Non-Pharmacological Treatment Methods of Lennox-Gastaut Syndrome-Review of the Literature.

Abstract

Lennox-Gastaut syndrome (LGS) is a severe form of childhood-onset epilepsy, often associated with pharmacoresistance. As complete seizure control is usually not achievable with the use of drug therapy, non-pharmacological treatment may be offered to intractable patients. In this review, we are going to present literature reports on various non-pharmacological treatments, including surgical and dietary methods. Surgical interventions, such as resective surgery, corpus callosotomy (CC), or neuromodulation therapies such as vagus nerve stimulation (VNS), deep brain stimulation (DBS), and responsive neurostimulation (RNS), can be offered to pharmacoresistant patients. If the epileptogenic area can be detected, resective surgery is a treatment of choice. On the contrary, if non-invasive and invasive diagnostic methods fail to detect epileptogenic lesions, CC and VNS are considered palliative surgical methods. While both CC and VNS are considered effective in seizure reduction, CC is still more popular than VNS, although VNS seems to be related to better tolerability. Although all neuromodulation therapies require multidirectional optimization, DBS appears to be particularly promising for LGS. The classic ketogenic diet (cKD) is considered an effective and well-tolerated method in LGS treatment. The modified Atkins diet (MAD) and the low glycemic index treatment (LGIT) could be used as valuable alternatives due to their lower restrictiveness and better tolerability. Moreover, combinations of several treatment methods could significantly improve LGS patients' seizure outcomes.