College of Medicine and Clinical Director of Epilepsy at Texas Children’s Hospital in Houston, and colleagues compared seizure control, cognitive and behavioral factors, quality of life, and parent satisfaction among patients who received VNS, underwent corpus callosotomy, or initiated the ketogenic diet. They identified 336 patients who had received one of these treatments at Dell Children’s Medical Center of Central Texas in Austin between January 2010 and November 2015. Parents of 210 of the patients completed a nine-item telephone survey.
Of the 210 patients whose parents completed the survey, 98 (33.6%) had initiated the ketogenic diet, 150 (51.4%) had received VNS, and 44 (15.1%) had undergone corpus callosotomy. Patients were between the ages of 8 months and 20 years. Patients who had initiated the ketogenic diet had a mean age of about 7, and patients who received VNS or underwent corpus callosotomy had a mean age of about 10. Patients had failed more than three AEDs on average (range, two to 13).
Parents reported a 50% or greater reduction in generalized seizures in 63% of patients who went on the ketogenic diet, 54% of patients who underwent corpus callosotomy, and 52% of patients who received VNS. Parents reported a 50% or greater reduction in focal seizures in 56% of children who went on the ketogenic diet, 56% of patients who had corpus callosotomy, and 53% of patients who received VNS.
In addition, parents reported improved quality of life in 48% of patients on the ketogenic diet, 63% of patients who had corpus callosotomy, and 44% of patients who received VNS. Overall, 80% of parents whose children were on the ketogenic diet or received VNS and 75% of parents whose children underwent corpus callosotomy reported that they were satisfied with the treatment that their child had received.
“Higher health-related quality of life after intervention was predicted by improved behavior, increased engagement, diminished frequency of atonic or generalized tonic-clonic seizures, and reduction in epilepsy-related injuries,” the researchers concluded. Parents were more likely to say that they would repeat the procedure if, after the treatment, “their child was more engaged, had diminished frequency of atonic or generalized tonic-clonic seizures, and had a reduction in epilepsy-related injuries.”
“Unfortunately, many doctors keep trying medications without considering alternatives,” said Dr. Clarke. “Based on the parents’ feedback, I would suggest doctors introduce the concept of alternatives after two AEDs fail to control seizures.” If surgery to ablate or remove the area of the brain where seizures originate is not an option, neurologists should talk to parents about the ketogenic diet, VNS, or corpus callosotomy. “If parents think the diet can be tolerated, trying it first may not be a bad option,” he said.