Non-pharmacological treatments for pediatric refractory epilepsies

Introduction: Antiseizure medications (ASMs) are the primary treatment option for epilepsies of wide etiologies, however, about 10–20% of children do not gain sustained seizure control and in this case, it is worth investigating ‘alternative’ therapeutic approaches aside from ASMs. Nowadays, non-pharmacological strategies for epilepsy treatment encompass dietary interventions, neurostimulation-based techniques, and biobehavioral approaches. Areas covered: A search on PubMed database was conducted. Experimental and clinical studies, as well as meta-analysis and structured reviews on the latest non-pharmacological treatments for drug-resistant epilepsy (DRE) in children, were included. Special attention is given to the efficacy and tolerability outcomes, trying to infer the role novel approaches may have in the future. Expert opinion: The large heterogeneity of primary clinical outcomes and the unavoidable subjective response of each patient to treatments prevents Researchers from the identification of a single, reliable, approach to treat DRE. The understanding of fine pathophysiologic processes is giving the way to the use of alternative therapies, such as the well-known ketogenic diet, in a ‘personalized’ view of treatment. The goal is to apply the non-pharmacological treatment most suitable for the patients sake.