Exploring non-pharmacologic treatment options for LGS

By Naveed Saleh, MD, MS | Medically reviewed by Alison Christy, MD, PhD

Published October 4, 2023

Key Takeaways

Patients with Lennox-Gastaut syndrome (LGS) often don’t benefit from anticonvulsant drugs, thus non-pharmacologic treatments, including complementary and alternative medicine (CAM), may be considered by pediatric neurologists to decrease seizure frequency.
Adopting a ketogenic diet has proven effective in reducing seizure frequency in patients with LGS who do not respond to antiepileptic drugs, as well as patients with other types of seizure disorders.
Physical therapy and music therapy are other treatments that may help patients with severe forms of epilepsy such as LGS.

Lennox-Gastaut syndrome (LGS) is a rare and severe presentation of childhood epilepsy, with pathognomonic electroencephalogram (EEG) features. LGS is classified as an epileptic encephalopathy and manifests as the following triad: multiple seizure types, characteristic EEG findings, and intellectual impairment.^[]

Pediatric neurologists treat LGS with various antiepileptic drugs, but such drugs are commonly ineffective. Complementary and alternative medicine (CAM), as well as other non-pharmacologic treatments, can improve quality of life in pediatric patients with LGS.

Insight into CAM

Complementary and alternative medicine (CAM) refers to treatments that are non-conventional or non-standard. The National Center for Complementary and Integrative Health (NCCIH) places this practice in two categories—either those involving natural products (eg, probiotics, vitamins, minerals) or mind-body practices (eg, massage, yoga, meditation).^[]

CAM is popular around the world, but its prevalence of its use in the US is estimated at 21.0% compared with 53.3% in China, according to the authors of a literature review in Systematic Reviews.^[] Encouragingly, up to an estimated 71.9% of patients are satisfied with CAM.

Despite the fact that the majority of physicians who have utilized CAM are very happy with the treatment, most doctors don’t offer this option because it isn’t standard of care.

“Some doctors are still skeptical of CAM because of a lack of specific knowledge and qualification as well as a lack of evidence from high-quality experimental studies on the efficacy of the CAM treatments,” wrote the review authors.

The ketogenic diet

Dietary interventions have been used to treat intractable epilepsy for centuries. The ketogenic diet has been used since the 1920s and gained popularity in the 1990s.

These interventions have proven effective in patients with LGS who do not respond to antiepileptic drugs, as well as patients with Ohtahara syndrome and Dravet syndrome.^[]

There is extensive data on use of the ketogenic diet to reduce seizure frequency in LGS.^[]^[] Ketogenic diet should be considered early in the treatment trajectory as an additional therapy or to replace medications.

The ketogenic diet for epilepsy is a high fat, low carbohydrate, and low protein diet. Because the medical ketogenic diet can have many adverse effects—including severe constipation, reflux, vitamin deficiencies, and acidosis—it should be started under the guidance of an epileptologist and a nutritionist. Some patients will instead eat a modified Atkins diet, which does not restrict protein but limits carbohydrates to 15 grams per day.

Physical therapy

Children with disorders/injuries that interfere with movement or coordination can require the care of a physical therapist. Physical therapists enhance mobility/coordination by means of exercise, stretching, and skills development.

The goal for patients with epilepsy is to maximize their functional level, including the ability to get out of bed, brush their teeth, get dressed, and use the toilet, as well as learning to stand up, sit down, run, walk, get into a car, and eat at a table.

Play is particularly important to children, thus it’s important to develop physical mobility and strength to play with their friends.

In an interview with the Epilepsy Foundation, Lori LaFrance, a physical therapist at Hasbro Children's Hospital, explained, “Helping each child become as independent as possible oftentimes requires our assessing them for appropriate bracing, equipment, therapy interventions, and a significant amount of parental or caregiver education and training. The real progress is made when children work day by day, following through with recommended therapeutic activities with the help of their caregivers.”^[]

Music therapy

In particular, the music of Mozart has been shown to decrease epileptiform discharges and seizures in various clinical trials, case reports, preclinical studies, and evidence-based medicine.^[]

The mechanisms of the “Mozart effect” are actively being researched. One hypothesis is that as soon as Mozart started composing at age 4, he leveraged the inherent spatial temporal firing patterns of the cortex, thus his music resonates with cortical structure and may mitigate seizure activity.^[]

Another interesting hypothesis involves the antiepileptic effects of infrasound (low-frequency sound), as described in a review published in Seizure.^[]

“The underlying antiepileptic mechanism of Mozart music is currently unknown, but interesting research is moving away from dopamine reward system theories to computational analysis of specific auditory parameters,” the authors wrote, noting prior rodent studies examining inaudible, low-intensity focused ultrasound as a neuro-modulatory intervention.

However, while rodent model studies have consistently demonstrated this antiepileptic potential, the effects have not yet been produced in the necessary large-scale human trial, the authors explain.

What this means for you

Many patients with Lennox-Gastaut syndrome (LGS) experience poor response to antiepileptic drugs. Therefore, many of these patients’ parents are interested in exploring CAM and other non-pharmacological treatment options, including the ketogenic diet, which could proffer neuroprotective and anticonvulsant effects; physical and music therapies; and more.