Ketogenic diet — The ketogenic diet (high-fat, low protein) diet has demonstrated efficacy in children with IE, with more than one-third experiencing a 50 percent or greater reduction in seizures
In two small case series of adult patients, the traditional ketogenic diet and a modified Atkins diet reduced seizure frequency by 50 percent or more in half of patients with DRE [124,125].
The ketogenic diet is discussed in detail separately. (See "The ketogenic diet".)
Catamenial seizures — Women with catamenial epilepsy may benefit from specific interventions to lower seizure frequency. (See "Catamenial epilepsy".)
Cannabinoids — At the present time, there are no data from controlled clinical trials to indicate that cannabinoids have any efficacy in the treatment of epilepsy.
Animal studies and anecdotal reports suggest that cannabinoids have anticonvulsant properties [126-128], although proconvulsant effects have also been described [129]. Despite limited safety and efficacy data in humans, marijuana use is not uncommon in patients with chronic epilepsy. In a 2004 telephone survey of 136 adults with epilepsy followed at a tertiary care epilepsy clinic in Canada, 21 percent of patients reported active marijuana use; of these, two-thirds believed that marijuana improved their seizure severity [130]. In a multivariable analysis, significant predictors of marijuana use included seizure frequency (≥1 seizure per month), longer disease duration, and other illicit drug use.
Data in humans are extremely limited. A 2014 systematic review found four randomized trial reports that included a total of 48 patients [131]. The treatment agent was cannabidiol in all reports. One report was an abstract and another was a letter to the editor. No adverse effects were reported for the dose of 200 to 300 mg of cannabidiol with short term treatment; safety of long term treatment could not be assessed. The authors concluded that no reliable conclusions could be drawn regarding the efficacy of cannabinoids as a treatment for epilepsy from the available data. A review by the American Academy of Neurology also concluded that there is insufficient evidence to prescribe cannabidiol or recommend self-treatment with smoked marijuana in patients with epilepsy [132].