Duda Piotr, Granat Michał, Czuczwar Stanisław J, Miziak Barbara
Student Scientific Group, Department of Pathophysiology, Medical University of Lublin, ul. Jaczewskiego 8b, 20-090 Lublin, Poland.
Department of Pathophysiology, Medical University of Lublin, ul. Jaczewskiego 8b, 20-090 Lublin, Poland.
Biomedicines. 2025 Sep 12;13(9):2247. doi: 10.3390/biomedicines13092247.
Lennox-Gastaut syndrome (LGS) is a severe form of childhood-onset epilepsy, often associated with pharmacoresistance. As complete seizure control is usually not achievable with the use of drug therapy, non-pharmacological treatment may be offered to intractable patients. In this review, we are going to present literature reports on various non-pharmacological treatments, including surgical and dietary methods. Surgical interventions, such as resective surgery, corpus callosotomy (CC), or neuromodulation therapies such as vagus nerve stimulation (VNS), deep brain stimulation (DBS), and responsive neurostimulation (RNS), can be offered to pharmacoresistant patients. If the epileptogenic area can be detected, resective surgery is a treatment of choice. On the contrary, if non-invasive and invasive diagnostic methods fail to detect epileptogenic lesions, CC and VNS are considered palliative surgical methods. While both CC and VNS are considered effective in seizure reduction, CC is still more popular than VNS, although VNS seems to be related to better tolerability. Although all neuromodulation therapies require multidirectional optimization, DBS appears to be particularly promising for LGS. The classic ketogenic diet (cKD) is considered an effective and well-tolerated method in LGS treatment. The modified Atkins diet (MAD) and the low glycemic index treatment (LGIT) could be used as valuable alternatives due to their lower restrictiveness and better tolerability. Moreover, combinations of several treatment methods could significantly improve LGS patients' seizure outcomes.
Lennox-Gastaut综合征（LGS）是一种儿童期起病的严重癫痫形式，常伴有药物抵抗。由于药物治疗通常无法实现完全控制癫痫发作，对于难治性患者可采用非药物治疗。在本综述中，我们将呈现关于各种非药物治疗的文献报道，包括手术和饮食方法。手术干预，如切除性手术、胼胝体切开术（CC），或神经调节疗法，如迷走神经刺激（VNS）、深部脑刺激（DBS）和反应性神经刺激（RNS），可用于药物抵抗患者。如果能检测到致痫区域，切除性手术是首选治疗方法。相反，如果非侵入性和侵入性诊断方法未能检测到致痫病变，CC和VNS被认为是姑息性手术方法。虽然CC和VNS都被认为在减少癫痫发作方面有效，但CC仍然比VNS更受欢迎，尽管VNS似乎耐受性更好。虽然所有神经调节疗法都需要多方面优化，但DBS对LGS似乎特别有前景。经典生酮饮食（cKD）被认为是LGS治疗中一种有效且耐受性良好的方法。改良阿特金斯饮食（MAD）和低血糖指数治疗（LGIT）因其限制较少和耐受性较好，可作为有价值的替代方法。此外，几种治疗方法的联合应用可显著改善LGS患者的癫痫发作结果。
