As not all cases of ring chromosome 20 syndrome are the same, different individuals may respond to treatment in different ways.Alternates to antiepileptic drug treatment include the ketogenic diet and vagus nerve stimulation but not epilepsy surgery. Ketogenic Diet
The ketogenic diet is a high fat, low carbohydrate diet reserved for intractable childhood epilepsies. There are no published reports on the use of the ketogenic diet in patients with ring chromosome 20 syndrome. However, its efficacy and safety are well established in other difficult to control epilepsy syndromes. Epilepsy Surgery
Epilepsy surgery investigations are performed to identify a discrete seizure focus. Extensive investigations in ring chromosome 20 syndrome  patients fails to identify a discrete seizure focus and published data supports that that epilepsy in ring chromosome 20 syndrome  is not amenable to resective surgery. The Cost ranges between £50,000 - £200,000. VNS Therapy
The vagal nerve stimulator is a battery-powered device similar to a pacemaker that is implanted under the skin. It delivers a mild electrical stimulation to the brain via the vagus nerve and has proven to be effective for the treatment of complex partial seizures. There are only a few published reports on the success of this therapy in ring chromosome 20 epilepsy syndrome, making it unclear if this is the optimal therapy. Prognosis
Limited data is available for the long-term prognosis of ring chromosome 20 syndrome since only over 60 patients with this syndrome have been reported in published literature.
The condition also generally becomes more accentuated with age. The prevalence of the condition increases significantly with age, occurring in 40% of the population after the age of 40. References


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