Non-pharmacological treatment of epilepsy. Ketogenic diets, Cannabidiol, marijuana. 8
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 a 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. Dr. Tracey Milligan, MD. Getting enough sleep is very important for patients with epilepsy. Keeping an overall good health is important. Have enough sleep, maintain good diet, do physical exercises regularly. Other specific treatments for epilepsy do include diet. For example, there is a type of diet called the ketogenic diet. Dr. Tracey Milligan, MD. Ketogenic diet can be just as helpful as an anti-epilepsy medication. Ketogenic diet 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 ketogenic diet. It is hard to eat only ketogenic diet every day. Many patients stop eating ketogenic diet just because it is hard to continue. Even when ketogenic diet does help with epileptic seizures. There are variations of ketogenic diet. There is a low glycemic diet, or a modified Atkins diet. That allows more calories, more protein. Dr. Tracey Milligan, MD. Again it is high fat, low carbohydrates 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 a restrictive a diet. But it can be very effective. There are other non-pharmacological epilepsy treatments. Patients ask me often about medical marijuana. This is the most common question about treatment of epilepsy without medications. Dr. Tracey Milligan, MD. There have been some clinical clinical trials of the marijuana plant called cannabidiol, or CBD. Marijuana plant has two main ingredients. One is THC. This ingredient makes patients high. The other ingredient is the CBD or the cannabidiol. That does not have any psychoactive properties. It does not cause patients to be high. But CBD oil has been tried in clinical trials in epilepsy. CBD oil has been shown to be helpful in some patients with very specific kinds of epilepsy. Those kinds of epilepsy are called Dravet Syndrome. CBD oil may also help in the Lennox Gaston syndrome. Lennox Gaston syndrome and Dravet syndrome are a 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. Dr. Tracey Milligan, MD. I do want to emphasize this important fact. Currently CBD and the marijuana, which is available to patients, is completely unregulated. We have done clinical trials looking at what is marketed as CBD oil. Some of the products have none, zero CBD oil. Some of those products have no cannabidiol in them. 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 the 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. These methods include different types of neurostimulation. These are different types of brain stimulators. Dr. Tracey Milligan, MD. 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 a drug-resistant epilepsy. These are technologies that are available to some patients. Why patients choose the non-pharmacological epilepsy treatments? Dr. Anton Titov, MD. Why patients choose to treat epilepsy with a diet? Is that because they are averse to anti-epileptic medications? Is it because the anti-epileptic medications don’t work for them? What kind of reasoning patients give to you? Dr. Anton Titov, MD. Why are patients interested to try the non-pharmacological epileptic seizure therapy? Dr. Tracey Milligan, MD. We always really emphasize that these methods should be a supplement to the pharmacologic epilepsy therapy. Because having epilepsy is potentially life-threatening. We do know that anti-epileptic medications work. But they may not work with a 100% effect. But they work to a certain degree. Then we can use other treatment methods. We can use a special diet to help those anti-epileptic medications work well. We never use them instead of anti-epileptic medications. Dr. Tracey Milligan, MD. We always use non-pharmacological epilepsy treatment in addition to anti-epilepsy medication.
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