Alternative epilepsy therapies: The ketogenic diet, immunoglobulins, and steroids

Despite the continued development and release of new antiepileptic drugs (AEDs), many children have seizures that do not respond to conventional therapy or have related side effects that preclude continued use. While some of these children are surgical candidates, the majority do not qualify for surgical resection. In these children alternative therapies are often considered by desperate physicians and parents. Three of the less conventional therapies which are currently used for intractable epilepsy are: the ketogenic diet, immunoglobulins, and steroids. None of these therapies has been adequately studied and it remains unclear which patients may benefit or be harmed by these therapies. Despite the lack of scientific vigor in evaluating these therapies, the television and print media has proclaimed these therapies as miraculous, yet grossly under-utilized by an ignorant medical community. The ketogenic diet has been demonstrated to reduce seizure frequency in some patients, but has an unclear mechanism of action, while immunoglobulins have both unknown efficacy and an unknown mechanism of action. While steroids are accepted as an effective therapy for infantile spasms, their role in the treatment of the Landau-Kleffner syndrome is far less clear. Although the ketogenic diet, immunoglobulins, and steroids may have a role in the treatment of severe childhood epilepsy, all three therapies need to be critically evaluated in regard to efficacy, mechanism of action, and safety.