This document discusses non-pharmacologic approaches for managing epilepsy, including dietary measures, yoga/meditation, surgery, and vagal nerve stimulation. It provides details on ketogenic diets, which are high in fat and low in carbohydrates, and their ability to reduce seizures by restoring energy to the brain. Yoga and meditation are noted to help relax the body and reduce stress levels, factors that may decrease seizure frequency. Surgery options aim to cure or palliatively reduce seizures, with around 50-60% of patients becoming seizure-free. Vagal nerve stimulation involves using a generator to stimulate the vagus nerve and has been found to lower seizure rates in 50% of treated patients.

1. Non Pharmacologic
Management of Epilepsy
By
Tilahun Belete Mossie (BSc, MSc)
College of Health Sciences
Mekelle University
Ethiopia
October 2016

2. Non Pharmacologic Management
of Epilepsy
1. Dietary Measure:
 High fat and low carbohydrate diet that
mimics the effect of starvation is called
a Ketogenic diet.
 This name is given because of its ability
to forms ketone in the blood.
 It has been implicated in the treatment
of epilepsy for a long period of time [1].
◦ By restoring energy to the central nervous
system, it can treat different forms of seizure
in infants and children [2 - 6].

3. I. Dietary measure…
 There is evidence that ketogenic diets can
treat or at least minimize seizure
frequency in refractory seizers to
anticonvulsants [7, 8].
 NB: Ketogenic diet is rich in fat, has low
carbohydrate and normal protein. Other
vitamins and calcium should also be
supplemented. Usually there is a
restriction in calories and fluids.
 Moreover, it must be monitored by
physicians

4. 2. Yoga/Meditation:
 Yoga is known for its relaxation and
stress reduction effect.
 It can bring changes in metabolism,
blood flow, and oxygen levels in the
brain by improving circulation,
respiration, and concentration.
 These in turn result in relaxation state
and reduced level of stress [9, 10].

5. 2. Yoga/Meditation…
 Now this day Yoga has been found
effective in reducing seizure attacks in
people who used anticonvulsants.
 However, its efficacy in uncontrolled
seizure is not yet determined [11].
 Also a meditation practice for 20
minutes a day has been found
effective in reducing seizure frequency
[12, 13].

6. 3. Surgery
 This has been performed in
refractory/drug resistant seizures.
 It might take curative form that includes
temporal and extra temporal resection,
hemispherectomy and radio surgery.
 Collasotomy and multiple transections
are considered as palliative measures
[14].
 About 50% to 60% people who were
treated with brain surgery became
seizure free; as well 60% to 85% had a
reduction in the frequency of seizure [14,
15].

7. 4. Vagal Nerve Stimulation
 t is a neuromodulary treatment carried
out by stimulating the vagus nerve
through a programmable pulse
generator.
 This appears to b effective treatment
for those with refractory seizure
resulting in at seizure reduction in
50% of people who got this treatment
[16, 17].

8. Conclusion
 Moreover common non pharmacologic
measures to manage seizure include:
◦ ketogenic diets,
◦ yoga/meditation,
◦ surgery and
◦ vagal nerve stimulation

9. References
1. Bailey EE, Pfeifer HH, Thiele EA. The use of diet in the treatment of
epilepsy. Epilepsy Behav.2005;6:4–8. [PubMed]
2. Wang D, Pascual JM, Yang H, et al. Glut-1 deficiency syndrome:
clinical, genetic, and
therapeutic aspects. Ann Neurol. 2005;57:111–118. [PubMed]
3. Wexler ID, Hemalatha SG, McConnell J, et al. Outcome of pyruvate
dehydrogenase deficiency treated with ketogenic diets. Studies in
patients with identical mutations. Neurology. 1997;49:1655–
1661.[PubMed]
4. Kossoff EH, Hedderick EF, Turner Z, Freeman JM. A case-control
evaluation of the ketogenic diet versus ACTH for new-onset infantile
spasms. Epilepsia. 2008 Apr 10; (Epub ahead of print) [PubMed]
5. Caraballo RH, Cersosimo RO, Sakr D, et al. Ketogenic diet in
patients with myoclonic- astatic epilepsy.Epileptic Disord.
2006;8:151–155. [PubMed]
6. Korff C, Laux L, Kelley K, et al. Dravet syndrome (severe myoclonic
epilepsy in infancy): a retrospective study of 16 patients. J Child
Neurol. 2007;22:185–194. [PubMed]

10. References…
7. Oguni H, Tanaka T, Hayashi K, et al. Treatment and
long-term prognosis of myoclonic- astatic epilepsy of
early childhood. Neuropediatrics. 2002;33:122–132.
[PubMed]
8. Hemingway C, Freeman JM, Pillas DJ, Pyzik PL. The
ketogenic diet: a 3- to 6-year follow up of 150 children
enrolled prospectively. Pediatrics. 2001;108:898– 905.
[PubMed]
9. Usha Panjwani, W. Selvamurthy, S.H. Singh, H.L.
Gupta, L.Thakur & U.C. Rai; "Effect of Sahaja Yoga on
Seizure Control and EEG Changes in Patients of
Epilepsy"; Indian Journal of Medical Research, 103,
March 1996, pp165-172
10. Yardi, Nandan; "Yoga For the Control of Epilepsy";
Seizure 2001: 10: 7-12
11. Panebianco M, Sridharan K, Ramaratnam S. Yoga for
epilepsy. Cochrane Database Syst Rev. 2015 May
2;(5):CD001524. doi:
10.1002/14651858.CD001524.pub2.

11. References…
12. Deepak KK, Manchanda SK, Maheshwari MC; "Meditation Improves
Clinicoelectroencephalographic measures in Drug-resistant Epileptics";
Biofeedback and
Self-Regulation, Vol. 19, No. 1, 1994, pp 25-40
13. Lansky EP, St Louis EK. Transcendental meditation: a double-edged sword in
epilepsy?
Epilepsy Behav. 2006 Nov; 9(3):394-400. Epub 2006 Aug 23.
14. Guénot M. [Surgical treatment of epilepsy: outcome of various surgical
procedures in
adults and children]. Rev Neurol (Paris).2004 Jun; 160 Spec No 1:5S241-50.
15. Téllez-Zenteno JF, Dhar R, Wiebe S. Long-term seizure outcomes following
epilepsy surgery: a systematic review and meta-analysis. Brain. 2005 May;128(Pt
5):1188-98.
Epub 2005 Mar 9.
16. Jennum P, Sabers A, Christensen J, Ibsen R, Kjellberg J. Socioeconomic
evaluation of vagus stimulation: A controlled national study. Seizure. 2016 Sep
13;42:15-19. doi:
10.1016/j.seizure.2016.08.011
17. Panebianco M, Rigby A, Weston J, Marson AG. Vagus nerve stimulation for partial
seizures. Cochrane Database Syst Rev. 2015 Apr 3;(4):CD002896. doi:
10.1002/14651858.CD002896.pub2.