Possibilities of non-pharmacological conservative treatment of epilepsy

Abstract

This study set out to assess the effect of non-pharmacological conservative (NPC) interventions as alternatives to antiepileptic pharmacotherapy. A prospective follow-up cohort study was conducted in an outpatient seizure clinic of a referral center for epilepsy. Twenty-five patients (nine males, 16 females) aged 16-45, with at least two well-described epileptic seizures, were included who had rejected antiepileptic pharmacotherapy. Twelve had idiopathic generalized epilepsy, 11 had symptomatic or cryptogenic localization-related epilepsy, and two had epilepsy with generalized and focal signs. Twenty-three of the patients were followed for more than 2 years. The patients were treated with arrest after focal seizure onset (2 cases), sensory protection against reflex seizures (3 cases), avoidance of non-specific seizure-precipitating factors ('life hygiene', 16 cases), and/or miscellaneous interventions (8 cases). The main outcome measures were complete seizure control (more than 2 years) or sufficient improvement to continue with NPC treatment alone. Eight of the 23 patients were completely seizure free for more than 4 years, and three were sufficiently improved to continue NPC treatment without drugs. Trends were observed for patients with idiopathic generalized epilepsies with less than seven convulsive seizures, and with only one seizure type to respond better to NPC treatment. The duration of epilepsy, and the finding of generalized epileptiform discharge in the EEG had no influence on the outcome. Rational NPC treatments which are aimed at specific factors in the precipitation and development of epileptic seizures can be useful therapeutic alternatives for patients with milder forms of epilepsy. Apart from photosensitive patients, those most likely to profit are patients with idiopathic generalized epilepsy, a maximum of six generalized tonic-clonic seizures which were precipitated by lack of sleep or excessive alcohol intake, and with no or rare concomitant absences. In such cases, NPC treatment may be as effective as pharmacotherapy and gives the patient a positive experience of regained self-control.

The Role of Nonpharmaceutic Conservative Interventions in the Treatment and Secondary Prevention of Epilepsy

“…If patients have only photically induced seizures, treatment by specific prevention alone may be sufficient, but if spontaneous seizures also occur, drugs must be given in addition (8).…”

Durch heißes Wasser reflektorisch ausgelöste Epilepsie

“…Entsprechend kann das Vermeiden solcher Risikoumstände wie Schlafentzug oder Alkoholkonsum allein bei Patienten mit diesen Epilepsien ggf. zu Anfallsfreiheit auch ohne antikonvulsive medikamentöse Therapie führen [3,4]. Mehr als 40 unterschiedliche potenziell anfallsauslösende Faktoren wurden in der Literatur benannt, darunter auch emotionaler Stress, wechselnde Vigilanzstadien, ein gestörter Säu-re-Basen-Status oder sensorische Stimuli [5].…”

“…Der besonders verantwortungsvolle Beruf des Patienten und die schwerwiegenden sozialen Folgen eines Rezidivs haben sehr einvernehmlich den Versuch unternehmen lassen, durch die gut vertragene medikamentöse Therapie eine zusätzliche Sicherheit anzustreben. Ansonsten sind genügend Fäl-le von Patienten mit Reflexanfällen bekannt, bei denen letztlich Antikonvulsiva nicht erforderlich waren [4]. …”

Trigger self-control and seizure arrest in the Andrews/Reiter behavioral approach to epilepsy: A retrospective analysis of seizure frequency

“…Therefore they have been proposed as adjunctive or alternative treatments to pharmaceutical and/or surgical treatment options. 3–5 …”