Indications and results of nonpharmacological treatments of epilepsies: vagal stimulation, ketogenic diet and gamma rays

In this paper we review alternative non pharmacological treatments for patients with epilepsy, both focal and generalized, which are resistant to the pharmacological treatment normally used. Vagal nerve stimulation (VNS) is a recently used palliative technique whose mechanism is not clearly understood. We analyze the clinical trials reported to date and the main indications and contra indications. Although the ketogenic diet (KD) has been used since the 1920s, recently there has been renewed interest in using it. Several papers have been published describing its use in children with epilepsy which was difficult to control. The complex metabolic and endocrine aspects of this type of diet make it difficult to select patients who may benefit from it. Gamma knife surgery is a new technique which has been discussed in this paper since it has been recently used in cases of refractory epilepsy, especially temporal medial epilepsy and hypothalamic hamartomas. VNS and KD are alternative treatments which may be used in patients whose condition cannot be satisfactorily controlled by pharmacological treatment and are not candidates for the surgery of epilepsy. Gamma knife surgery is a surgical technique which has recently been introduced for the treatment of these patients.