Non-Pharmacological Epilepsy Treatments: Diets, CBD, and Neurostimulation

Jump To Section

• Ketogenic Diet Epilepsy Treatment
• CBD Oil for Seizures
• Risks of Unregulated CBD
• Neurostimulation for Epilepsy
• Integrating Non-Drug Therapies
• Full Transcript

Ketogenic Diet Epilepsy Treatment

Dr. Tracey Milligan, MD, identifies the ketogenic diet as a powerful non-pharmacological treatment for epilepsy. This high-fat, low-protein, and low-carbohydrate diet can be as effective as an anti-epileptic medication. For some patients with drug-resistant epilepsy, the ketogenic diet may even provide superior seizure control.

Dr. Milligan acknowledges the significant challenge of maintaining this restrictive diet. The difficulty often leads patients to discontinue it, even when it is effective. Variations like the modified Atkins diet or low glycemic index diet offer slightly more flexibility. These modified diets allow approximately 15 to 20 grams of carbohydrates per day, which is equivalent to a single slice of bread.

CBD Oil for Seizures

Medical marijuana, specifically cannabidiol (CBD), is a common topic of patient inquiry. Dr. Tracey Milligan, MD, clarifies that the marijuana plant contains two main compounds: THC and CBD. THC is the psychoactive component that produces a "high," while CBD lacks these psychoactive properties.

Clinical trial evidence supports the use of CBD oil for specific, severe epilepsy syndromes. Dr. Tracey Milligan, MD, notes that CBD has shown efficacy in treating Dravet syndrome and Lennox-Gastaut syndrome. The evidence for its use in other, more common forms of epilepsy is still under scientific investigation.

Risks of Unregulated CBD

Dr. Tracey Milligan, MD, issues a strong warning about the current state of the CBD market. Products available to consumers are completely unregulated and lack quality control. Scientific analysis of marketed CBD oils has revealed some contain zero cannabidiol, despite their labeling.

These unregulated products can also be contaminated with harmful substances. Dr. Tracey Milligan, MD, highlights the potential presence of pesticides and heavy metals in available CBD oil. Due to these significant safety and efficacy concerns, she does not recommend its use outside of rigorous clinical trials.

Neurostimulation for Epilepsy

For patients with drug-resistant epilepsy who are not candidates for surgery, neurostimulation devices offer another option. Dr. Tracey Milligan, MD, discusses technologies like the vagus nerve stimulator (VNS). These devices work by delivering electrical impulses to the brain or nervous system to help prevent seizures.

Dr. Anton Titov, MD, explores the various reasons patients seek out these alternative treatments during his interview. This technology represents a advanced intervention for carefully selected patients who have exhausted other medical options.

Integrating Non-Drug Therapies

A fundamental principle in epilepsy care is that non-pharmacological treatments are adjuncts, not replacements. Dr. Tracey Milligan, MD, emphasizes that anti-epileptic medications are the proven cornerstone of therapy. These drugs are essential because epilepsy is a potentially life-threatening condition.

The role of diets, CBD in trials, or neurostimulation is to supplement medication. The goal is to help medications work better and improve overall seizure control. Dr. Milligan stresses that these methods should always be used in addition to, not instead of, anti-epilepsy medication.

Full Transcript

Dr. Anton Titov, MD: What non-pharmacological treatments exist for epilepsy? How to treat epilepsy without medications? What diets or plant-based therapies have some evidence of efficacy? What are popular epilepsy treatments that have no evidence of efficacy?

Non-pharmacologic treatments of epilepsy are of great interest to patients who have epileptic seizures.

Dr. Tracey Milligan, MD: Pharmacologic treatments are an important cornerstone of the treatment of epilepsy. But there are other important parameters in keeping good epileptic seizure control.

Getting enough sleep is very important for patients with epilepsy. Keeping overall good health is important. Have enough sleep, maintain a good diet, and do physical exercises regularly.

Other specific treatments for epilepsy do include diet. For example, there is a type of diet called the ketogenic diet. Ketogenic diet can be just as helpful as an anti-epilepsy medication. It could be even more helpful in some patients with epilepsy.

The ketogenic diet is a very high fat, low protein, low carbohydrate diet. It is very hard for patients to eat a ketogenic diet. It is hard to eat only ketogenic diet every day.

Many patients stop eating the ketogenic diet just because it is hard to continue, even when it does help with epileptic seizures.

There are variations of the ketogenic diet. There is a low glycemic diet, or a modified Atkins diet, that allows more calories and more protein. Again, it is a high fat, low carbohydrate diet.

But the most carbohydrates allowed in that diet are about 15 to 20 grams a day. That means a slice of bread. That is the entire carbohydrate energy source allowed.

Dr. Anton Titov, MD: Again, it can be very hard for patients to maintain such a restrictive diet, but it can be very effective.

Dr. Tracey Milligan, MD: There are other non-pharmacological epilepsy treatments. Patients often ask me about medical marijuana. This is the most common question about treatment of epilepsy without medications.

There have been some clinical trials of the marijuana plant called cannabidiol, or CBD. The marijuana plant has two main ingredients: one is THC, which makes patients high, and the other is CBD or cannabidiol, which does not have any psychoactive properties and does not cause patients to be high.

CBD oil has been tried in clinical trials in epilepsy. It has been shown to be helpful in some patients with very specific kinds of epilepsy, such as Dravet Syndrome. CBD oil may also help in Lennox-Gastaut syndrome.

Lennox-Gastaut syndrome and Dravet syndrome are more severe forms of epilepsy. It is not necessarily true that CBD oil will help patients with other types of epilepsy. That is being studied now.

I do want to emphasize this important fact: currently, CBD and marijuana available to patients are completely unregulated. We have done clinical trials looking at what is marketed as CBD oil. Some of the products have none—zero—CBD oil.

Even though those "CBD oil products" are marketed as such, they may also have pesticides and heavy metals.

Dr. Anton Titov, MD: Currently, the cannabidiol available is unregulated.

Dr. Tracey Milligan, MD: We are still doing scientific clinical trials. It is not something I would recommend at this point.

There are other non-pharmacologic epilepsy treatment methods that we have more evidence of efficacy for. These methods include different types of neurostimulation, such as brain stimulators.

We have a vagus nerve stimulator. We use stimulators when we cannot use surgical operation to resect a locus of epileptic seizures, but we know that the patient has drug-resistant epilepsy. These are technologies that are available to some patients.

Dr. Anton Titov, MD: Why do patients choose non-pharmacological epilepsy treatments? Why do patients choose to treat epilepsy with a diet? Is it because they are averse to anti-epileptic medications, or because the anti-epileptic medications don't work for them? What kind of reasoning do patients give to you?

Why are patients interested in trying non-pharmacological epileptic seizure therapy?

Dr. Tracey Milligan, MD: We always really emphasize that these methods should be a supplement to pharmacologic epilepsy therapy, because having epilepsy is potentially life-threatening.

We do know that anti-epileptic medications work. They may not work with 100% effect, but they work to a certain degree. Then we can use other treatment methods, like a special diet, to help those anti-epileptic medications work well.

We never use them instead of anti-epileptic medications. We always use non-pharmacological epilepsy treatment in addition to anti-epilepsy medication.