Non-pharmacological treatments for pediatric refractory epilepsies

Rotondo, Eleonora; Riva, Antonella; Graziosi, Alessandro; Pellegrino, Noemi; Battista, Caterina Di; Stefano, Vincenzo Di; Striano, Pasquale

doi:10.1080/14737175.2022.2057847

Cited by 8 publications

(9 citation statements)

References 112 publications

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“…Because nutritional factors play a significant role in neurological regulation, dietary intake is heavily studied in patients with epilepsy [ 92 ]. Apart from the ketogenic or Atkins diet and dietary considerations in children with metabolic syndromes, patients or families may turn to diet therapies that are self-imposed.…”

Section: Resultsmentioning

confidence: 99%

Use of Integrative, Complementary, and Alternative Medicine in Children with Epilepsy: A Global Scoping Review

et al. 2023

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(1) Background: Epilepsy is one of the most common chronic neurological disorders in childhood. Complementary and alternative medicine (CAM) use is highly prevalent in patients with epilepsy. Despite CAM’s widespread and increasing popularity, its prevalence, forms, perceived benefits, and potential risks in pediatric epilepsy are rarely explored. (2) Methods: We performed a scoping review of the available literature on the use of CAM in pediatric epilepsy. (3) Results: Overall, global cross-sectional studies showed a variable degree of CAM usage among children with epilepsy, ranging from 13 to 44% in prevalence. Popular types of CAMs reported were supplements, cannabis products, aromatherapy, herbal remedies, dietary therapy, massage therapy, and prayer. Families often report that CAM is effective, although there are limited objective measures of this. Potential risks lie in the use of CAM, such as herbal remedies, and/or unregulated, contaminated, or unpurified products. Studies also underscored inadequate patient–physician discussions regarding CAM. (4) Conclusions: A better understanding of this topic would aid clinicians in guiding patients/families on the use of CAM. Further studies on the efficacy of the different types of CAM used, as well as potential side effects and drug interactions are needed.

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Section: Resultsmentioning

confidence: 99%

Use of Integrative, Complementary, and Alternative Medicine in Children with Epilepsy: A Global Scoping Review

et al. 2023

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“…The microbiota-gut-brain (MGB) axis was a bidirectional communication between the gut microbiota and the brain, and there is growing preclinical and clinical evidence that the gut microbial ecosystem could influence neuropsychiatric health also plays an important role in regulating the modulation of inflammation. [71][72][73][74][75][76] 76 From the perspective of AD, the 'communication line' of the gut-brain-skin axis is the SCFAs produced by the gut microbiota fermenting and breaking down FOS. The gut microbiota could regulate systems such as inflammation, tissue lipid levels, and mood-regulating neurotransmitter levels through SCFAs.…”

Section: Discussionmentioning

confidence: 99%

Fructo‐oligofructose ameliorates 2,4‐dinitrofluorobenzene‐induced atopic dermatitis‐like skin lesions and psychiatric comorbidities in mice

et al. 2023

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BACKGROUND Atopic dermatitis (AD) is a chronic inflammatory skin disorder characterized by pruritus and eczema lesions and psychiatric comorbidities. The gut–brain–skin axis plays a pivotal role during AD development, which might suggest a novel therapeutic strategy for AD. The present study aims to uncover the protective effects and underlying mechanisms of fructo‐oligofructose (FOS), a type of prebiotic, on AD‐like skin manifestations and comorbid anxiety and depression in AD mice. RESULTS Female Kunming mice were treated topically with 2,4‐dinitrofluorobenzene (DNFB) to induce AD‐like symptoms and FOS was administered daily for 14 days. The results showed that FOS could alleviate AD‐like skin lesions markedly as evidenced by dramatic decreases in severity score, scratching bouts, the levels of immunoglobulin E (IgE) and T helper 1(Th1)/Th2‐related cytokines, and the infiltration of inflammatory cells and mast cells to the dermal tissues. The comorbid anxiety and depressive‐like behaviors, estimated by the forced swimming test (FST), the tail‐suspension test (TST), the open‐field test (OFT), and the zero maze test (ZMT) in AD mice, were significantly attenuated by FOS. Fructo‐oligofructose significantly upregulated brain neurotransmitters levels of 5‐hydroxytryptamine (5‐HT) and dopamine (DA). Furthermore, FOS treatment increased the relative abundance of gut microbiota, such as Prevotella and Lactobacillus and the concentrations of short‐chain fatty acids (SCFAs), especially acetate and iso‐butyrate in the feces of AD mice. The correlation analysis indicated that the reshaped gut microbiome composition and enhanced SCFAs formation are associated with skin inflammation and behavioral alteration. CONCLUSION Collectively, these data identify FOS as a promising microbiota‐targeted treatment for AD‐like skin inflammation and comorbid anxiety and depressive‐like behaviors. © 2023 Society of Chemical Industry.

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“…1,26,27 Additional, less well-known and less well-studied complementary therapies that may be beneficial as a complement to ASMs and other non-pharmacological interventions in the management of epilepsies include lifestyle interventions, nutritional supplements, music therapy, and herbal remedies. [28][29][30][31][32] Non-pharmacological treatments that are part of the multidisciplinary care surrounding the non-seizure symptoms of CDD include speech therapy, physiotherapy, psychosocial support, and occupational therapy. 5,13 There is also evidence to suggest that early use of neuro-visual rehabilitation through stimulation of eye movements can enhance development based on neuronal plasticity.…”

Section: • Diagnosis By Key Clinical Features and Genetic Test-mentioning

confidence: 99%

Providing quality care for people with CDKL5 deficiency disorder: A European expert panel opinion on the patient journey

Amin,

Møller,

Aledo‐Serrano

et al. 2024

Epilepsia Open

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Cyclin‐dependent kinase‐like 5 (CDKL5) deficiency disorder (CDD) is a developmental and epileptic encephalopathy caused by variants in the CDKL5 gene. The disorder is characterized by intractable early‐onset seizures, severe neurodevelopmental delay, hypotonia, motor disabilities, cerebral (cortical) visual impairment and microcephaly. With no disease‐modifying therapies available for CDD, treatment is symptomatic with an initial focus on seizure control. Another unmet need in the management of people with CDD is the lack of evidence to aid standardized care and guideline development. To address this gap, experts in CDD and representatives from patient advocacy groups from Denmark, Finland, France, Germany, Italy, Poland, Spain, and the United Kingdom convened to form an Expert Working Group. The aim was to provide an expert opinion consensus on how to ensure quality care in routine clinical practice within the European setting, including in settings with limited experience or resources for multidisciplinary care of CDD and other developmental and epileptic encephalopathies. By means of one‐to‐one interviews around the current treatment landscape in CDD, insights from the Expert Working Group were collated and developed into a Europe‐specific patient journey for individuals with CDD, which was later validated by the group. Further discussions followed to gain consensus of opinions on challenges and potential solutions for achieving quality care in this setting. The panel recognized the benefit of early genetic testing, a holistic personalized approach to seizure control (taking into consideration various factors such as concomitant medications and comorbidities), and age‐ and comorbidity‐dependent multidisciplinary care for optimizing patient outcomes and quality of life. However, their insights and experiences also highlighted much disparity in management approaches and resources across different European countries. Development of standardized European recommendations is required to align realistic diagnostic criteria, treatment goals, and management approaches that can be adapted for different settings.Plain language summaryCyclin‐dependent kinase‐like 5 (CDKL5) deficiency disorder (CDD) is a rare condition caused by a genetic mutation with a broad range of symptoms apparent from early childhood, including epileptic seizures that do not respond to medication and severe delays in development. Due to the lack of guidance on managing CDD, international experts and patient advocates discussed best practices in the care of people with CDD in Europe. The panel agreed that early testing, a personalized approach to managing seizures, and access to care from different disciplines are beneficial. Development of guidelines to ensure that care is standardized would also be valuable.

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Non-pharmacological treatments for pediatric refractory epilepsies

Cited by 8 publications

References 112 publications

Use of Integrative, Complementary, and Alternative Medicine in Children with Epilepsy: A Global Scoping Review

Use of Integrative, Complementary, and Alternative Medicine in Children with Epilepsy: A Global Scoping Review

Fructo‐oligofructose ameliorates 2,4‐dinitrofluorobenzene‐induced atopic dermatitis‐like skin lesions and psychiatric comorbidities in mice

Providing quality care for people with CDKL5 deficiency disorder: A European expert panel opinion on the patient journey

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