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Özcan E, Yu KB, Dinh L, Lum GR, Lau K, Hsu J, Arino M, Paramo J, Lopez-Romero A, Hsiao EY. Dietary fiber content in clinical ketogenic diets modifies the gut microbiome and seizure resistance in mice. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.07.31.606041. [PMID: 39131354 PMCID: PMC11312565 DOI: 10.1101/2024.07.31.606041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 08/13/2024]
Abstract
The gut microbiome is emerging as an important modulator of the anti-seizure effects of the classic ketogenic diet. However, many variations of the ketogenic diet are used clinically to treat refractory epilepsy, and how different dietary formulations differentially modify the gut microbiome in ways that impact seizure outcome is poorly understood. We find that clinically prescribed ketogenic infant formulas vary in macronutrient ratio, fat source, and fiber content and also in their ability to promote resistance to 6-Hz psychomotor seizures in mice. By screening specific dietary variables for their effects on a model human infant microbial community, we observe that dietary fiber, rather than fat ratio or source, drives substantial metagenomic shifts. Addition of dietary fiber to a fiber-deficient ketogenic formula restores seizure resistance, and supplementing protective ketogenic formulas with excess dietary fiber further potentiates seizure resistance. By screening 13 fiber sources and types, we identify distinct subsets of metagenomic responses in the model human infant microbial community that correspond with increased seizure resistance in mice. In particular, supplementation with seizure-protective fibers enriches microbial representation of genes related to queuosine biosynthesis and preQ0 biosynthesis and decreases representation of microbial genes related to sucrose degradation, which is also seen in seizure-protected mice that are fed fiber-containing ketogenic infant formulas. Overall, this study reveals that different formulations of clinical ketogenic diets, and dietary fiber content in particular, differentially impact seizure outcome in mice, likely through modification of the gut microbiome. Understanding interactions between dietary components of the ketogenic diet, the gut microbiome, and host susceptibility to seizures could inform novel microbiome-guided approaches to treat refractory epilepsy.
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Affiliation(s)
- Ezgi Özcan
- Department of Integrative Biology & Physiology, University of California, Los Angeles, Los Angeles, CA 90095
| | - Kristie B Yu
- Department of Integrative Biology & Physiology, University of California, Los Angeles, Los Angeles, CA 90095
| | - Lyna Dinh
- Department of Integrative Biology & Physiology, University of California, Los Angeles, Los Angeles, CA 90095
| | - Gregory R Lum
- Department of Integrative Biology & Physiology, University of California, Los Angeles, Los Angeles, CA 90095
| | - Katie Lau
- Department of Integrative Biology & Physiology, University of California, Los Angeles, Los Angeles, CA 90095
| | - Jessie Hsu
- Department of Integrative Biology & Physiology, University of California, Los Angeles, Los Angeles, CA 90095
| | - Mariana Arino
- Department of Integrative Biology & Physiology, University of California, Los Angeles, Los Angeles, CA 90095
| | - Jorge Paramo
- UCLA Goodman-Luskin Microbiome Center, Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine, Los Angeles, CA 90095, USA
| | - Arlene Lopez-Romero
- UCLA Goodman-Luskin Microbiome Center, Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine, Los Angeles, CA 90095, USA
| | - Elaine Y Hsiao
- Department of Integrative Biology & Physiology, University of California, Los Angeles, Los Angeles, CA 90095
- UCLA Goodman-Luskin Microbiome Center, Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine, Los Angeles, CA 90095, USA
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Priya, Yadav N, Anand S, Banerjee J, Tripathi M, Chandra PS, Dixit AB. The multifaceted role of Wnt canonical signalling in neurogenesis, neuroinflammation, and hyperexcitability in mesial temporal lobe epilepsy. Neuropharmacology 2024; 251:109942. [PMID: 38570066 DOI: 10.1016/j.neuropharm.2024.109942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 03/18/2024] [Accepted: 03/29/2024] [Indexed: 04/05/2024]
Abstract
Epilepsy is a neurological disorder characterised by unprovoked, repetitive seizures caused by abnormal neuronal firing. The Wnt/β-Catenin signalling pathway is involved in seizure-induced neurogenesis, aberrant neurogenesis, neuroinflammation, and hyperexcitability associated with epileptic disorder. Wnt/β-Catenin signalling is crucial for early brain development processes including neuronal patterning, synapse formation, and N-methyl-d-aspartate receptor (NMDAR) regulation. Disruption of molecular networks such as Wnt/β-catenin signalling in epilepsy could offer encouraging anti-epileptogenic targets. So, with a better understanding of the canonical Wnt/-Catenin pathway, we highlight in this review the important elements of Wnt/-Catenin signalling specifically in Mesial Temporal Lobe Epilepsy (MTLE) for potential therapeutic targets.
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Affiliation(s)
- Priya
- Dr. B.R Ambedkar Center for Biomedical Research, University of Delhi, Delhi, India
| | - Nitin Yadav
- Dr. B.R Ambedkar Center for Biomedical Research, University of Delhi, Delhi, India
| | - Sneha Anand
- Dr. B.R Ambedkar Center for Biomedical Research, University of Delhi, Delhi, India
| | - Jyotirmoy Banerjee
- Department of Biophysics, All India Institute of Medical Sciences, New Delhi, India
| | - Manjari Tripathi
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - P Sarat Chandra
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
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3
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Manral M, Tripathi S, Rawat D, Tripathi M. Modified Atkins Diet in Adolescents and Adults with Drug Resistant Epilepsy: A Systematic Review and Meta-Analysis. J Epilepsy Res 2024; 14:1-8. [PMID: 38978527 PMCID: PMC11227925 DOI: 10.14581/jer.24001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 01/13/2024] [Accepted: 02/19/2024] [Indexed: 07/10/2024] Open
Abstract
Epilepsy is one of the common neurological diseases which affects 65-70 million people worldwide. Modified Atkins diet (MAD) as a therapy is used as one of the treatments to reduce the seizures occurrence in epileptic patients. The purpose of this purpose is to review all evidence regarding the efficacy of the MAD from randomized controlled trials (RCTs) in adolescents and adults with drug resistant epilepsy (DRE). The total of three databases were searched (PubMed, Embase, and Cochrane Library) till 31 January 2023. Only RCTs with MAD as a one of the treatment arms were included in meta-analysis. The proportion of reduction of seizures in patients with epilepsy and relative risk to identify the relationship between MAD (as risk) to decrease the epileptic seizure was used as outcomes. The Jadad score with three domains was used to estimate the quality of RCTs included for meta-analysis. Only three RCTs were included following the stringent inclusion criteria in current meta-analysis. The pooled proportion from 142 patients going through MAD therapy shows the reduction in epileptic seizure ≥50%, by the random effect model was 0.23 (95% confidence interval [CI], 0.10 to 0.37). Our meta-analysis underlines a significant efficacy of MAD compared to the control group in seizure reduction ≥50%, The pooled relative risk was 6.47 (95% CI, 1.60 to 26.14; p-value <0.05). MAD therapy was efficacious and had better compliance for seizure reduction in subjects with DRE.
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Affiliation(s)
- Mala Manral
- Department of Neurology, All India Institute of Medical Science, New Delhi,
India
| | - Shashank Tripathi
- Department of Community Medicine (Biostatistics), University College of Medical Sciences, New Delhi,
India
| | - Dimple Rawat
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi,
India
| | - Manjari Tripathi
- Department of Neurology, All India Institute of Medical Science, New Delhi,
India
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Meeusen H, Romagnolo A, Holsink SAC, van den Broek TJM, van Helvoort A, Gorter JA, van Vliet EA, Verkuyl JM, Silva JP, Aronica E. A novel hepatocyte ketone production assay to help the selection of nutrients for the ketogenic diet treatment of epilepsy. Sci Rep 2024; 14:11940. [PMID: 38789658 PMCID: PMC11126716 DOI: 10.1038/s41598-024-62723-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 05/21/2024] [Indexed: 05/26/2024] Open
Abstract
The classic ketogenic diet is an effective treatment option for drug-resistant epilepsy, but its high fat content challenges patient compliance. Optimizing liver ketone production guided by a method comparing substrates for their ketogenic potential may help to reduce the fat content of the diet without loss in ketosis induction. Here, we present a liver cell assay measuring the β-hydroxybutyrate (βHB) yield from fatty acid substrates. Even chain albumin-conjugated fatty acids comprising between 4 and 18 carbon atoms showed a sigmoidal concentration-βHB response curve (CRC) whereas acetate and omega-3 PUFAs produced no CRC. While CRCs were not distinguished by their half-maximal effective concentration (EC50), they differed by maximum response, which related inversely to the carbon chain length and was highest for butyrate. The assay also suitably assessed the βHB yield from fatty acid blends detecting shifts in maximum response from exchanging medium chain fatty acids for long chain fatty acids. The assay further detected a dual role for butyrate and hexanoic acid as ketogenic substrate at high concentration and ketogenic enhancer at low concentration, augmenting the βHB yield from oleic acid and a fatty acid blend. The assay also found propionate to inhibit ketogenesis from oleic acid and a fatty acid blend at low physiological concentration. Although the in vitro assay shows promise as a tool to optimize the ketogenic yield of a fat blend, its predictive value requires human validation.
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Affiliation(s)
- Hester Meeusen
- Department of (Neuro)Pathology, Amsterdam UMC, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, The Netherlands
- Department of Nutritional Physiology and Functional Nutrients, Medical & Nutrition Science, Danone Nutricia Research, Uppsalalaan 12, 3584CT, Utrecht, The Netherlands
| | - Alessia Romagnolo
- Department of (Neuro)Pathology, Amsterdam UMC, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, The Netherlands
- Department of Nutritional Physiology and Functional Nutrients, Medical & Nutrition Science, Danone Nutricia Research, Uppsalalaan 12, 3584CT, Utrecht, The Netherlands
| | - Sophie A C Holsink
- Department of Nutritional Physiology and Functional Nutrients, Medical & Nutrition Science, Danone Nutricia Research, Uppsalalaan 12, 3584CT, Utrecht, The Netherlands
| | - Thijs J M van den Broek
- Department of Nutritional Physiology and Functional Nutrients, Medical & Nutrition Science, Danone Nutricia Research, Uppsalalaan 12, 3584CT, Utrecht, The Netherlands
| | - Ardy van Helvoort
- Department of Nutritional Physiology and Functional Nutrients, Medical & Nutrition Science, Danone Nutricia Research, Uppsalalaan 12, 3584CT, Utrecht, The Netherlands
- Department of Respiratory Medicine, NUTRIM - Research Institute of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht University, Maastricht, The Netherlands
| | - Jan A Gorter
- Swammerdam Institute for Life Sciences, Center for Neuroscience, University of Amsterdam, Amsterdam, The Netherlands
| | - Erwin A van Vliet
- Department of (Neuro)Pathology, Amsterdam UMC, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, The Netherlands
- Swammerdam Institute for Life Sciences, Center for Neuroscience, University of Amsterdam, Amsterdam, The Netherlands
| | - J Martin Verkuyl
- Department of Nutritional Physiology and Functional Nutrients, Medical & Nutrition Science, Danone Nutricia Research, Uppsalalaan 12, 3584CT, Utrecht, The Netherlands
| | - Jose P Silva
- Department of Nutritional Physiology and Functional Nutrients, Medical & Nutrition Science, Danone Nutricia Research, Uppsalalaan 12, 3584CT, Utrecht, The Netherlands.
| | - Eleonora Aronica
- Department of (Neuro)Pathology, Amsterdam UMC, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, The Netherlands
- Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, The Netherlands
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5
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Sethi S, Wakeham D, Ketter T, Hooshmand F, Bjornstad J, Richards B, Westman E, Krauss RM, Saslow L. Ketogenic Diet Intervention on Metabolic and Psychiatric Health in Bipolar and Schizophrenia: A Pilot Trial. Psychiatry Res 2024; 335:115866. [PMID: 38547601 DOI: 10.1016/j.psychres.2024.115866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 03/15/2024] [Accepted: 03/17/2024] [Indexed: 04/14/2024]
Abstract
The ketogenic diet (KD, also known as metabolic therapy) has been successful in the treatment of obesity, type 2 diabetes, and epilepsy. More recently, this treatment has shown promise in the treatment of psychiatric illness. We conducted a 4-month pilot study to investigate the effects of a KD on individuals with schizophrenia or bipolar disorder with existing metabolic abnormalities. Twenty-three participants were enrolled in a single-arm trial. Results showcased improvements in metabolic health, with no participants meeting metabolic syndrome criteria by study conclusion. Adherent individuals experienced significant reduction in weight (12 %), BMI (12 %), waist circumference (13 %), and visceral adipose tissue (36 %). Observed biomarker enhancements in this population include a 27 % decrease in HOMA-IR, and a 25 % drop in triglyceride levels. In psychiatric measurements, participants with schizophrenia showed a 32 % reduction in Brief Psychiatric Rating Scale scores. Overall Clinical Global Impression (CGI) severity improved by an average of 31 %, and the proportion of participants that started with elevated symptomatology improved at least 1-point on CGI (79 %). Psychiatric outcomes across the cohort encompassed increased life satisfaction (17 %) and enhanced sleep quality (19 %). This pilot trial underscores the potential advantages of adjunctive ketogenic dietary treatment in individuals grappling with serious mental illness.
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Affiliation(s)
- Shebani Sethi
- Metabolic Psychiatry, Dept. of Psychiatry and Behavioral Sciences, Stanford Medicine, Stanford, CA, USA.
| | - Diane Wakeham
- Metabolic Psychiatry, Dept. of Psychiatry and Behavioral Sciences, Stanford Medicine, Stanford, CA, USA
| | - Terence Ketter
- Metabolic Psychiatry, Dept. of Psychiatry and Behavioral Sciences, Stanford Medicine, Stanford, CA, USA
| | - Farnaz Hooshmand
- Metabolic Psychiatry, Dept. of Psychiatry and Behavioral Sciences, Stanford Medicine, Stanford, CA, USA
| | - Julia Bjornstad
- Metabolic Psychiatry, Dept. of Psychiatry and Behavioral Sciences, Stanford Medicine, Stanford, CA, USA
| | - Blair Richards
- Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, MI, USA
| | - Eric Westman
- Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Ronald M Krauss
- Department of Pediatrics and Medicine, University of California-San Francisco, San Francisco, CA, USA
| | - Laura Saslow
- Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, MI, USA
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Wang YY, Zhou YQ, Luo LJ, Wang CJ, Shen N, Li H, Wang JW. Ketogenic diet therapy in children with epilepsy caused by SLC2A1 mutations: a single-center single-arm retrospective study. World J Pediatr 2024; 20:517-524. [PMID: 36303089 DOI: 10.1007/s12519-022-00620-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 09/05/2022] [Indexed: 10/31/2022]
Abstract
BACKGROUND This retrospective study assessed the efficacy and safety of ketogenic diet therapies in children with epilepsy caused by SLC2A1 genetic mutations and glucose transporter type 1 deficiency syndrome. METHODS Pediatric patients with epilepsy symptoms admitted to our medical center between January 2017 and October 2021 were included if they presented with an SLC2A1 genetic mutation on whole-exome sequencing. We analyzed the patients' convulsions and treatment with antiepileptic drugs. The patients were followed up at different time periods after ketogenic diet therapies. RESULTS Six patients with SLC2A1 mutations were included in this study. The patients had seizures of different types and frequencies, and they took antiepileptic drugs to relieve their symptoms. They were then treated with a ketogenic diet for at least four months. We analyzed epilepsy control rates at 1, 2, 3, 6, and 12 months after ketogenic diet treatment. All patients were seizure-free within a month of receiving the diet therapy. All patients were followed up for six months, three were followed up for 12 months after the treatment, and there was no recurrence of epilepsy during this period. After antiepileptic drug withdrawal, none of the patients experienced seizure relapse when receiving ketogenic diet treatment alone. No severe adverse events occurred during the therapy. CONCLUSIONS Ketogenic diet therapy is very effective and safe for the treatment of epilepsy caused by SLC2A1 mutations. Therefore, patients with glucose transporter type 1 deficiency syndrome caused by SLC2A1 mutations should begin ketogenic diet treatment as soon as possible.
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Affiliation(s)
- Ying-Yan Wang
- Department of Neurology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yun-Qing Zhou
- Department of Neurology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Li-Juan Luo
- Department of Infectious Diseases, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Cui-Jin Wang
- Department of Neurology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Nan Shen
- Department of Infectious Diseases, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Hao Li
- Department of Neurology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
- Clinical Research Ward, Clinical Research Center, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
| | - Ji-Wen Wang
- Department of Neurology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
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Borowicz-Reutt K, Krawczyk M, Czernia J. Ketogenic Diet in the Treatment of Epilepsy. Nutrients 2024; 16:1258. [PMID: 38732505 PMCID: PMC11085120 DOI: 10.3390/nu16091258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 04/17/2024] [Accepted: 04/21/2024] [Indexed: 05/13/2024] Open
Abstract
Epilepsy is one of the most disabling neurological diseases. Despite proper pharmacotherapy and the availability of 2nd and 3rd generation antiepileptic drugs, deep brain stimulation, and surgery, up to 30-40% of epilepsy patients remain drug-resistant. Consequences of this phenomenon include not only decreased a quality of life, and cognitive, behavioral, and personal disorders, but also an increased risk of death, i.e., in the mechanism of sudden unexpected death in epilepsy patients (SUDEP). The main goals of epilepsy treatment include three basic issues: achieving the best possible seizure control, avoiding the undesired effects of treatment, and maintaining/improving the quality of patients' lives. Therefore, numerous attempts are made to offer alternative treatments for drug-resistant seizures, an example of which is the ketogenic diet. It is a long-known but rarely used dietary therapy for intractable seizures. One of the reasons for this is the unpalatability of the classic ketogenic diet, which reduces patient compliance and adherence rates. However, its antiseizure effects are often considered to be worth the effort. Until recently, the diet was considered the last-resort treatment. Currently, it is believed that a ketogenic diet should be used much earlier in patients with well-defined indications. In correctly qualified patients, seizure activity may be reduced by over 90% or even abolished for long periods after the diet is stopped. A ketogenic diet can be used in all age groups, although most of the available literature addresses pediatric epilepsy. In this article, we focus on the mechanisms of action, effectiveness, and adverse effects of different variants of the ketogenic diet, including its classic version, a medium-chain triglyceride diet, a modified Atkins diet, and a low glycemic index treatment.
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Affiliation(s)
- Kinga Borowicz-Reutt
- Independent Unit of Experimental Neuropathophysiology, Department of Toxicology, Medical University of Lublin, Jaczewskiego 8b, PL-20-090 Lublin, Poland; (M.K.); (J.C.)
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Rohani P, Shervin Badv R, Sohouli MH, Guimarães NS. The efficacy of low glycemic index diet on seizure frequency in pediatric patients with epilepsy: A systematic review and meta-analysis. Seizure 2024; 117:150-158. [PMID: 38422595 DOI: 10.1016/j.seizure.2024.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 02/19/2024] [Accepted: 02/21/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Despite extensive research examining the effect of a low glycemic index (LGI) diet on the frequency of seizures in patients with epilepsy, the findings are inconclusive. Hence, we performed a systematic review and meta-analysis in order to clarify the potential effect of a low glycemic index (LGI) diet on the frequency of seizures in children. METHODS A systematic review and meta-analysis written in accordance with the PRISMA checklist was realized using a comprehensive systematic search in four electronic databases until October 2023 without time or language restrictions. A random effects model was employed to combine the data. The main outcomes were analyzed using weight mean difference (WMD) and 95 % confidence interval (95 % CI). In total, 13 studies met the eligible criteria and were included. RESULTS The publications included in this study were published between 2005 and 2021. The duration of the interventions in the studies included in this analysis ranged from 6 to 58 weeks. Our findings indicated that the pooled efficacy rate for < 50 %, ≥ 50 %, > 90 % seizure reduction in patients with epilepsy receiving a low glycemic index diet was 39 % (95 % CI: 26, 52), 34 % (95 % CI: 23, 45), and 19 % (95 % CI: 13, 25), respectively. It seems that the efficacy of this ketogenic diet in reducing seizures is greater during a shorter intervention period than 12 weeks. CONCLUSION This systematic review and meta-analysis suggests that the low glycemia index diet can be beneficial as a treatment for epilepsy in pediatric patients.
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Affiliation(s)
- Pejman Rohani
- Pediatric Gastroenterology and Hepatology Research Center, Pediatrics Centre of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Shervin Badv
- Paediatrics Centre of Excellence, Department of Paediatric Neurology, Children's Medical Centre, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Hassan Sohouli
- Pediatric Gastroenterology and Hepatology Research Center, Pediatrics Centre of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran; Student Research Committee, Department of Clinical Nutrition and Dietetics, Faculty of Nutrition and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Nathalia Sernizon Guimarães
- Professor at Department of Nutrition, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais 30130-100, Brazil
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Mishra P, Singh SC, Ramadass B. Drug resistant epilepsy and ketogenic diet: A narrative review of mechanisms of action. World Neurosurg X 2024; 22:100328. [PMID: 38444870 PMCID: PMC10914588 DOI: 10.1016/j.wnsx.2024.100328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 02/21/2024] [Indexed: 03/07/2024] Open
Abstract
Drug-resistant epilepsy (DRE) poses a significant global challenge, impacting the well-being of patients. Anti-epileptic drugs often fail to effectively control seizures in individuals with DRE. This condition not only leads to persistent seizures but also induces neurochemical imbalances, elevating the risk of sudden unexpected death in epilepsy and comorbidities. Moreover, patients experience mood and personality alterations, educational and vocational setbacks, social isolation, and cognitive impairments. Ketogenic diet has emerged as a valuable therapeutic approach for DRE, having been utilized since 1920. Various types of ketogenic diets have demonstrated efficacy in controlling seizures. By having a multimodal mechanism of action, the ketogenic diet reduces neuronal excitability and the frequency of seizure episodes. In our narrative review, we have initially provided a concise overview of the factors contributing to drug resistance in epilepsy. Subsequently, we have discussed the different available ketogenic diets. We have reviewed the underlying mechanisms through which the ketogenic diet operates. These mechanisms encompass decreased neuronal excitability, enhanced mitochondrial function, alterations in sleep patterns, and modulation of the gut microbiome. Understanding the complex mechanisms by which this diet acts is essential as it is a rigorous diet and requires good compliance. Hence knowledge of the mechanisms may help to advance research on achieving similar therapeutic effects through other less stringent approaches.
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Affiliation(s)
- Priyadarshini Mishra
- Department of Physiology, All India Institute of Medical Sciences Bhubaneswar, Odisha, India
| | - Sajal Clarence Singh
- Department of Physiology, Institute of Medical Sciences & SUM Hospital, Odisha, India
| | - Balamurugan Ramadass
- Department of Biochemistry, All India Institute of Medical Sciences Bhubaneswar, Odisha, India
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Baylie T, Ayelgn T, Tiruneh M, Tesfa KH. Effect of Ketogenic Diet on Obesity and Other Metabolic Disorders: Narrative Review. Diabetes Metab Syndr Obes 2024; 17:1391-1401. [PMID: 38529169 PMCID: PMC10962461 DOI: 10.2147/dmso.s447659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 03/06/2024] [Indexed: 03/27/2024] Open
Abstract
Obesity is defined as an abnormal or excessive accumulation of fat that increases the burden of different chronic diseases in the population. It has reached epidemic proportions and is a major risk factor for a variety of diseases, including hypertension, cardiovascular disease, type 2 diabetes, dyslipidaemia, atherosclerosis, and some malignancies. Weight gain is a result of excessive energy intake compared to energy expenditure (energy loss from metabolism and physical exercise). A ketogenic diet has a more useful effect on obesity than other diets. A ketogenic diet is a low-carbohydrate, high-fat, moderate-protein diet that induces the production of ketone bodies by mimicking the breakdown of a fasting state. The mechanism behind the ketogenic diet is still unknown, although it obviously helps people with obesity lose weight. Several pathways for the ketogenic diet effect on weight loss have been hypothesized by researchers, including reduced appetite due to effects on appetite control hormones and a possible direct appetite suppressant action of ketone bodies; reduced lipogenesis and increased lipolysis; greater metabolic efficiency; and increased metabolic costs.
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Affiliation(s)
- Temesgen Baylie
- Department of Biomedical Science, School of Medicine, Debre Markos University, Debre Markos, Ethiopia
| | - Tiget Ayelgn
- Department of Biochemistry, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Markeshaw Tiruneh
- Department of Biochemistry, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Kibur Hunie Tesfa
- Department of Biochemistry, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Qiao YN, Li L, Hu SH, Yang YX, Ma ZZ, Huang L, An YP, Yuan YY, Lin Y, Xu W, Li Y, Lin PC, Cao J, Zhao JY, Zhao SM. Ketogenic diet-produced β-hydroxybutyric acid accumulates brain GABA and increases GABA/glutamate ratio to inhibit epilepsy. Cell Discov 2024; 10:17. [PMID: 38346975 PMCID: PMC10861483 DOI: 10.1038/s41421-023-00636-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 12/06/2023] [Indexed: 02/15/2024] Open
Abstract
Ketogenic diet (KD) alleviates refractory epilepsy and reduces seizures in children. However, the metabolic/cell biologic mechanisms by which the KD exerts its antiepileptic efficacy remain elusive. Herein, we report that KD-produced β-hydroxybutyric acid (BHB) augments brain gamma-aminobutyric acid (GABA) and the GABA/glutamate ratio to inhibit epilepsy. The KD ameliorated pentetrazol-induced epilepsy in mice. Mechanistically, KD-produced BHB, but not other ketone bodies, inhibited HDAC1/HDAC2, increased H3K27 acetylation, and transcriptionally upregulated SIRT4 and glutamate decarboxylase 1 (GAD1). BHB-induced SIRT4 de-carbamylated and inactivated glutamate dehydrogenase to preserve glutamate for GABA synthesis, and GAD1 upregulation increased mouse brain GABA/glutamate ratio to inhibit neuron excitation. BHB administration in mice inhibited epilepsy induced by pentetrazol. BHB-mediated relief of epilepsy required high GABA level and GABA/glutamate ratio. These results identified BHB as the major antiepileptic metabolite of the KD and suggested that BHB may serve as an alternative and less toxic antiepileptic agent than KD.
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Affiliation(s)
- Ya-Nan Qiao
- The Obstetrics & Gynaecology Hospital of Fudan University, State Key Laboratory of Genetic Engineering, Shanghai Key Laboratory of Metabolic Remodelling and Health, Institutes of Biomedical Sciences, and Children's Hospital of Fudan University, Fudan University, Shanghai, China
| | - Lei Li
- Department of Anatomy, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, Henan, China
| | - Song-Hua Hu
- Department of Cell Biology, Blavatnik Institute, Harvard Medical School, Boston, MA, USA
| | - Yuan-Xin Yang
- The Obstetrics & Gynaecology Hospital of Fudan University, State Key Laboratory of Genetic Engineering, Shanghai Key Laboratory of Metabolic Remodelling and Health, Institutes of Biomedical Sciences, and Children's Hospital of Fudan University, Fudan University, Shanghai, China
| | - Zhen-Zhen Ma
- The Obstetrics & Gynaecology Hospital of Fudan University, State Key Laboratory of Genetic Engineering, Shanghai Key Laboratory of Metabolic Remodelling and Health, Institutes of Biomedical Sciences, and Children's Hospital of Fudan University, Fudan University, Shanghai, China
| | - Lin Huang
- The Obstetrics & Gynaecology Hospital of Fudan University, State Key Laboratory of Genetic Engineering, Shanghai Key Laboratory of Metabolic Remodelling and Health, Institutes of Biomedical Sciences, and Children's Hospital of Fudan University, Fudan University, Shanghai, China
| | - Yan-Peng An
- The Obstetrics & Gynaecology Hospital of Fudan University, State Key Laboratory of Genetic Engineering, Shanghai Key Laboratory of Metabolic Remodelling and Health, Institutes of Biomedical Sciences, and Children's Hospital of Fudan University, Fudan University, Shanghai, China
| | - Yi-Yuan Yuan
- The Obstetrics & Gynaecology Hospital of Fudan University, State Key Laboratory of Genetic Engineering, Shanghai Key Laboratory of Metabolic Remodelling and Health, Institutes of Biomedical Sciences, and Children's Hospital of Fudan University, Fudan University, Shanghai, China
| | - Yan Lin
- The Obstetrics & Gynaecology Hospital of Fudan University, State Key Laboratory of Genetic Engineering, Shanghai Key Laboratory of Metabolic Remodelling and Health, Institutes of Biomedical Sciences, and Children's Hospital of Fudan University, Fudan University, Shanghai, China
| | - Wei Xu
- The Obstetrics & Gynaecology Hospital of Fudan University, State Key Laboratory of Genetic Engineering, Shanghai Key Laboratory of Metabolic Remodelling and Health, Institutes of Biomedical Sciences, and Children's Hospital of Fudan University, Fudan University, Shanghai, China
| | - Yao Li
- The Obstetrics & Gynaecology Hospital of Fudan University, State Key Laboratory of Genetic Engineering, Shanghai Key Laboratory of Metabolic Remodelling and Health, Institutes of Biomedical Sciences, and Children's Hospital of Fudan University, Fudan University, Shanghai, China
| | - Peng-Cheng Lin
- Key Laboratory for Tibet Plateau Phytochemistry of Qinghai Province, College of Pharmacy, Qinghai University for Nationalities, Xining, Qinghai, China
| | - Jing Cao
- Department of Anatomy, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, Henan, China
| | - Jian-Yuan Zhao
- Institute for Developmental and Regenerative Cardiovascular Medicine, MOE-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shi-Min Zhao
- The Obstetrics & Gynaecology Hospital of Fudan University, State Key Laboratory of Genetic Engineering, Shanghai Key Laboratory of Metabolic Remodelling and Health, Institutes of Biomedical Sciences, and Children's Hospital of Fudan University, Fudan University, Shanghai, China.
- Department of Cell Biology, Blavatnik Institute, Harvard Medical School, Boston, MA, USA.
- Key Laboratory for Tibet Plateau Phytochemistry of Qinghai Province, College of Pharmacy, Qinghai University for Nationalities, Xining, Qinghai, China.
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Armstrong OJ, Neal ES, Vidovic D, Xu W, Borges K. Transient anticonvulsant effects of time-restricted feeding in the 6-Hz mouse model. Epilepsy Behav 2024; 151:109618. [PMID: 38184948 DOI: 10.1016/j.yebeh.2023.109618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 12/23/2023] [Accepted: 12/27/2023] [Indexed: 01/09/2024]
Abstract
INTRODUCTION Intermittent fasting enhances neural bioenergetics, is neuroprotective, and elicits antioxidant effects in various animal models. There are conflicting findings on seizure protection, where intermittent fasting regimens often cause severe weight loss resembling starvation which is unsustainable long-term. Therefore, we tested whether a less intensive intermittent fasting regimen such as time-restricted feeding (TRF) may confer seizure protection. METHODS Male CD1 mice were assigned to either ad libitum-fed control, continuous 8 h TRF, or 8 h TRF with weekend ad libitum food access (2:5 TRF) for one month. Body weight, food intake, and blood glucose levels were measured. Seizure thresholds were determined at various time points using 6-Hz and maximal electroshock seizure threshold (MEST) tests. Protein levels and mRNA expression of genes, enzyme activity related to glucose metabolism, as well as mitochondrial dynamics were assessed in the cortex and hippocampus. Markers of antioxidant defence were evaluated in the plasma, cortex, and liver. RESULTS Body weight gain was similar in the ad libitum-fed and TRF mouse groups. In both TRF regimens, blood glucose levels did not change between the fed and fasted state and were higher during fasting than in the ad libitum-fed groups. Mice in the TRF group had increased seizure thresholds in the 6-Hz test on day 15 and on day 19 in a second cohort of 2:5 TRF mice, but similar seizure thresholds at other time points compared to ad libitum-fed mice. Continuous TRF did not alter MEST seizure thresholds on day 28. Mice in the TRF group showed increased maximal activity of pyruvate dehydrogenase in the cortex, which was accompanied by increased protein levels of mitochondrial pyruvate carrier 1 in the cortex and hippocampus. There were no other major changes in protein or mRNA levels associated with energy metabolism and mitochondrial dynamics in the brain, nor markers of antioxidant defence in the brain, liver, or plasma. CONCLUSIONS Both continuous and 2:5 TRF regimens transiently increased seizure thresholds in the 6-Hz model at around 2 weeks, which coincided with stability of blood glucose levels during the fed and fasted periods. Our findings suggest that the lack of prolonged anticonvulsant effects in the acute electrical seizure models employed may be attributed to only modest metabolic and antioxidant adaptations found in the brain and liver. Our findings underscore the potential therapeutic value of TRF in managing seizure-related conditions.
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Affiliation(s)
- Oliver J Armstrong
- School of Biomedical Sciences, Skerman Building 65, The University of Queensland, St. Lucia, QLD 4072, Australia
| | - Elliott S Neal
- School of Biomedical Sciences, Skerman Building 65, The University of Queensland, St. Lucia, QLD 4072, Australia
| | - Diana Vidovic
- School of Biomedical Sciences, Medical Building 181, The University of Melbourne, Parkville, VIC 3010, Australia
| | - Weizhi Xu
- School of Biomedical Sciences, Skerman Building 65, The University of Queensland, St. Lucia, QLD 4072, Australia
| | - Karin Borges
- School of Biomedical Sciences, Skerman Building 65, The University of Queensland, St. Lucia, QLD 4072, Australia.
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13
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Ye YC, Chai SF, Li XR, Wu MN, Cai HY, Wang ZJ. Intermittent fasting and Alzheimer's disease-Targeting ketone bodies as a potential strategy for brain energy rescue. Metab Brain Dis 2024; 39:129-146. [PMID: 37823968 DOI: 10.1007/s11011-023-01288-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 09/01/2023] [Indexed: 10/13/2023]
Abstract
Alzheimer's disease (AD) lacks effective clinical treatments. As the disease progresses, the cerebral glucose hypometabolism that appears in the preclinical phase of AD gradually worsens, leading to increasingly severe brain energy disorders. This review analyzes the brain energy deficit in AD and its etiology, brain energy rescue strategies based on ketone intervention, the effects and mechanisms of IF, the differences in efficacy between IF and ketogenic diet and the duality of IF. The evidence suggests that brain energy deficits lead to the development and progression of AD pathology. IF, which improves brain energy impairments by promoting ketone metabolism, thus has good therapeutic potential for AD.
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Affiliation(s)
- Yu- Cai Ye
- Department of Physiology, Key Laboratory of Cellular Physiology, Ministry of Education, Shanxi Medical University, Taiyuan, People's Republic of China
| | - Shi-Fan Chai
- Department of Physiology, Key Laboratory of Cellular Physiology, Ministry of Education, Shanxi Medical University, Taiyuan, People's Republic of China
| | - Xin-Ru Li
- Department of Physiology, Key Laboratory of Cellular Physiology, Ministry of Education, Shanxi Medical University, Taiyuan, People's Republic of China
| | - Mei-Na Wu
- Department of Physiology, Key Laboratory of Cellular Physiology, Ministry of Education, Shanxi Medical University, Taiyuan, People's Republic of China
| | - Hong-Yan Cai
- Department of Microbiology and Immunology, Shanxi Medical University, Taiyuan, People's Republic of China
| | - Zhao-Jun Wang
- Department of Physiology, Key Laboratory of Cellular Physiology, Ministry of Education, Shanxi Medical University, Taiyuan, People's Republic of China.
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14
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Oliveira TPD, Morais ALB, dos Reis PLB, Palotás A, Vieira LB. A Potential Role for the Ketogenic Diet in Alzheimer's Disease Treatment: Exploring Pre-Clinical and Clinical Evidence. Metabolites 2023; 14:25. [PMID: 38248828 PMCID: PMC10818526 DOI: 10.3390/metabo14010025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 12/18/2023] [Accepted: 12/21/2023] [Indexed: 01/23/2024] Open
Abstract
Given the remarkable progress in global health and overall quality of life, the significant rise in life expectancy has become intertwined with the surging occurrence of neurodegenerative disorders (NDs). This emerging trend is poised to pose a substantial challenge to the fields of medicine and public health in the years ahead. In this context, Alzheimer's disease (AD) is regarded as an ND that causes recent memory loss, motor impairment and cognitive deficits. AD is the most common cause of dementia in the elderly and its development is linked to multifactorial interactions between the environment, genetics, aging and lifestyle. The pathological hallmarks in AD are the accumulation of β-amyloid peptide (Aβ), the hyperphosphorylation of tau protein, neurotoxic events and impaired glucose metabolism. Due to pharmacological limitations and in view of the prevailing glycemic hypometabolism, the ketogenic diet (KD) emerges as a promising non-pharmacological possibility for managing AD, an approach that has already demonstrated efficacy in addressing other disorders, notably epilepsy. The KD consists of a food regimen in which carbohydrate intake is discouraged at the expense of increased lipid consumption, inducing metabolic ketosis whereby the main source of energy becomes ketone bodies instead of glucose. Thus, under these dietary conditions, neuronal death via lack of energy would be decreased, inasmuch as the metabolism of lipids is not impaired in AD. In this way, the clinical picture of patients with AD would potentially improve via the slowing down of symptoms and delaying of the progression of the disease. Hence, this review aims to explore the rationale behind utilizing the KD in AD treatment while emphasizing the metabolic interplay between the KD and the improvement of AD indicators, drawing insights from both preclinical and clinical investigations. Via a comprehensive examination of the studies detailed in this review, it is evident that the KD emerges as a promising alternative for managing AD. Moreover, its efficacy is notably enhanced when dietary composition is modified, thereby opening up innovative avenues for decreasing the progression of AD.
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Affiliation(s)
- Tadeu P. D. Oliveira
- Departamento de Fisiologia e Centro de Investigação em Medicina Molecular (CIMUS), Universidad De Santiago de Compostela, 15782 Santiago de Compostela, Spain;
| | - Ana L. B. Morais
- Departamento de Farmacologia, Instituto de Ciências Biológicas (ICB), Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, Brazil; (A.L.B.M.); (P.L.B.d.R.)
| | - Pedro L. B. dos Reis
- Departamento de Farmacologia, Instituto de Ciências Biológicas (ICB), Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, Brazil; (A.L.B.M.); (P.L.B.d.R.)
| | - András Palotás
- Asklepios-Med (Private Medical Practice and Research Center), H-6722 Szeged, Hungary;
- Kazan Federal University, Kazan R-420012, Russia
- Tokaj-Hegyalja University, H-3910 Tokaj, Hungary
| | - Luciene B. Vieira
- Departamento de Farmacologia, Instituto de Ciências Biológicas (ICB), Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, Brazil; (A.L.B.M.); (P.L.B.d.R.)
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15
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McDonald TJW, Diaz-Arias L, Vizthum D, Henry-Barron BJ, Cervenka MC. Predictors of elevations in fasting lipid levels in adults with epilepsy on a modified Atkins diet. Seizure 2023; 113:86-92. [PMID: 38006874 DOI: 10.1016/j.seizure.2023.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 11/16/2023] [Accepted: 11/20/2023] [Indexed: 11/27/2023] Open
Abstract
BACKGROUND Ketogenic diet therapies can improve seizure control in patients with drug-resistant epilepsy (DRE). The current study investigated whether dietary fat composition is associated with elevations in serum lipid levels in adults with epilepsy who began a modified Atkins diet (MAD). METHODS Adults with DRE were instructed to follow the MAD. Food records collected at baseline and follow-up were analyzed to extract median daily macro- and micronutrient composition. Total cholesterol (TC), low-density lipoprotein (LDL) cholesterol, triglyceride (TG), high-density lipoprotein (HDL) cholesterol, non-HDL and TC/HDL ratio were measured at baseline and follow-up. RESULTS Study participants initiating MAD showed higher fat intake at 1 month (p<0.001) and 2 months (p<0.001) and lower carbohydrate intake at 1 month (p<0.001) and 2 months (p<0.001) compared to baseline. Study participants also showed higher intake of cholesterol (p<0.001), saturated fatty acid (p<0.001) and monounsaturated fatty acid (p<0.001) over time. Following MAD initiation, study participants showed significant increases in levels of TC (p = 0.007), LDL (p<0.001), and non-HDL (p = 0.009) over time. Dietary intake variables, including cholesterol and fat subtypes, were significantly associated with difference in 1 month TC and LDL levels from baseline but not absolute 1 month lipid values. In a sub-analysis, participants with baseline dyslipidemia showed smaller changes in lipid values during diet use. CONCLUSIONS Adults with DRE starting MAD increased fat intake, particularly saturated and monounsaturated fat subtypes, and reduced carbohydrate intake. Changes in TC and LDL levels 1 month after MAD initiation are associated with dietary intake of cholesterol and fat.
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Affiliation(s)
- Tanya J W McDonald
- Department of Neurology, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Meyer 2-147, Baltimore, MD 21287, United States.
| | - Luisa Diaz-Arias
- Department of Neurology, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Meyer 2-147, Baltimore, MD 21287, United States
| | - Diane Vizthum
- Institute for Clinical and Translational Research, Johns Hopkins University, Baltimore, MD, United States; Department of Behavioral Health and Nutrition, University of Delaware, Newark, DE, United States
| | - Bobbie J Henry-Barron
- Institute for Clinical and Translational Research, Johns Hopkins University, Baltimore, MD, United States
| | - Mackenzie C Cervenka
- Department of Neurology, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Meyer 2-147, Baltimore, MD 21287, United States
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Field R, Field T, Pourkazemi F, Rooney K. Low-carbohydrate and ketogenic diets: a scoping review of neurological and inflammatory outcomes in human studies and their relevance to chronic pain. Nutr Res Rev 2023; 36:295-319. [PMID: 35438071 DOI: 10.1017/s0954422422000087] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Dietary restriction of carbohydrate has been demonstrated to be beneficial for nervous system dysfunction in animal models and may be beneficial for human chronic pain. The purpose of this review is to assess the impact of a low-carbohydrate/ketogenic diet on the adult nervous system function and inflammatory biomarkers to inform nutritional research for chronic pain. An electronic database search was carried out in May 2021. Publications were screened for prospective research with dietary carbohydrate intake <130 g per day and duration of ≥2 weeks. Studies were categorised into those reporting adult neurological outcomes to be extracted for analysis and those reporting other adult research outcomes. Both groups were screened again for reported inflammatory biomarkers. From 1548 studies, there were 847 studies included. Sixty-four reported neurological outcomes with 83% showing improvement. Five hundred and twenty-three studies had a different research focus (metabolic n = 394, sport/performance n = 51, cancer n = 33, general n = 30, neurological with non-neuro outcomes n = 12, or gastrointestinal n = 4). The second screen identified sixty-three studies reporting on inflammatory biomarkers, with 71% reporting a reduction in inflammation. The overall results suggest a favourable outcome on the nervous system and inflammatory biomarkers from a reduction in dietary carbohydrates. Both nervous system sensitisation and inflammation occur in chronic pain, and the results from this review indicate it may be improved by low-carbohydrate nutritional therapy. More clinical trials within this population are required to build on the few human trials that have been done.
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Affiliation(s)
- Rowena Field
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Tara Field
- The New South Wales Ministry of Health (NSW Health), Sydney, Australia
| | | | - Kieron Rooney
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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Chen S, Su X, Feng Y, Li R, Liao M, Fan L, Liu J, Chen S, Zhang S, Cai J, Zhu S, Niu J, Ye Y, Lo K, Zeng F. Ketogenic Diet and Multiple Health Outcomes: An Umbrella Review of Meta-Analysis. Nutrients 2023; 15:4161. [PMID: 37836444 PMCID: PMC10574428 DOI: 10.3390/nu15194161] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 09/22/2023] [Accepted: 09/22/2023] [Indexed: 10/15/2023] Open
Abstract
Numerous studies have examined the effects of ketogenic diets (KD) on health-related outcomes through meta-analyses. However, the presence of biases may compromise the reliability of conclusions. Therefore, we conducted an umbrella review to collate and appraise the strength of evidence on the efficacy of KD interventions. We conducted a comprehensive search on PubMed, EMBASE, and the Cochrane Database until April 2023 to identify meta-analyses that investigated the treatment effects of KD for multiple health conditions, which yielded 23 meta-analyses for quantitative analyses. The evidence suggests that KD could increase the levels of low-density lipoprotein cholesterol (LDL-C), total cholesterol (TC) and high-density lipoprotein cholesterol (HDL-C), the respiratory exchange rate (RER), and could decrease total testosterone and testosterone levels (all p-random effects: <0.05). The combination of KD and physical activity can significantly reduce body weight and increase the levels of LDL-C and cortisol. In addition, KD was associated with seizure reduction in children, which can be explained by the ketosis state as induced by the diet. Furthermore, KD demonstrated a better alleviation effect in refractory childhood epilepsy, in terms of median effective rates for seizure reduction of ≥50%, ≥90%, and seizure freedom. However, the strength of evidence supporting the aforementioned associations was generally weak, thereby challenging their credibility. Consequently, future studies should prioritize stringent research protocols to ascertain whether KD interventions with longer intervention periods hold promise as a viable treatment option for various diseases.
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Affiliation(s)
- Shiyun Chen
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, No. 601 Huangpu Road West, Guangzhou 510632, China; (S.C.); (X.S.); (Y.F.); (R.L.); (J.L.); (S.C.); (S.Z.); (J.C.); (S.Z.)
| | - Xin Su
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, No. 601 Huangpu Road West, Guangzhou 510632, China; (S.C.); (X.S.); (Y.F.); (R.L.); (J.L.); (S.C.); (S.Z.); (J.C.); (S.Z.)
| | - Yonghui Feng
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, No. 601 Huangpu Road West, Guangzhou 510632, China; (S.C.); (X.S.); (Y.F.); (R.L.); (J.L.); (S.C.); (S.Z.); (J.C.); (S.Z.)
| | - Ruojie Li
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, No. 601 Huangpu Road West, Guangzhou 510632, China; (S.C.); (X.S.); (Y.F.); (R.L.); (J.L.); (S.C.); (S.Z.); (J.C.); (S.Z.)
| | - Minqi Liao
- Institute of Epidemiology, Helmholtz Zentrum Munich-German Research Center for Environmental Health, Ingolstadt Landstr. 1, 85764 Neuherberg, Germany;
| | - Laina Fan
- Department of Clinical Medicine, International School, Jinan University, No. 601 Huangpu Road West, Guangzhou 510632, China;
| | - Jiazi Liu
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, No. 601 Huangpu Road West, Guangzhou 510632, China; (S.C.); (X.S.); (Y.F.); (R.L.); (J.L.); (S.C.); (S.Z.); (J.C.); (S.Z.)
| | - Shasha Chen
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, No. 601 Huangpu Road West, Guangzhou 510632, China; (S.C.); (X.S.); (Y.F.); (R.L.); (J.L.); (S.C.); (S.Z.); (J.C.); (S.Z.)
| | - Shiwen Zhang
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, No. 601 Huangpu Road West, Guangzhou 510632, China; (S.C.); (X.S.); (Y.F.); (R.L.); (J.L.); (S.C.); (S.Z.); (J.C.); (S.Z.)
| | - Jun Cai
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, No. 601 Huangpu Road West, Guangzhou 510632, China; (S.C.); (X.S.); (Y.F.); (R.L.); (J.L.); (S.C.); (S.Z.); (J.C.); (S.Z.)
| | - Sui Zhu
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, No. 601 Huangpu Road West, Guangzhou 510632, China; (S.C.); (X.S.); (Y.F.); (R.L.); (J.L.); (S.C.); (S.Z.); (J.C.); (S.Z.)
| | - Jianxiang Niu
- General Surgery, The Affiliated Hospital of Inner Mongolia Medical University, No. 1 Tongdao North Road, Hohhot 010000, China;
| | - Yanbin Ye
- Department of Clinical Nutrition, The First Affiliated Hospital, Jinan University, Guangzhou 510630, China;
| | - Kenneth Lo
- Department of Food Science and Nutrition, The Hong Kong Polytechnic University, Kowloon, Hong Kong 100872, China
- Research Institute for Future Food, The Hong Kong Polytechnic University, Kowloon, Hong Kong 100872, China
| | - Fangfang Zeng
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, No. 601 Huangpu Road West, Guangzhou 510632, China; (S.C.); (X.S.); (Y.F.); (R.L.); (J.L.); (S.C.); (S.Z.); (J.C.); (S.Z.)
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Alves SS, Servilha-Menezes G, Rossi L, da Silva Junior RMP, Garcia-Cairasco N. Evidence of disturbed insulin signaling in animal models of Alzheimer's disease. Neurosci Biobehav Rev 2023; 152:105326. [PMID: 37479008 DOI: 10.1016/j.neubiorev.2023.105326] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 06/02/2023] [Accepted: 07/17/2023] [Indexed: 07/23/2023]
Abstract
Since glucose reuptake by neurons is mostly independent of insulin, it has been an intriguing question whether insulin has or not any roles in the brain. Consequently, the identification of insulin receptors in the central nervous system has fueled investigations of insulin functions in the brain. It is also already known that insulin can influence glucose reuptake by neurons, mostly during activities that have the highest energy demand. The identification of high density of insulin receptors in the hippocampus also suggests that insulin may present important roles related to memory. In this context, studies have reported worse performance in cognitive tests among diabetic patients. In addition, alterations in the regulation of central insulin pathways have been observed in the brains of Alzheimer's disease (AD) patients. In fact, some authors have proposed AD as a third type of diabetes and recently, our group proposed insulin resistance as a common link between different AD hypotheses. Therefore, in the present narrative review, we intend to revise and gather the evidence of disturbed insulin signaling in experimental animal models of AD.
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Affiliation(s)
- Suélen Santos Alves
- Department of Neurosciences and Behavioral Sciences, Ribeirão Preto Medical School, University of São Paulo (FMRP-USP), Brazil
| | - Gabriel Servilha-Menezes
- Department of Physiology, Ribeirão Preto Medical School - University of São Paulo (FMRP-USP), Brazil
| | - Leticia Rossi
- Department of Physiology, Ribeirão Preto Medical School - University of São Paulo (FMRP-USP), Brazil
| | - Rui Milton Patrício da Silva Junior
- Department of Physiology, Ribeirão Preto Medical School - University of São Paulo (FMRP-USP), Brazil; Institute of Neuroscience of Castilla y León, University of Salamanca, Salamanca, Spain
| | - Norberto Garcia-Cairasco
- Department of Neurosciences and Behavioral Sciences, Ribeirão Preto Medical School, University of São Paulo (FMRP-USP), Brazil; Department of Physiology, Ribeirão Preto Medical School - University of São Paulo (FMRP-USP), Brazil.
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Cohen Y, Valdés-Mas R, Elinav E. The Role of Artificial Intelligence in Deciphering Diet-Disease Relationships: Case Studies. Annu Rev Nutr 2023; 43:225-250. [PMID: 37207358 DOI: 10.1146/annurev-nutr-061121-090535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Modernization of society from a rural, hunter-gatherer setting into an urban and industrial habitat, with the associated dietary changes, has led to an increased prevalence of cardiometabolic and additional noncommunicable diseases, such as cancer, inflammatory bowel disease, and neurodegenerative and autoimmune disorders. However, while dietary sciences have been rapidly evolving to meet these challenges, validation and translation of experimental results into clinical practice remain limited for multiple reasons, including inherent ethnic, gender, and cultural interindividual variability, among other methodological, dietary reporting-related, and analytical issues. Recently, large clinical cohorts with artificial intelligence analytics have introduced new precision and personalized nutrition concepts that enable one to successfully bridge these gaps in a real-life setting. In this review, we highlight selected examples of case studies at the intersection between diet-disease research and artificial intelligence. We discuss their potential and challenges and offer an outlook toward the transformation of dietary sciences into individualized clinical translation.
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Affiliation(s)
- Yotam Cohen
- Systems Immunology Department, Weizmann Institute of Science, Rehovot, Israel;
| | - Rafael Valdés-Mas
- Systems Immunology Department, Weizmann Institute of Science, Rehovot, Israel;
| | - Eran Elinav
- Systems Immunology Department, Weizmann Institute of Science, Rehovot, Israel;
- Division of Microbiome & Cancer, National German Cancer Research Center (DKFZ), Heidelberg, Germany;
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20
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De Giorgis V, Tagliabue A, Bisulli F, Brambilla I, Camerini A, Cusmai R, Darra F, Dianin A, Domenica E, Lodi MAM, Matricardi S, Messana T, Operto F, Ragona F, Russo E, Varesio C, Volpi L, Zanaboni MP, Pasca L, Veggiotti P. Ketogenic dietary therapies in epilepsy: recommendations of the Italian League against Epilepsy Dietary Therapy Study Group. Front Neurol 2023; 14:1215618. [PMID: 37497012 PMCID: PMC10368245 DOI: 10.3389/fneur.2023.1215618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 05/24/2023] [Indexed: 07/28/2023] Open
Abstract
A stepwise increase in the utilization of ketogenic dietary therapies for drug-resistant epilepsy has been observed in Italy in the last decade, although it is still considered often underused in many centers when compared to other countries. The Dietary Therapy Study Group of the Italian League against Epilepsy proposes practical recommendations to improve shared knowledge and facilitate the application of ketogenic dietary therapies, optimizing its efficacy and tolerability. The experts involved (11 child neuropsychiatrists, two adult neurologists, one psychologist, one pharmacologist, one pediatric endocrinologist, one representative of patients' associations, and three dietitians and clinical nutritionists) responded to a survey on current clinical practice issues and were asked to discuss controversial topics related to supplementation, long-term maintenance, transition, and a multidisciplinary approach to ketogenic dietary therapies. Practical indications for patient selection, diet initiation, management, side effects prevention, and follow-up are provided.
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Affiliation(s)
- Valentina De Giorgis
- Department of Brain and Behaviour Neuroscience, University of Pavia, Pavia, Italy
- Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Anna Tagliabue
- Department of Public Health, Human Nutrition and Eating Disorder Research Center and Ketogenic Metabolic Therapy Laboratory—Experimental and Forensic Medicine University of Pavia, Pavia, Italy
| | - Francesca Bisulli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Full Member of the European Reference Network for Rare and Complex Epilepsies (EpiCARE), Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Ilaria Brambilla
- Endocrinologia, Diabetologia e Ginecologia Pediatrica, Fondazione IRCCS Policlinico San Matteo di Pavia, Università degli Studi di Pavia, Pavia, Italy
| | | | - Raffaella Cusmai
- Child Neurology Unit, Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children's Research Hospital, IRCCS, Rome, Italy
| | - Francesca Darra
- Child Neuropsychiatry Unit, Department of Engineering for Innovation Medicine, University of Verona, Full Member of European Reference Network EpiCARE, Verona, Italy
| | - Alice Dianin
- Inherited Metabolic Diseases Unit and Regional Centre for Newborn Screening, Diagnosis and Treatment of Inherited Metabolic Diseases and Congenital Endocrine Diseases, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Elia Domenica
- Artificial Nutrition Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Monica Anna Maria Lodi
- Department of Child Neuropsychiatry, Epilepsy Center, Fatebenefratelli Hospital, Milan, Italy
| | - Sara Matricardi
- Department of Pediatrics, University of Chieti, Chieti, Italy
| | - Tullio Messana
- Istituto delle Scienze Neurologiche di Bologna, UOC Neuropsichiatria dell'etá pediatrica, Member of the ERN Epicare, Bologna, Italy
| | - Francesca Operto
- Department of Science of Health, School of Medicine, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Francesca Ragona
- Department of Pediatric Neurology, IRCCS Foundation Carlo Besta Neurological Institute, Milan, Italy
| | - Emilio Russo
- Science of Health Department, University of Catanzaro, Catanzaro, Italy
| | - Costanza Varesio
- Department of Brain and Behaviour Neuroscience, University of Pavia, Pavia, Italy
- Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Lilia Volpi
- UOC Neurologia, IRCCS Istituto delle Scienze Neurologiche, Azienda USL di Bologna, Ospedale Bellaria Bologna, Bologna, Italy
| | | | - Ludovica Pasca
- Department of Brain and Behaviour Neuroscience, University of Pavia, Pavia, Italy
- Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Pierangelo Veggiotti
- Vittore Buzzi Children's Hospital, Pediatric Neurology Unit, Milan, Italy
- Department of Biomedical and Clinical Sciences, L. Sacco, University of Milan, Milan, Italy
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21
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Muller AL, Diaz-Arias L, Cervenka MC, McDonald TJW. The effect of anti-seizure medications on lipid values in adults with epilepsy. Epilepsy Behav 2023; 144:109260. [PMID: 37244221 DOI: 10.1016/j.yebeh.2023.109260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 05/09/2023] [Accepted: 05/11/2023] [Indexed: 05/29/2023]
Abstract
PURPOSE Certain anti-seizure medications (ASMs) adversely impact lipid values. Here, we explored the impact of ASMs on lipid values in adults with epilepsy. METHODS A total of 228 adults with epilepsy were divided into four groups based on ASMs used: strong EIASMs, weak EIASMs, non-EIASMs, and no ASMs. Demographic information, epilepsy-specific clinical history, and lipid values were obtained through chart review. RESULTS While there was no significant difference in lipid values between groups, there was a significant difference in the proportion of participants with dyslipidemia. Specifically, more participants exhibited elevated low-density lipoprotein (LDL) level in the strong EIASM group compared to the non-EIASM group (46.7% vs 18%, p < 0.05). In addition, more participants showed elevated LDL level in the weak EIASM group compared to the non-EIASM group (38% vs 18%, p < 0.05). Users of strong EIASMs showed greater odds of high LDL level (OR 5.734, p = 0.005) and high total cholesterol level (OR 4.913, p = 0.008) compared to users of non-EIASMs. When we analyzed the impact of individual ASMs used by more than 15% of the cohort on lipid levels, participants using valproic acid (VPA) showed lower high-density lipoprotein (p = 0.002) and higher triglyceride levels (p = 0.002) compared to participants not using VPA. CONCLUSION Our study demonstrated a difference in the proportion of participants with dyslipidemia between ASM groups. Thus, adults with epilepsy using EIASMs should have careful monitoring of lipid values to address the risk of cardiovascular disease.
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Affiliation(s)
- Ashley L Muller
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
| | - Luisa Diaz-Arias
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
| | - Mackenzie C Cervenka
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
| | - Tanya J W McDonald
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
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22
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Erkent I, Ilgaz F, Dericioglu N. Difficulties in the implementation of the ketogenic diet in adult patients with refractory epilepsy. Epilepsy Behav 2023; 144:109234. [PMID: 37192580 DOI: 10.1016/j.yebeh.2023.109234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 04/22/2023] [Accepted: 04/23/2023] [Indexed: 05/18/2023]
Abstract
BACKGROUND Ketogenic diet therapies (KDT) are appropriate therapeutic options for pediatric and adult patients with intractable epilepsy. The application of KDT among adult patients with refractory epilepsy is limited compared to children for several reasons, including poor compliance. We present the significant reasons for the lack of adherence to KDT in our adult patients with intractable epilepsy. METHODS This study was conducted retrospectively in adult patients with drug-resistant epilepsy who wereofferedand accepted toimplementKDT between 2014 and 2021. Demographic and clinical data were collected via electronic health records. The eventual outcome of KDT results was obtained from the consultant dietitian. The prevalence and reasons for the failure to implement KDT were investigated. We also obtained detailed information about patients who successfully applied the KDT. RESULTS A total of 33 patients (18F; median age 28) who wereoffered and accepted to implement KDT were included. Baseline seizure frequency was >4 per week in 49%, and more than half of the patients used >3 anti-seizure medications (ASM). Epilepsy types were temporal in 10 (30%), extratemporal in 10 (30%), generalized in 6 (18%), and unclassified in 7 (22%) patients.Only 3 patients (9%) were able to maintain KDT in the long term. One of them (33%) benefited from this therapy.In the remaining 30 patients, the reasons for failure were inability to contact the dietitian in 5, failure to apply KDT for a particular reason in 7, inappropriate blood test results or any medical/surgical comorbidities in 6, improvement in seizure burden due to change in ASM in 5, still insufficient knowledge of KDT in 3, unresponsiveness to diet due to incorrect implementation in 1 and unidentified reasons in 3 patients. CONCLUSIONS A significant percentage of adult patients with refractory seizures failed to use KDTin our study(91%).Strategies to improve compliance and minimize the side effects might increase the number of drug-refractory epilepsy patients who could benefit from this therapy.
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Affiliation(s)
- Irem Erkent
- Clinical Neurophysiology, Department of Neurology, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
| | - Fatma Ilgaz
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey.
| | - Nese Dericioglu
- Clinical Neurophysiology, Department of Neurology, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
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23
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Ketogenic Diet Applied in Weight Reduction of Overweight and Obese Individuals with Progress Prediction by Use of the Modified Wishnofsky Equation. Nutrients 2023; 15:nu15040927. [PMID: 36839285 PMCID: PMC9968058 DOI: 10.3390/nu15040927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 02/06/2023] [Accepted: 02/08/2023] [Indexed: 02/15/2023] Open
Abstract
Ketogenic diet is often used as diet therapy for certain diseases, among other things, its positive effect related to weight loss is highlighted. Precisely because of the suggestion that KD can help with weight loss, visceral obesity, and appetite control, 100 respondents joined the weight loss program (of which 31% were men and 69% were women). The aforementioned respondents were interviewed in order to determine their eating habits, the amount of food consumed, and the time when they consume meals. Basic anthropometric data (body height, body mass, chest, waist, hips, biceps, and thigh circumferences) were also collected, in order to be able to monitor their progress during the different phases of the ketogenic diet. Important information is the expected body mass during the time frame of a certain keto diet phase. This information is important for the nutritionist, medical doctor, as well as for the participant in the reduced diet program; therefore, the model was developed that modified the original equation according to Wishnofsky. The results show that women lost an average of 22.7 kg (average number of days in the program 79.5), and for men the average weight loss was slightly higher, 29.7 kg (with an average of 76.8 days in the program). The prediction of expected body mass by the modified Wishnofsky's equation was extremely well aligned with the experimental values, as shown by the Bland-Altman graph (bias for women 0.021 kg and -0.697 kg for men) and the coefficient of determination of 0.9903. The modification of the Wishnofsky equation further shed light on the importance of controlled energy reduction during the dietetic options of the ketogenic diet.
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24
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Makievskaya CI, Popkov VA, Andrianova NV, Liao X, Zorov DB, Plotnikov EY. Ketogenic Diet and Ketone Bodies against Ischemic Injury: Targets, Mechanisms, and Therapeutic Potential. Int J Mol Sci 2023; 24:2576. [PMID: 36768899 PMCID: PMC9916612 DOI: 10.3390/ijms24032576] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 01/17/2023] [Accepted: 01/25/2023] [Indexed: 02/03/2023] Open
Abstract
The ketogenic diet (KD) has been used as a treatment for epilepsy since the 1920s, and its role in the prevention of many other diseases is now being considered. In recent years, there has been an intensive investigation on using the KD as a therapeutic approach to treat acute pathologies, including ischemic ones. However, contradictory data are observed for the effects of the KD on various organs after ischemic injury. In this review, we provide the first systematic analysis of studies conducted from 1980 to 2022 investigating the effects and main mechanisms of the KD and its mimetics on ischemia-reperfusion injury of the brain, heart, kidneys, liver, gut, and eyes. Our analysis demonstrated a high diversity of both the composition of the used KD and the protocols for the treatment of animals, which could be the reason for contradictory effects in different studies. It can be concluded that a true KD or its mimetics, such as β-hydroxybutyrate, can be considered as positive exposure, protecting the organ from ischemia and its negative consequences, whereas the shift to a rather similar high-calorie or high-fat diet leads to the opposite effect.
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Affiliation(s)
- Ciara I. Makievskaya
- Faculty of Bioengineering and Bioinformatics, Lomonosov Moscow State University, 119992 Moscow, Russia
| | - Vasily A. Popkov
- A.N. Belozersky Institute of Physico-Chemical Biology, Lomonosov Moscow State University, 119991 Moscow, Russia
- V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology and Perinatology, 117997 Moscow, Russia
| | - Nadezda V. Andrianova
- A.N. Belozersky Institute of Physico-Chemical Biology, Lomonosov Moscow State University, 119991 Moscow, Russia
| | - Xinyu Liao
- Faculty of Bioengineering and Bioinformatics, Lomonosov Moscow State University, 119992 Moscow, Russia
| | - Dmitry B. Zorov
- A.N. Belozersky Institute of Physico-Chemical Biology, Lomonosov Moscow State University, 119991 Moscow, Russia
- V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology and Perinatology, 117997 Moscow, Russia
| | - Egor Y. Plotnikov
- A.N. Belozersky Institute of Physico-Chemical Biology, Lomonosov Moscow State University, 119991 Moscow, Russia
- V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology and Perinatology, 117997 Moscow, Russia
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25
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Abu Dayyih W, Layth R, Hailat M, Alkhawaja B, Al Tamimi L, Zakaraya Z, Aburumman A, Al Dmour N, Saadh MJ, Al-Matubsi H, Aldalaen SM. Effect of date molasses on levetiracetam pharmacokinetics in healthy rats. Sci Rep 2023; 13:758. [PMID: 36641484 PMCID: PMC9840612 DOI: 10.1038/s41598-023-28074-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 01/12/2023] [Indexed: 01/15/2023] Open
Abstract
Twelve healthy eight-week-old male Wistar rats weighing 200 g were used. Rats were chosen randomly, and their tails were identified and separated into cages/groups. The first group received an oral dose of 11.5 mg of levetiracetam in 5 mL of water, and the second group was given date syrup (250 g mixed with 250 mL water) for seven days, then 11.5 mg LEV in 5 mL water on day 7. One week of preadministered date molasses significantly decreased levetiracetam pharmacokinetic parameters in rats, such as Cmax (72 vs. 14 ng/mL, p = 0.01), Tmax (1.78 vs. 0.44 h, p < 0.001), and AUC (880 vs. 258 ng.h/mL, p < 0.001). This decrease in plasma levetiracetam levels caused by date molasses could be attributed to decreased levetiracetam absorption. On the other hand, the current study discovered that rats given date molasses for a week had a reduced rate and extent of absorption. As a result, date molasses might increase the risk of epileptic seizures in oral LEV-treated ones.
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Affiliation(s)
| | - Raghad Layth
- Faculty of Pharmacy and Medical Sciences, University of Petra, Amman, Jordan
| | - Mohammad Hailat
- Faculty of Pharmacy, Al-Zaytoonah University of Jordan, Amman, Jordan
| | - Bayan Alkhawaja
- Faculty of Pharmacy and Medical Sciences, University of Petra, Amman, Jordan
| | | | - Zainab Zakaraya
- Faculty of Pharmacy, Al-Ahliyya Amman University, Amman, Jordan
| | - Aseel Aburumman
- Pharmacological and Diagnostic Research Centre, Faculty of Pharmacy, Al-Ahliyya Amman University, Amman, Jordan
| | | | - Mohamed J Saadh
- Faculty of Pharmacy, Middle East University, Amman, 11831, Jordan
| | - Hisham Al-Matubsi
- Faculty of Pharmacy and Medical Sciences, University of Petra, Amman, Jordan
| | - Saed M Aldalaen
- Department of Pharmacology, Faculty of Medicine, Mutah University, Al-Karak, Jordan
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26
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Andersen JV, Westi EW, Neal ES, Aldana BI, Borges K. β-Hydroxybutyrate and Medium-Chain Fatty Acids are Metabolized by Different Cell Types in Mouse Cerebral Cortex Slices. Neurochem Res 2023; 48:54-61. [PMID: 35999339 DOI: 10.1007/s11064-022-03726-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 07/06/2022] [Accepted: 08/11/2022] [Indexed: 01/11/2023]
Abstract
Ketogenic diets and medium-chain triglycerides are gaining attention as treatment of neurological disorders. Their major metabolites, β-hydroxybutyrate (βHB) and the medium-chain fatty acids (MCFAs) octanoic acid (C8) and decanoic acid (C10), are auxiliary brain fuels. To which extent these fuels compete for metabolism in different brain cell types is unknown. Here, we used acutely isolated mouse cerebral cortical slices to (1) compare metabolism of 200 µM [U-13C]C8, [U-13C]C10 and [U-13C]βHB and (2) assess potential competition between metabolism of βHB and MCFAs by quantifying metabolite 13C enrichment using gas chromatography-mass spectrometry (GC-MS) analysis. The 13C enrichment in most metabolites was similar with [U-13C]C8 and [U-13C]C10 as substrates, but several fold lower with [U-13C]βHB. The 13C enrichment in glutamate was in a similar range for all three substrates, whereas the 13C enrichments in citrate and glutamine were markedly higher with both [U-13C]C8 and [U-13C]C10 compared with [U-13C]βHB. As citrate and glutamine are indicators of astrocytic metabolism, the results indicate active MCFA metabolism in astrocytes, while βHB is metabolized in a different cellular compartment. In competition experiments, 12C-βHB altered 13C incorporation from [U-13C]C8 and [U-13C]C10 in only a few instances, while 12C-C8 and 12C-C10 only further decreased the low [U-13C]βHB-derived 13C incorporation into citrate and glutamine, signifying little competition for oxidative metabolism between βHB and the MCFAs. Overall, the data demonstrate that βHB and MCFAs are supplementary fuels in different cellular compartments in the brain without notable competition. Thus, the use of medium-chain triglycerides in ketogenic diets is likely to be beneficial in conditions with carbon and energy shortages in both astrocytes and neurons, such as GLUT1 deficiency.
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Affiliation(s)
- Jens V Andersen
- Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Universitetsparken 2, 2100, Copenhagen, Denmark.
| | - Emil W Westi
- Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Universitetsparken 2, 2100, Copenhagen, Denmark
| | - Elliott S Neal
- School of Biomedical Sciences, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Blanca I Aldana
- Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Universitetsparken 2, 2100, Copenhagen, Denmark
| | - Karin Borges
- School of Biomedical Sciences, Faculty of Medicine, The University of Queensland, Brisbane, Australia.
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27
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Quiroga-Padilla PJ, Briceño C, Mayor LC. Effect of the modified Atkins diet in adults with drug-resistant epilepsy: A controlled study. Epilepsy Behav 2022; 136:108936. [PMID: 36215831 DOI: 10.1016/j.yebeh.2022.108936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 09/21/2022] [Accepted: 09/24/2022] [Indexed: 12/14/2022]
Abstract
The objective of this study was to be a proof of concept of an analysis strategy to assess the effectiveness of the modified Atkins diet (MAD) in adults with drug-resistant epilepsy (DRE). This retrospective cohort study included participants aged >16 years with at least two failed antiseizure medications (ASMs). The variables were self-reported and gathered from medical records or phone calls. Two groups are compared: MAD adjuvant to ASM (diet group) and ASM only (control). To make both groups comparable, diet and control groups were matched (1:2) by predictors of seizure remission (PSR) in adults with DRE. A systematic review of the literature was conducted to establish PSR. A total of 127 patients were eligible. Forty-six participants (36 %) initiated the MAD, but only 28 (22 %) continued the diet after 3 months. The number of past and new ASMs, epilepsy type, and follow-up time were selected as PSR. Twelve patients were included in the diet group and 24 in the control group, matched by PSR. Compared with the control group, the diet group had 4.5 greater odds of achieving ≥50 % seizure frequency reduction at 1-3 months (OR 5.5; 90 % confidence interval 1.1-26.65). Mean seizure frequency and other secondary outcomes did not differ significantly between the groups. In summary, the MAD showed a modest effect over seizure control compared with only ASM. Matching by PSR could be an alternative analysis approach to determine the effectiveness of the ketogenic diet in controlled studies. Additional studies are required to validate the analysis proposed.
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Affiliation(s)
- Pedro J Quiroga-Padilla
- Diabetes, Lipids and Metabolism Laboratory, Faculty of Medicine, Universidad de los Andes, Bogotá D.C. 111021, Colombia.
| | - Claudia Briceño
- Department of Nutrition, Hospital Universitario Fundación Santa Fé de Bogotá, Bogotá D.C. 110111, Colombia
| | - Luis C Mayor
- Epilepsy Clinic, Department of Neurology, Hospital Universitario Fundación Santa Fé de Bogotá, Bogotá D.C. 110111, Colombia; Faculty of Medicine, Universidad de los Andes, Bogotá D.C. 111021, Colombia.
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28
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Kaul N, Nation J, Laing J, Nicolo J, Deane AM, Udy AA, Kwan P, O'Brien TJ. Modified low ratio ketogenic therapy in the treatment of adults with super-refractory status epilepticus. JPEN J Parenter Enteral Nutr 2022; 46:1819-1827. [PMID: 35285036 PMCID: PMC9790306 DOI: 10.1002/jpen.2373] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 02/14/2022] [Accepted: 03/06/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Induction of ketosis by manipulation of nutrition intake has been proposed as an adjunctive treatment for super-refractory status epilepticus (SRSE). However, the classical 4:1 ketogenic ratio may not meet the nutrition needs, specifically protein for critically ill adults. The aim of this study was to analyze the outcomes of adults with SRSE who received a lower ketogenic ratio of 2:1 grams of fat to non-fat grams, including 20%-30% of energy from medium chain triglycerides. METHODS We reviewed patients aged ≥18 years with SRSE treated with ketogenic therapy between July 2015 and December 2020 at two quaternary teaching hospitals in Melbourne, Australia. Data collected from medical records included patient demographics, nutrition prescription, clinical outcomes, and ketogenic therapy-related complications. The primary outcome of the study was to assess tolerability of ketogenic therapy. RESULTS Twelve patients (female = 7) were treated with ketogenic therapy for SRSE. Patients received between 4 and 8 antiseizure medications and 1-5 anesthetic agents prior to commencement of ketogenic therapy. Blood beta-hydroxybutyrate concentrations were variable (median = 0.5 mmol/L, range: 0.0-6.1 mmol/L). SRSE resolved in 10 cases (83%) after a median of 9 days (range: 2-21 days) following commencement of ketogenic therapy. Ketogenic therapy-associated complications were reported in five patients, leading to cessation in two patients. CONCLUSION Despite the challenge in maintaining ketosis during critical illness, low ratio 2:1 ketogenic therapy incorporating medium chain triglycerides is tolerable for adults with SRSE. Further studies are required to determine the optimal timing, nutrition prescription and duration of ketogenic therapy for SRSE treatment.
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Affiliation(s)
- Neha Kaul
- Department of Nutrition and DieteticsAlfred HospitalMelbourneVictoriaAustralia,Department of Allied Health (Clinical Nutrition)Royal Melbourne HospitalParkvilleVictoriaAustralia,Departments of Neurosciences and NeurologyAlfred Hospital and Monash UniversityMelbourneVictoriaAustralia,Department of Medicine, Royal Melbourne HospitalUniversity of MelbourneParkvilleVictoriaAustralia
| | - Judy Nation
- Department of Medicine, Royal Melbourne HospitalUniversity of MelbourneParkvilleVictoriaAustralia
| | - Joshua Laing
- Departments of Neurosciences and NeurologyAlfred Hospital and Monash UniversityMelbourneVictoriaAustralia
| | - John‐Paul Nicolo
- Departments of Neurosciences and NeurologyAlfred Hospital and Monash UniversityMelbourneVictoriaAustralia,Department of NeurologyRoyal Melbourne HospitalParkvilleVictoriaAustralia
| | - Adam M. Deane
- Department of Medicine, Royal Melbourne HospitalUniversity of MelbourneParkvilleVictoriaAustralia,Intensive Care UnitRoyal Melbourne HospitalParkvilleVictoriaAustralia
| | - Andrew A. Udy
- Department of Epidemiology and Preventative Medicine, Australian and New Zealand Intensive Care Research CentreMonash UniversityMelbourneVictoriaAustralia,Department of Intensive Care and Hyperbaric MedicineAlfred HospitalMelbourneVictoriaAustralia
| | - Patrick Kwan
- Departments of Neurosciences and NeurologyAlfred Hospital and Monash UniversityMelbourneVictoriaAustralia,Department of Medicine, Royal Melbourne HospitalUniversity of MelbourneParkvilleVictoriaAustralia,Department of NeurologyRoyal Melbourne HospitalParkvilleVictoriaAustralia
| | - Terence J. O'Brien
- Departments of Neurosciences and NeurologyAlfred Hospital and Monash UniversityMelbourneVictoriaAustralia,Department of Medicine, Royal Melbourne HospitalUniversity of MelbourneParkvilleVictoriaAustralia,Department of NeurologyRoyal Melbourne HospitalParkvilleVictoriaAustralia
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29
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Saito ER, Warren CE, Hanegan CM, Larsen JG, du Randt JD, Cannon M, Saito JY, Campbell RJ, Kemberling CM, Miller GS, Edwards JG, Bikman BT. A Novel Ketone-Supplemented Diet Improves Recognition Memory and Hippocampal Mitochondrial Efficiency in Healthy Adult Mice. Metabolites 2022; 12:1019. [PMID: 36355101 PMCID: PMC9693360 DOI: 10.3390/metabo12111019] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 10/20/2022] [Accepted: 10/21/2022] [Indexed: 09/13/2023] Open
Abstract
Mitochondrial dysfunction and cognitive impairment are common symptoms in many neurologic and psychiatric disorders, as well as nonpathological aging. Ketones have been suggested as therapeutic for their efficacy in epilepsy and other brain pathologies such as Alzheimer's disease and major depressive disorder. However, their effects on cognitive function in healthy individuals is less established. Here, we explored the mitochondrial and performative outcomes of a novel eight-week ketone-supplemented ketogenic (KETO) diet in healthy adult male and female mice. In a novel object recognition test, KETO mice spent more time with the novel, compared to familiar, object, indicating an improvement in recognition memory. High-resolution respirometry on permeabilized hippocampal tissue returned significant reductions in mitochondrial O2 consumption. No changes in ATP production were observed, yielding a significantly higher ATP:O2 ratio, a measure of mitochondrial efficiency. Together, these findings demonstrate the KETO diet improves hippocampal mitochondrial efficiency. They add to a growing body of evidence that suggests ketones and ketogenic diets are neuroprotective and metabolically and cognitively relevant, even in healthy adults. They also suggest that ketogenic lifestyle changes may be effective strategies for protecting against cognitive decline associated with aging and disease.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Benjamin T. Bikman
- Department of Cell Biology and Physiology, Brigham Young University, Provo, UT 84602, USA
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30
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Anic K, Schmidt MW, Furtado L, Weidenbach L, Battista MJ, Schmidt M, Schwab R, Brenner W, Ruckes C, Lotz J, Lackner KJ, Hasenburg A, Hasenburg A. Intermittent Fasting-Short- and Long-Term Quality of Life, Fatigue, and Safety in Healthy Volunteers: A Prospective, Clinical Trial. Nutrients 2022; 14:nu14194216. [PMID: 36235868 PMCID: PMC9571750 DOI: 10.3390/nu14194216] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 09/14/2022] [Accepted: 09/19/2022] [Indexed: 11/25/2022] Open
Abstract
Background: Intermittent fasting (IF) is defined as an eating pattern without calorie restrictions, alternating between periods of fasting and eating. In the past decades IF has not only become a popular weight-reducing diet but is thought to improve Quality of Life (QoL) and fatigue. However, very little evidence exists for the general population. Thus, we aimed to assess the impact of a 16-h fasting period per day over a three-month study period on QoL and especially fatigue in healthy people. Methods: We conducted a prospective cohort study including healthy subjects. All participants fasted 16 h for at least five days a week while maintaining their normal lifestyle. In the study, we analysed blood samples as well as QoL through standardized questionnaires (WHO-5 questionnaire, Short Form Health 36). Furthermore, we measured the degree of fatigue with the Fatigue Assessment Scale (FAS) and Fatigue Severity Scale (FSS) as well as compliance, activity records, and weight alterations. All endpoints were evaluated at baseline, after two weeks, four weeks, and three months of IF. Results: A total of 30 participants fasted for the entire study period. The results of the WHO-5 questionnaire (15.6 ± 4.6 vs. 18 ± 3.6, p < 0.0019) demonstrated a significant increase in QoL. For long-term QoL six out of eight domains measured by the Short Form Health 36 (SF-36) significantly improved (e.g., physical health: 92.3 ± 11.6 vs. 96.5 ± 6.3, p = 0.015; mental health: 75.5 ± 12.0 vs. 81.7 ± 9.0; p < 0.001 and body pain: 74.1 ± 31.8 vs. 89.5 ± 14.9; p = 0.008) after three months. Fatigue significantly decreased from 10.3 ± 3.2 to 8.4 ± 2.5; p = 0.002 for mental fatigue and from 12.6 ± 3.8 to 10.7 ± 3.3; p = 0.002 measured by the FAS. The mean FSS-Score at baseline was 3.5 ± 1.2 compared to 2.9 ± 1.1 (scale 1−7) after three months (p < 0.001). Notably, the proliferation marker IGF-1 was significantly reduced. No clinically significant changes in laboratory parameters were observed that would have endangered a participant’s safety. Conclusions: IF according to the 16:8 regime over a fasting period of three months significantly improved several aspects of the QoL and decreased fatigue in healthy people, while maintaining a good safety profile. The practicability of this diet was also demonstrated for shift workers and people with a high percentage of active labour. Apart from the improvement in QoL and fatigue, the significant reduction in IGF-1, which can act as an accelerator of tumour development and progression, might be an indicator of the potential benefits of IF for patients with cancer.
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Affiliation(s)
- Katharina Anic
- Department of Gynecology and Obstetrics, University Medical Center of Johannes Gutenberg, University Mainz, 55131 Mainz, Germany
- Correspondence: ; Tel.: +49-6131-5303
| | - Mona W. Schmidt
- Department of Gynecology and Obstetrics, University Medical Center of Johannes Gutenberg, University Mainz, 55131 Mainz, Germany
| | - Larissa Furtado
- Department of Gynecology and Obstetrics, University Medical Center of Johannes Gutenberg, University Mainz, 55131 Mainz, Germany
| | - Lina Weidenbach
- Department of Gynecology and Obstetrics, University Medical Center of Johannes Gutenberg, University Mainz, 55131 Mainz, Germany
| | - Marco J. Battista
- Department of Gynecology and Obstetrics, University Medical Center of Johannes Gutenberg, University Mainz, 55131 Mainz, Germany
| | - Marcus Schmidt
- Department of Gynecology and Obstetrics, University Medical Center of Johannes Gutenberg, University Mainz, 55131 Mainz, Germany
| | - Roxana Schwab
- Department of Gynecology and Obstetrics, University Medical Center of Johannes Gutenberg, University Mainz, 55131 Mainz, Germany
| | - Walburgis Brenner
- Department of Gynecology and Obstetrics, University Medical Center of Johannes Gutenberg, University Mainz, 55131 Mainz, Germany
| | - Christian Ruckes
- Interdisciplinary Center Clinical Trials, University Medical Center Mainz, 55131 Mainz, Germany
| | - Johannes Lotz
- Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center of Johannes Gutenberg University Mainz, 55131 Mainz, Germany
| | - Karl J. Lackner
- Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center of Johannes Gutenberg University Mainz, 55131 Mainz, Germany
| | | | - Annette Hasenburg
- Department of Gynecology and Obstetrics, University Medical Center of Johannes Gutenberg, University Mainz, 55131 Mainz, Germany
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Macri E, Azhar Y. Prevention of Neurologic Disease with Fasting. Semin Neurol 2022; 42:549-557. [PMID: 36216359 DOI: 10.1055/a-1957-8449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Fasting has been widely studied in both prevention and treatment of many neurologic disorders. Some conditions may be prevented with any type of fasting, while some may require a stricter regimen. Fasting reduces weight, fasting blood glucose, and insulin resistance, and favorably alters the gut biome and the immune system. This article discusses various versions of fasting that have been studied as well as the known and theoretical mechanisms of how fasting effects the body and the brain. This article will then review evidence supporting the potential preventive and treatment effects of fasting in specific neurologic disorders including ameliorating the symptoms of Parkinson's disease, improving cognition in Alzheimer's disease, reducing migraine frequency and intensity, and reducing seizure frequency in epilepsy.
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Affiliation(s)
- Elizabeth Macri
- Department of Neurology, The University of New Mexico, Albuquerque, New Mexico
| | - Yusra Azhar
- Department of Neurology, The University of New Mexico, Albuquerque, New Mexico
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Siang LH, Arulsamy A, Yoon YK, Shaikh MF. Fruits for Seizures? A Systematic Review on the Potential Anti-Convulsant Effects of Fruits and their Phytochemicals. Curr Neuropharmacol 2022; 20:1925-1940. [PMID: 34517803 PMCID: PMC9886799 DOI: 10.2174/1570159x19666210913120637] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 08/04/2021] [Accepted: 09/10/2021] [Indexed: 11/22/2022] Open
Abstract
Epilepsy is a devastating neurological disorder. Current anti-convulsant drugs are only effective in about 70% of patients, while the rest remain drug-resistant. Thus, alternative methods have been explored to control seizures in these drug-resistant patients. One such method may be through the utilization of fruit phytochemicals. These phytochemicals have been reported to have beneficial properties such as anti-convulsant, anti-oxidant, and anti-inflammatory activities. However, some fruits may also elicit harmful effects. This review aims to summarize and elucidate the anti- or pro-convulsant effects of fruits used in relation to seizures in hopes of providing a good therapeutic reference to epileptic patients and their carers. Three databases, SCOPUS, ScienceDirect, and PubMed, were utilized for the literature search. Based on the PRISMA guidelines, a total of 40 articles were selected for critical appraisal in this review. Overall, the extracts and phytochemicals of fruits managed to effectively reduce seizure activities in various preclinical seizure models, acting mainly through the activation of the inhibitory neurotransmission and blocking the excitatory neurotransmission. Only star fruit has been identified as a pro-convulsant fruit due to its caramboxin and oxalate compounds. Future studies should focus more on utilizing these fruits as possible treatment strategies for epilepsy.
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Affiliation(s)
| | | | | | - Mohd. Farooq Shaikh
- Address correspondence to this author at the Neuropharmacology Research Laboratory, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Selangor, Malaysia; Tel/Fax: +60 3 5514 4483; E-mail:
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Tyagi A, Wu SY, Watabe K. Metabolism in the progression and metastasis of brain tumors. Cancer Lett 2022; 539:215713. [PMID: 35513201 PMCID: PMC9999298 DOI: 10.1016/j.canlet.2022.215713] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 04/21/2022] [Accepted: 04/22/2022] [Indexed: 01/30/2023]
Abstract
Malignant brain tumors and metastases pose significant health problems and cause substantial morbidity and mortality in children and adults. Based on epidemiological evidence, gliomas comprise 30% and 80% of primary brain tumors and malignant tumors, respectively. Brain metastases affect 15-30% of cancer patients, particularly primary tumors of the lung, breast, colon, and kidney, and melanoma. Despite advancements in multimodal molecular targeted therapy and immunotherapy that do not ensure long-term treatment, malignant brain tumors and metastases contribute significantly to cancer related mortality. Recent studies have shown that metastatic cancer cells possess distinct metabolic traits to adapt and survive in new environment that differs significantly from the primary site in both nutrient composition and availability. As metabolic regulation lies at the intersection of many research areas, concerted efforts to understand the metabolic mechanism(s) driving malignant brain tumors and metastases may reveal novel therapeutic targets to prevent or reduce metastasis and predict biomarkers for the treatment of this aggressive disease. This review focuses on various aspects of metabolic signaling, interface between metabolic regulators and cellular processes, and implications of their dysregulation in the context of brain tumors and metastases.
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Affiliation(s)
- Abhishek Tyagi
- Department of Cancer Biology, Wake Forest University School of Medicine, Winston-Salem, NC, 27157, USA
| | - Shih-Ying Wu
- Department of Cancer Biology, Wake Forest University School of Medicine, Winston-Salem, NC, 27157, USA
| | - Kounosuke Watabe
- Department of Cancer Biology, Wake Forest University School of Medicine, Winston-Salem, NC, 27157, USA.
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Cicek E, Sanlier N. The place of a ketogenic diet in the treatment of resistant epilepsy: a comprehensive review. Nutr Neurosci 2022:1-14. [PMID: 35791085 DOI: 10.1080/1028415x.2022.2095819] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Objective: The ketogenic diet (KD) is a high-fat, adequate-protein, and low-carb diet. Ketone bodies increase in the blood due to low carbohydrate content and high-fat content in the diet. The most important feature of the ketogenic diet is that it causes the production of ketone bodies in the liver. Ketone bodies are an alternative fuel to glucose for the brain and form the structure necessary for the cell membrane and biosynthesis of triglycerides. The ketogenic diet provides evidence on seizure control with anticonvulsant effects. In this review, the positive/negative effects of KD on seizure control, place, importance, quality of life, cognition, and behavior in the treatment of resistant epilepsy were examined.Methods: Scientific information on the subject was obtained from the literature accessed through databases such as MEDLINE, Embase, Web of Science, Cochrane Central, www.ClinicalTrials.gov, PubMed, Science Direct, and Google Scholar.Results: Although it has started to be used as a treatment method in many diseases today, the main area of effect of KD is drug-resistant epilepsy. In order for the ketogenic diet to be successful in these patients, it is necessary to choose the appropriate patient, medical treatment and diet plan, inform the patient sufficiently, and perform frequent monitoring in accordance with the follow-up criteria. It is argued that KD is one of the most effective treatments for epilepsy.Conclusion: The fact that KDs generally have a restricted diet pattern, the need for supplementation, biochemical findings and possible side effects raise the issue of diet sustainability. More clinical studies are needed to generalize.
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Affiliation(s)
- Ebru Cicek
- Ankara Medipol University, School of Health Sciences, Department of Nutrition and Dietetics, Ankara, Turkey
| | - Nevin Sanlier
- Ankara Medipol University, School of Health Sciences, Department of Nutrition and Dietetics, Ankara, Turkey
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Basolo A, Magno S, Santini F, Ceccarini G. Ketogenic Diet and Weight Loss: Is There an Effect on Energy Expenditure? Nutrients 2022; 14:nu14091814. [PMID: 35565778 PMCID: PMC9105638 DOI: 10.3390/nu14091814] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 04/23/2022] [Accepted: 04/24/2022] [Indexed: 02/01/2023] Open
Abstract
A dysregulation between energy intake (EI) and energy expenditure (EE), the two components of the energy balance equation, is one of the mechanisms responsible for the development of obesity. Conservation of energy equilibrium is deemed a dynamic process and alterations of one component (energy intake or energy expenditure) lead to biological and/or behavioral compensatory changes in the counterpart. The interplay between energy demand and caloric intake appears designed to guarantee an adequate fuel supply in variable life contexts. In the past decades, researchers focused their attention on finding efficient strategies to fight the obesity pandemic. The ketogenic or “keto” diet (KD) gained substantial consideration as a potential weight-loss strategy, whereby the concentration of blood ketones (acetoacetate, 3-β-hydroxybutyrate, and acetone) increases as a result of increased fatty acid breakdown and the activity of ketogenic enzymes. It has been hypothesized that during the first phase of KDs when glucose utilization is still prevalent, an increase in EE may occur, due to increased hepatic oxygen consumption for gluconeogenesis and for triglyceride-fatty acid recycling. Later, a decrease in 24-h EE may ensue due to the slowing of gluconeogenesis and increase in fatty acid oxidation, with a reduction of the respiratory quotient and possibly the direct action of additional hormonal signals.
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36
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Cai M, Xu W, Zheng Y, Ding M. Ketogenic dietary therapy in adult status epilepticus: current progress and clinical application. ACTA EPILEPTOLOGICA 2022. [DOI: 10.1186/s42494-022-00082-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
AbstractStatus epilepticus (SE) is a common fatal neurological disease with high morbidity and mortality. Even if a large proportion of patients might be relieved from anti-seizure medications, sedatives and anesthetics, some still remain out of control. The ketogenic dietary (KD) has been proven useful in patients refractory to medications and/or who have failed to respond to surgical intervention. Recently, KD has shown beneficial therapeutic effects in children with SE, but studies in adults have rarely been reported. In this paper, we review the efficacy and utility of KD in adult SE patients and highlight its application for clinical reference and management.
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Kalafut KC, Mitchell SJ, MacArthur MR, Mitchell JR. Short-Term Ketogenic Diet Induces a Molecular Response That Is Distinct From Dietary Protein Restriction. Front Nutr 2022; 9:839341. [PMID: 35433789 PMCID: PMC9005751 DOI: 10.3389/fnut.2022.839341] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 02/17/2022] [Indexed: 12/17/2022] Open
Abstract
There is increasing interest in utilizing short-term dietary interventions in the contexts of cancer, surgical stress and metabolic disease. These short-term diets may be more feasible than extended interventions and may be designed to complement existing therapies. In particular, the high-fat, low-carbohydrate ketogenic diet (KD), traditionally used to treat epilepsy, has gained popularity as a potential strategy for weight loss and improved metabolic health. In mice, long-term KD improves insulin sensitivity and may extend lifespan and healthspan. Dietary protein restriction (PR) causes increased energy expenditure, weight loss and improved glucose homeostasis. Since KD is inherently a low-protein diet (10% of calories from protein vs. >18% in control diet), here we evaluated the potential for mechanistic overlap between PR and KD via activation of a PR response. Mice were fed control, protein-free (PF), or one of four ketogenic diets with varying protein content for 8 days. PF and KD both decreased body weight, fat mass, and liver weights, and reduced fasting glucose and insulin levels, compared to mice fed the control diet. However, PF-fed animals had significantly improved insulin tolerance compared to KD. Furthermore, contrary to the PF-fed mice, mice fed ketogenic diets containing more than 5% of energy from protein did not increase hepatic Fgf21 or brown adipose Ucp1 expression. Interestingly, mice fed KD lacking protein demonstrated greater elevations in hepatic Fgf21 than mice fed a low-fat PF diet. To further elucidate potential mechanistic differences between PF and KD and the interplay between dietary protein and carbohydrate restriction, we conducted RNA-seq analysis on livers from mice fed each of the six diets and identified distinct gene sets which respond to dietary protein content, dietary fat content, and ketogenesis. We conclude that KD with 10% of energy from protein does not induce a protein restriction response, and that the overlapping metabolic benefits of KD and PF diets may occur via distinct underlying mechanisms.
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Affiliation(s)
- Krystle C. Kalafut
- Department of Molecular Metabolism, Harvard T. H. Chan School of Public Health, Boston, MA, United States
| | - Sarah J. Mitchell
- Department of Health Sciences and Technology, Swiss Federal Institute of Technology (ETH) Zürich, Zurich, Switzerland
| | - Michael R. MacArthur
- Department of Health Sciences and Technology, Swiss Federal Institute of Technology (ETH) Zürich, Zurich, Switzerland
| | - James R. Mitchell
- Department of Health Sciences and Technology, Swiss Federal Institute of Technology (ETH) Zürich, Zurich, Switzerland
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Pickel L, Iliuta IA, Scholey J, Pei Y, Sung HK. Dietary Interventions in Autosomal Dominant Polycystic Kidney Disease. Adv Nutr 2022; 13:652-666. [PMID: 34755831 PMCID: PMC8970828 DOI: 10.1093/advances/nmab131] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 10/12/2021] [Accepted: 11/02/2021] [Indexed: 12/22/2022] Open
Abstract
Autosomal dominant polycystic kidney disease (ADPKD) is characterized by the progressive growth of renal cysts, leading to the loss of functional nephrons. Recommendations for individuals with ADPKD to maintain a healthy diet and lifestyle are largely similar to those for the general population. However, recent evidence from preclinical models suggests that more tightly specified dietary regimens, including caloric restriction, intermittent fasting, and ketogenic diets, hold promise to slow disease progression, and the results of ongoing human clinical trials are eagerly awaited. These dietary interventions directly influence nutrient signaling and substrate availability in the cystic kidney, while also conferring systemic metabolic benefits. The present review focuses on the importance of local and systemic metabolism in ADPKD and summarizes current evidence for dietary interventions to slow disease progression and improve quality of life.
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Affiliation(s)
- Lauren Pickel
- Translational Medicine Program, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Ioan-Andrei Iliuta
- Division of Nephrology, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - James Scholey
- Division of Nephrology, University Health Network, University of Toronto, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - York Pei
- Division of Nephrology, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Hoon-Ki Sung
- Translational Medicine Program, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.
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Zhu H, Bi D, Zhang Y, Kong C, Du J, Wu X, Wei Q, Qin H. Ketogenic diet for human diseases: the underlying mechanisms and potential for clinical implementations. Signal Transduct Target Ther 2022; 7:11. [PMID: 35034957 PMCID: PMC8761750 DOI: 10.1038/s41392-021-00831-w] [Citation(s) in RCA: 100] [Impact Index Per Article: 50.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 10/21/2021] [Accepted: 11/09/2021] [Indexed: 02/06/2023] Open
Abstract
The ketogenic diet (KD) is a high-fat, adequate-protein, and very-low-carbohydrate diet regimen that mimics the metabolism of the fasting state to induce the production of ketone bodies. The KD has long been established as a remarkably successful dietary approach for the treatment of intractable epilepsy and has increasingly garnered research attention rapidly in the past decade, subject to emerging evidence of the promising therapeutic potential of the KD for various diseases, besides epilepsy, from obesity to malignancies. In this review, we summarize the experimental and/or clinical evidence of the efficacy and safety of the KD in different diseases, and discuss the possible mechanisms of action based on recent advances in understanding the influence of the KD at the cellular and molecular levels. We emphasize that the KD may function through multiple mechanisms, which remain to be further elucidated. The challenges and future directions for the clinical implementation of the KD in the treatment of a spectrum of diseases have been discussed. We suggest that, with encouraging evidence of therapeutic effects and increasing insights into the mechanisms of action, randomized controlled trials should be conducted to elucidate a foundation for the clinical use of the KD.
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Affiliation(s)
- Huiyuan Zhu
- Department of Pathology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Dexi Bi
- Department of Pathology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Youhua Zhang
- Department of Pathology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Cheng Kong
- Research Institute of Intestinal Diseases, Tongji University School of Medicine, Shanghai, China
- Department of Gastrointestinal Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jiahao Du
- Research Institute of Intestinal Diseases, Tongji University School of Medicine, Shanghai, China
| | - Xiawei Wu
- Research Institute of Intestinal Diseases, Tongji University School of Medicine, Shanghai, China
- Shanghai Clinical College, Anhui Medical University, Hefei, China
| | - Qing Wei
- Department of Pathology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.
| | - Huanlong Qin
- Research Institute of Intestinal Diseases, Tongji University School of Medicine, Shanghai, China.
- Department of Gastrointestinal Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.
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Ketogenic diet for epilepsy: an overview of systematic review and meta-analysis. Eur J Clin Nutr 2022; 76:1234-1244. [PMID: 35027683 DOI: 10.1038/s41430-021-01060-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 11/24/2021] [Accepted: 12/07/2021] [Indexed: 02/07/2023]
Abstract
Ketogenic diet therapy (KDT) is an established nonpharmacologic treatment in various types of epilepsy. We aim to evaluate the quality of the systematic reviews and meta-analyses (SRMAs) of KDT for epilepsy and summarize the evidence on their effects. We conducted an overview on MEDLINE, EMBASE, Cochrane Database of Systematic Review, and Web of Science from database inception to 3 September 2020. Two investigators independently performed study selection to include SRMAs, extracted data and assessed the quality of SRMAs with the AMSTAR-2 and PRISMA statement. Twenty-four SRMAs were selected which encompassed a total of 255 original studies. Four reviews assessed the effects of KDT on infant patients; thirteen reviews reported on children and adolescent patients; eight reviews focused on adults or all patients; four assessed cognitive and behavior outcomes; three assessed quality of life; two assessed growth and development outcomes; seventeen reported on adverse effects; seven reported on retention; ten reported on attrition and reasons; and four reported on death outcomes. Overall, positive effects of KDT for epilepsy on seizure frequency reduction, as well as cognition and behavior were observed. In contrast, the effects of KDT on quality of life, growth and development were more controversial. The present overview indicates that KDT is safe. The most prevalent adverse events were GI, weight loss, and metabolic disorders, while the most common reasons for discontinuance were the lack of observed efficacy and dietary intolerance.
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Šimončičová E, Gonçalves de Andrade E, Vecchiarelli HA, Awogbindin IO, Delage CI, Tremblay MÈ. Present and future of microglial pharmacology. Trends Pharmacol Sci 2022; 43:669-685. [PMID: 35031144 DOI: 10.1016/j.tips.2021.11.006] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 10/28/2021] [Accepted: 11/09/2021] [Indexed: 12/14/2022]
Abstract
Microglia, brain resident immune cells, modulate development, activity, and plasticity of the central nervous system. Mechanistically implicated in numerous neurological pathologies, microglia emerge as strong contenders for novel neurotherapies. Shifting away from merely an attenuation of excessive microglial inflammatory and phagocytic activities, current therapies aim toward targeting the complex context-dependent microglial heterogeneity, unveiled by large-scale genetic studies and emerging single-cell analyses. Although lacking the necessary selectivity, initial therapies attempting to target specific state-associated microglial properties and functions (e.g., inflammatory activity, phagocytosis, proliferation, metabolism, or surveillance) are currently under pre- or even clinical (Phase I-IV) investigation. Here, we provide an update on current microglial therapeutic research and discuss what the future in the field might look like.
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Affiliation(s)
- Eva Šimončičová
- Neuroscience Graduate Program, University of Victoria, Victoria, BC, Canada; Division of Medical Sciences, University of Victoria, Victoria, BC, Canada
| | - Elisa Gonçalves de Andrade
- Neuroscience Graduate Program, University of Victoria, Victoria, BC, Canada; Division of Medical Sciences, University of Victoria, Victoria, BC, Canada
| | | | - Ifeoluwa O Awogbindin
- Division of Medical Sciences, University of Victoria, Victoria, BC, Canada; Neuroimmunology Group, Molecular Drug Metabolism and Toxicology Laboratory, Department of Biochemistry, University of Ibadan, Ibadan, Nigeria
| | - Charlotte I Delage
- Division of Medical Sciences, University of Victoria, Victoria, BC, Canada
| | - Marie-Ève Tremblay
- Division of Medical Sciences, University of Victoria, Victoria, BC, Canada; Axe Neurosciences, Centre de Recherche du CHU de Québec, Université Laval, Québec City, QC, Canada; Neurology and Neurosurgery Department, McGill University, Montréal, QC, Canada; Department of Molecular Medicine, Université Laval, Québec City, QC, Canada; Department of Biochemistry and Molecular Biology, University of British Columbia, Vancouver, BC, Canada; Centre for Advanced Materials and Related Technology (CAMTEC), University of Victoria, Victoria, BC, Canada.
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Salvati KA, Ritger ML, Davoudian PA, O’Dell F, Wyskiel DR, Souza GMPR, Lu AC, Perez-Reyes E, Drake JC, Yan Z, Beenhakker MP. OUP accepted manuscript. Brain 2022; 145:2332-2346. [PMID: 35134125 PMCID: PMC9337815 DOI: 10.1093/brain/awac037] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 12/20/2021] [Accepted: 12/26/2021] [Indexed: 11/21/2022] Open
Abstract
Metabolism regulates neuronal activity and modulates the occurrence of epileptic seizures. Here, using two rodent models of absence epilepsy, we show that hypoglycaemia increases the occurrence of spike-wave seizures. We then show that selectively disrupting glycolysis in the thalamus, a structure implicated in absence epilepsy, is sufficient to increase spike-wave seizures. We propose that activation of thalamic AMP-activated protein kinase, a sensor of cellular energetic stress and potentiator of metabotropic GABAB-receptor function, is a significant driver of hypoglycaemia-induced spike-wave seizures. We show that AMP-activated protein kinase augments postsynaptic GABAB-receptor-mediated currents in thalamocortical neurons and strengthens epileptiform network activity evoked in thalamic brain slices. Selective thalamic AMP-activated protein kinase activation also increases spike-wave seizures. Finally, systemic administration of metformin, an AMP-activated protein kinase agonist and common diabetes treatment, profoundly increased spike-wave seizures. These results advance the decades-old observation that glucose metabolism regulates thalamocortical circuit excitability by demonstrating that AMP-activated protein kinase and GABAB-receptor cooperativity is sufficient to provoke spike-wave seizures.
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Affiliation(s)
- Kathryn A Salvati
- Department of Pharmacology, University of Virginia School of Medicine, Charlottesville, VA 22908, USA
- Epilepsy Research Laboratory and Weil Institute for Neurosciences, Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Matthew L Ritger
- Department of Pharmacology, University of Virginia School of Medicine, Charlottesville, VA 22908, USA
| | - Pasha A Davoudian
- Department of Pharmacology, University of Virginia School of Medicine, Charlottesville, VA 22908, USA
- MD-PhD Program, Yale University School of Medicine, New Haven, CT 06520, USA
| | - Finnegan O’Dell
- Department of Pharmacology, University of Virginia School of Medicine, Charlottesville, VA 22908, USA
| | - Daniel R Wyskiel
- Department of Pharmacology, University of Virginia School of Medicine, Charlottesville, VA 22908, USA
| | - George M P R Souza
- Department of Pharmacology, University of Virginia School of Medicine, Charlottesville, VA 22908, USA
| | - Adam C Lu
- Department of Pharmacology, University of Virginia School of Medicine, Charlottesville, VA 22908, USA
| | - Edward Perez-Reyes
- Department of Pharmacology, University of Virginia School of Medicine, Charlottesville, VA 22908, USA
| | - Joshua C Drake
- Department of Human Nutrition, Foods and Exercise, Virginia Polytechnic Institute and State University, Blacksburg, VA 24061, USA
- The Robert M. Berne Center for Cardiovascular Research Center, University of Virginia School of Medicine, Charlottesville, VA 22908, USA
| | - Zhen Yan
- Department of Pharmacology, University of Virginia School of Medicine, Charlottesville, VA 22908, USA
- The Robert M. Berne Center for Cardiovascular Research Center, University of Virginia School of Medicine, Charlottesville, VA 22908, USA
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA
- Department of Molecular Physiology and Biological Physics, University of Virginia School of Medicine, Charlottesville, VA 22908, USA
| | - Mark P Beenhakker
- Correspondence to: Mark P. Beenhakker Department of Pharmacology University of Virginia School of Medicine Charlottesville, VA, 22908, USA E-mail:
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The Role of Ketogenic Metabolic Therapy on the Brain in Serious Mental Illness: A Review. JOURNAL OF PSYCHIATRY AND BRAIN SCIENCE 2022; 7:e220009. [PMID: 36483840 PMCID: PMC9728807 DOI: 10.20900/jpbs.20220009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
In search of interventions targeting brain dysfunction and underlying cognitive impairment in schizophrenia, we look at the brain and beyond to the potential role of dysfunctional systemic metabolism on neural network instability and insulin resistance in serious mental illness. We note that disrupted insulin and cerebral glucose metabolism are seen even in medication-naïve first-episode schizophrenia, suggesting that people with schizophrenia are at risk for Type 2 diabetes and cardiovascular disease, resulting in a shortened life span. Although glucose is the brain's default fuel, ketones are a more efficient fuel for the brain. We highlight evidence that a ketogenic diet can improve both the metabolic and neural stability profiles. Specifically, a ketogenic diet improves mitochondrial metabolism, neurotransmitter function, oxidative stress/inflammation, while also increasing neural network stability and cognitive function. To reverse the neurodegenerative process, increasing the brain's access to ketone bodies may be needed. We describe evidence that metabolic, neuroprotective, and neurochemical benefits of a ketogenic diet potentially provide symptomatic relief to people with schizophrenia while also improving their cardiovascular or metabolic health. We review evidence for KD side effects and note that although high in fat it improves various cardiovascular and metabolic risk markers in overweight/obese individuals. We conclude by calling for controlled clinical trials to confirm or refute the findings from anecdotal and case reports to address the potential beneficial effects of the ketogenic diet in people with serious mental illness.
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Kaul N, Laing J, Nicolo JP, Nation J, Kwan P, O'Brien TJ. Practical Considerations for Ketogenic Diet in Adults With Super-Refractory Status Epilepticus. Neurol Clin Pract 2021; 11:438-444. [PMID: 34840870 DOI: 10.1212/cpj.0000000000001009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 10/05/2020] [Indexed: 01/04/2023]
Abstract
Purpose of Review Ketogenic diet therapy can be used as an adjuvant treatment of super-refractory status epilepticus (SRSE). However, the drug and metabolic interactions with concomitant treatments present a challenge for clinicians. In this review, we focus on the practical considerations of implementing ketogenic dietary therapy in the acute setting, including the dietary composition, potential drug-diet interactions, and monitoring during ketogenic treatment. Recent Findings This report describes the ketogenic diet therapy protocol implemented for the treatment of SRSE and a review of the current evidence to support clinical practice. Summary The control of SRSE is critical in reducing morbidity and mortality. There is emerging evidence that ketogenic diet may be a safe and effective treatment option for these patients.
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Affiliation(s)
- Neha Kaul
- Department of Allied Health (Clinical Nutrition) (NK), Royal Melbourne Hospital; Department of Nutrition and Dietetics, (NK) Alfred Hospital; Departments of Medicine and Neurology (NK, J-PN, JN, PK, TJO), Royal Melbourne Hospital, University of Melbourne; and Departments of Neurosciences and Neurology (NK, JL, J-PN, PK, TJO), Alfred Hospital and Monash University, Melbourne, Australia
| | - Joshua Laing
- Department of Allied Health (Clinical Nutrition) (NK), Royal Melbourne Hospital; Department of Nutrition and Dietetics, (NK) Alfred Hospital; Departments of Medicine and Neurology (NK, J-PN, JN, PK, TJO), Royal Melbourne Hospital, University of Melbourne; and Departments of Neurosciences and Neurology (NK, JL, J-PN, PK, TJO), Alfred Hospital and Monash University, Melbourne, Australia
| | - John-Paul Nicolo
- Department of Allied Health (Clinical Nutrition) (NK), Royal Melbourne Hospital; Department of Nutrition and Dietetics, (NK) Alfred Hospital; Departments of Medicine and Neurology (NK, J-PN, JN, PK, TJO), Royal Melbourne Hospital, University of Melbourne; and Departments of Neurosciences and Neurology (NK, JL, J-PN, PK, TJO), Alfred Hospital and Monash University, Melbourne, Australia
| | - Judy Nation
- Department of Allied Health (Clinical Nutrition) (NK), Royal Melbourne Hospital; Department of Nutrition and Dietetics, (NK) Alfred Hospital; Departments of Medicine and Neurology (NK, J-PN, JN, PK, TJO), Royal Melbourne Hospital, University of Melbourne; and Departments of Neurosciences and Neurology (NK, JL, J-PN, PK, TJO), Alfred Hospital and Monash University, Melbourne, Australia
| | - Patrick Kwan
- Department of Allied Health (Clinical Nutrition) (NK), Royal Melbourne Hospital; Department of Nutrition and Dietetics, (NK) Alfred Hospital; Departments of Medicine and Neurology (NK, J-PN, JN, PK, TJO), Royal Melbourne Hospital, University of Melbourne; and Departments of Neurosciences and Neurology (NK, JL, J-PN, PK, TJO), Alfred Hospital and Monash University, Melbourne, Australia
| | - Terence J O'Brien
- Department of Allied Health (Clinical Nutrition) (NK), Royal Melbourne Hospital; Department of Nutrition and Dietetics, (NK) Alfred Hospital; Departments of Medicine and Neurology (NK, J-PN, JN, PK, TJO), Royal Melbourne Hospital, University of Melbourne; and Departments of Neurosciences and Neurology (NK, JL, J-PN, PK, TJO), Alfred Hospital and Monash University, Melbourne, Australia
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Bonilla-Jaime H, Zeleke H, Rojas A, Espinosa-Garcia C. Sleep Disruption Worsens Seizures: Neuroinflammation as a Potential Mechanistic Link. Int J Mol Sci 2021; 22:12531. [PMID: 34830412 PMCID: PMC8617844 DOI: 10.3390/ijms222212531] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 11/16/2021] [Accepted: 11/18/2021] [Indexed: 12/13/2022] Open
Abstract
Sleep disturbances, such as insomnia, obstructive sleep apnea, and daytime sleepiness, are common in people diagnosed with epilepsy. These disturbances can be attributed to nocturnal seizures, psychosocial factors, and/or the use of anti-epileptic drugs with sleep-modifying side effects. Epilepsy patients with poor sleep quality have intensified seizure frequency and disease progression compared to their well-rested counterparts. A better understanding of the complex relationship between sleep and epilepsy is needed, since approximately 20% of seizures and more than 90% of sudden unexpected deaths in epilepsy occur during sleep. Emerging studies suggest that neuroinflammation, (e.g., the CNS immune response characterized by the change in expression of inflammatory mediators and glial activation) may be a potential link between sleep deprivation and seizures. Here, we review the mechanisms by which sleep deprivation induces neuroinflammation and propose that neuroinflammation synergizes with seizure activity to worsen neurodegeneration in the epileptic brain. Additionally, we highlight the relevance of sleep interventions, often overlooked by physicians, to manage seizures, prevent epilepsy-related mortality, and improve quality of life.
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Affiliation(s)
- Herlinda Bonilla-Jaime
- Departamento de Biología de la Reproducción, Área de Biología Conductual y Reproductiva, Universidad Autónoma Metropolitana-Iztapalapa, Ciudad de Mexico CP 09340, Mexico;
| | - Helena Zeleke
- Neuroscience and Behavioral Biology Program, College of Arts and Sciences, Emory University, Atlanta, GA 30322, USA;
| | - Asheebo Rojas
- Department of Pharmacology and Chemical Biology, School of Medicine, Emory University, Atlanta, GA 30322, USA
| | - Claudia Espinosa-Garcia
- Department of Pharmacology and Chemical Biology, School of Medicine, Emory University, Atlanta, GA 30322, USA
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47
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Иванникова ЕВ, Алташина МВ, Трошина ЕА. [The ketogenic diet: history, mechanism of action, indications and contraindications]. PROBLEMY ENDOKRINOLOGII 2021; 68:49-72. [PMID: 35262297 PMCID: PMC9761873 DOI: 10.14341/probl12724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 10/20/2021] [Accepted: 11/01/2021] [Indexed: 01/09/2023]
Abstract
Low-carb diets have been successfully used to alleviate a number of severe neurological diseases for about 100 years. The publication of the results of new studies suggesting that this type of diet may play a therapeutic role in other pathologies such as diabetes, obesity, polycystic ovary syndrome, and oncology is of particular interest for both doctors and the public. However, the long-term safety of using a low-carb or ketogenic diet, as well as its impact, primarily on the risks of developing cardiovascular diseases, remains poorly studied. This article presents the results of observation of patients against the background of a low-carbohydrate diet, both in the short-term perspective as well as provides an assessment of its long-term consequences.
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Affiliation(s)
| | - М. В. Алташина
- Национальный медицинский исследовательский центр
эндокринологии
| | - Е. А. Трошина
- Национальный медицинский исследовательский центр
эндокринологии
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48
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Cervenka MC, Wood S, Bagary M, Balabanov A, Bercovici E, Brown MG, Devinsky O, Di Lorenzo C, Doherty CP, Felton E, Healy LA, Klein P, Kverneland M, Lambrechts D, Langer J, Nathan J, Munn J, Nguyen P, Phillips M, Roehl K, Tanner A, Williams C, Zupec-Kania B. International Recommendations for the Management of Adults Treated With Ketogenic Diet Therapies. Neurol Clin Pract 2021; 11:385-397. [PMID: 34840865 PMCID: PMC8610544 DOI: 10.1212/cpj.0000000000001007] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 10/16/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To evaluate current clinical practices and evidence-based literature to establish preliminary recommendations for the management of adults using ketogenic diet therapies (KDTs). METHODS A 12-topic survey was distributed to international experts on KDTs in adults consisting of neurologists and dietitians at medical institutions providing KDTs to adults with epilepsy and other neurologic disorders. Panel survey responses were tabulated by the authors to determine the common and disparate practices between institutions and to compare these practices in adults with KDT recommendations in children and the medical literature. Recommendations are based on a combination of clinical evidence and expert opinion regarding management of KDTs. RESULTS Surveys were obtained from 20 medical institutions with >2,000 adult patients treated with KDTs for epilepsy or other neurologic disorders. Common side effects reported are similar to those observed in children, and recommendations for management are comparable with important distinctions, which are emphasized. Institutions differ with regard to recommended biochemical assessment, screening, monitoring, and concern for long-term side effects, and further investigation is warranted to determine the optimal clinical management. Differences also exist between screening and monitoring practices among adult and pediatric providers. CONCLUSIONS KDTs may be safe and effective in treating adults with drug-resistant epilepsy, and there is emerging evidence supporting the use in other adult neurologic disorders and general medical conditions as well. Therefore, expert recommendations to guide optimal care are critical as well as further evidence-based investigation.
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Affiliation(s)
- Mackenzie C Cervenka
- Department of Neurology (MCC), Johns Hopkins University School of Medicine, Baltimore, MD; Matthew's Friends Clinics for Ketogenic Dietary Therapies (SW), Lingfield, Surrey, United Kingdom; Complex Epilepsy and Sleep Service (MB, JM), The Barberry, Birmingham, United Kingdom; Department of Neurology (AB, KR), Rush University Medical Center, Chicago, IL; Department of Neurology (EB), University of Toronto, Ontario, Canada; Department of Neurology (M-GB), University of Colorado, Denver; Department of Neurology (OD), New York University School of Medicine; Department of Medico-Surgical Sciences and Biotechnologies (CDL), Sapienza University of Rome Polo Pontino, Italy; Academic Unit of Neurology (CPD), Trinity College Dublin & FutureNeuro, Ireland; Department of Neurology (EF), UW Health, Madison; Department of Clinical Nutrition (LAH), St James' Hospital, Dublin, Ireland; Mid-Atlantic Epilepsy and Sleep Center (PK), Bethesda, MD; National Center for Epilepsy (MK), Oslo, Norway; Department of Neurology (DL), Academic Center for Epileptology, Kempenhaeghe and Maastricht University Medical Center, Heeze, The Netherlands; Department of Neurology (JL), University of Virginia, Charlottesville; Department of Neurology (JN), Shushrusha Hospital, Mumbai, India; Charles Dent Metabolic Unit (PN), University College London Hospitals NHS Foundation Trust, United Kingdom; Department of Neurology (MP), Waikato Hospital, Hamilton, New Zealand; Mercy Health Hauenstein Neurosciences (AT), Grand Rapids, MI; Department of Dietetics and Foodservices (CW), Mater Group, South Brisbane, QLD, Australia; and The Charlie Foundation for Ketogenic Therapies (BZ-K), Santa Monica, CA
| | - Susan Wood
- Department of Neurology (MCC), Johns Hopkins University School of Medicine, Baltimore, MD; Matthew's Friends Clinics for Ketogenic Dietary Therapies (SW), Lingfield, Surrey, United Kingdom; Complex Epilepsy and Sleep Service (MB, JM), The Barberry, Birmingham, United Kingdom; Department of Neurology (AB, KR), Rush University Medical Center, Chicago, IL; Department of Neurology (EB), University of Toronto, Ontario, Canada; Department of Neurology (M-GB), University of Colorado, Denver; Department of Neurology (OD), New York University School of Medicine; Department of Medico-Surgical Sciences and Biotechnologies (CDL), Sapienza University of Rome Polo Pontino, Italy; Academic Unit of Neurology (CPD), Trinity College Dublin & FutureNeuro, Ireland; Department of Neurology (EF), UW Health, Madison; Department of Clinical Nutrition (LAH), St James' Hospital, Dublin, Ireland; Mid-Atlantic Epilepsy and Sleep Center (PK), Bethesda, MD; National Center for Epilepsy (MK), Oslo, Norway; Department of Neurology (DL), Academic Center for Epileptology, Kempenhaeghe and Maastricht University Medical Center, Heeze, The Netherlands; Department of Neurology (JL), University of Virginia, Charlottesville; Department of Neurology (JN), Shushrusha Hospital, Mumbai, India; Charles Dent Metabolic Unit (PN), University College London Hospitals NHS Foundation Trust, United Kingdom; Department of Neurology (MP), Waikato Hospital, Hamilton, New Zealand; Mercy Health Hauenstein Neurosciences (AT), Grand Rapids, MI; Department of Dietetics and Foodservices (CW), Mater Group, South Brisbane, QLD, Australia; and The Charlie Foundation for Ketogenic Therapies (BZ-K), Santa Monica, CA
| | - Manny Bagary
- Department of Neurology (MCC), Johns Hopkins University School of Medicine, Baltimore, MD; Matthew's Friends Clinics for Ketogenic Dietary Therapies (SW), Lingfield, Surrey, United Kingdom; Complex Epilepsy and Sleep Service (MB, JM), The Barberry, Birmingham, United Kingdom; Department of Neurology (AB, KR), Rush University Medical Center, Chicago, IL; Department of Neurology (EB), University of Toronto, Ontario, Canada; Department of Neurology (M-GB), University of Colorado, Denver; Department of Neurology (OD), New York University School of Medicine; Department of Medico-Surgical Sciences and Biotechnologies (CDL), Sapienza University of Rome Polo Pontino, Italy; Academic Unit of Neurology (CPD), Trinity College Dublin & FutureNeuro, Ireland; Department of Neurology (EF), UW Health, Madison; Department of Clinical Nutrition (LAH), St James' Hospital, Dublin, Ireland; Mid-Atlantic Epilepsy and Sleep Center (PK), Bethesda, MD; National Center for Epilepsy (MK), Oslo, Norway; Department of Neurology (DL), Academic Center for Epileptology, Kempenhaeghe and Maastricht University Medical Center, Heeze, The Netherlands; Department of Neurology (JL), University of Virginia, Charlottesville; Department of Neurology (JN), Shushrusha Hospital, Mumbai, India; Charles Dent Metabolic Unit (PN), University College London Hospitals NHS Foundation Trust, United Kingdom; Department of Neurology (MP), Waikato Hospital, Hamilton, New Zealand; Mercy Health Hauenstein Neurosciences (AT), Grand Rapids, MI; Department of Dietetics and Foodservices (CW), Mater Group, South Brisbane, QLD, Australia; and The Charlie Foundation for Ketogenic Therapies (BZ-K), Santa Monica, CA
| | - Antoaneta Balabanov
- Department of Neurology (MCC), Johns Hopkins University School of Medicine, Baltimore, MD; Matthew's Friends Clinics for Ketogenic Dietary Therapies (SW), Lingfield, Surrey, United Kingdom; Complex Epilepsy and Sleep Service (MB, JM), The Barberry, Birmingham, United Kingdom; Department of Neurology (AB, KR), Rush University Medical Center, Chicago, IL; Department of Neurology (EB), University of Toronto, Ontario, Canada; Department of Neurology (M-GB), University of Colorado, Denver; Department of Neurology (OD), New York University School of Medicine; Department of Medico-Surgical Sciences and Biotechnologies (CDL), Sapienza University of Rome Polo Pontino, Italy; Academic Unit of Neurology (CPD), Trinity College Dublin & FutureNeuro, Ireland; Department of Neurology (EF), UW Health, Madison; Department of Clinical Nutrition (LAH), St James' Hospital, Dublin, Ireland; Mid-Atlantic Epilepsy and Sleep Center (PK), Bethesda, MD; National Center for Epilepsy (MK), Oslo, Norway; Department of Neurology (DL), Academic Center for Epileptology, Kempenhaeghe and Maastricht University Medical Center, Heeze, The Netherlands; Department of Neurology (JL), University of Virginia, Charlottesville; Department of Neurology (JN), Shushrusha Hospital, Mumbai, India; Charles Dent Metabolic Unit (PN), University College London Hospitals NHS Foundation Trust, United Kingdom; Department of Neurology (MP), Waikato Hospital, Hamilton, New Zealand; Mercy Health Hauenstein Neurosciences (AT), Grand Rapids, MI; Department of Dietetics and Foodservices (CW), Mater Group, South Brisbane, QLD, Australia; and The Charlie Foundation for Ketogenic Therapies (BZ-K), Santa Monica, CA
| | - Eduard Bercovici
- Department of Neurology (MCC), Johns Hopkins University School of Medicine, Baltimore, MD; Matthew's Friends Clinics for Ketogenic Dietary Therapies (SW), Lingfield, Surrey, United Kingdom; Complex Epilepsy and Sleep Service (MB, JM), The Barberry, Birmingham, United Kingdom; Department of Neurology (AB, KR), Rush University Medical Center, Chicago, IL; Department of Neurology (EB), University of Toronto, Ontario, Canada; Department of Neurology (M-GB), University of Colorado, Denver; Department of Neurology (OD), New York University School of Medicine; Department of Medico-Surgical Sciences and Biotechnologies (CDL), Sapienza University of Rome Polo Pontino, Italy; Academic Unit of Neurology (CPD), Trinity College Dublin & FutureNeuro, Ireland; Department of Neurology (EF), UW Health, Madison; Department of Clinical Nutrition (LAH), St James' Hospital, Dublin, Ireland; Mid-Atlantic Epilepsy and Sleep Center (PK), Bethesda, MD; National Center for Epilepsy (MK), Oslo, Norway; Department of Neurology (DL), Academic Center for Epileptology, Kempenhaeghe and Maastricht University Medical Center, Heeze, The Netherlands; Department of Neurology (JL), University of Virginia, Charlottesville; Department of Neurology (JN), Shushrusha Hospital, Mumbai, India; Charles Dent Metabolic Unit (PN), University College London Hospitals NHS Foundation Trust, United Kingdom; Department of Neurology (MP), Waikato Hospital, Hamilton, New Zealand; Mercy Health Hauenstein Neurosciences (AT), Grand Rapids, MI; Department of Dietetics and Foodservices (CW), Mater Group, South Brisbane, QLD, Australia; and The Charlie Foundation for Ketogenic Therapies (BZ-K), Santa Monica, CA
| | - Mesha-Gay Brown
- Department of Neurology (MCC), Johns Hopkins University School of Medicine, Baltimore, MD; Matthew's Friends Clinics for Ketogenic Dietary Therapies (SW), Lingfield, Surrey, United Kingdom; Complex Epilepsy and Sleep Service (MB, JM), The Barberry, Birmingham, United Kingdom; Department of Neurology (AB, KR), Rush University Medical Center, Chicago, IL; Department of Neurology (EB), University of Toronto, Ontario, Canada; Department of Neurology (M-GB), University of Colorado, Denver; Department of Neurology (OD), New York University School of Medicine; Department of Medico-Surgical Sciences and Biotechnologies (CDL), Sapienza University of Rome Polo Pontino, Italy; Academic Unit of Neurology (CPD), Trinity College Dublin & FutureNeuro, Ireland; Department of Neurology (EF), UW Health, Madison; Department of Clinical Nutrition (LAH), St James' Hospital, Dublin, Ireland; Mid-Atlantic Epilepsy and Sleep Center (PK), Bethesda, MD; National Center for Epilepsy (MK), Oslo, Norway; Department of Neurology (DL), Academic Center for Epileptology, Kempenhaeghe and Maastricht University Medical Center, Heeze, The Netherlands; Department of Neurology (JL), University of Virginia, Charlottesville; Department of Neurology (JN), Shushrusha Hospital, Mumbai, India; Charles Dent Metabolic Unit (PN), University College London Hospitals NHS Foundation Trust, United Kingdom; Department of Neurology (MP), Waikato Hospital, Hamilton, New Zealand; Mercy Health Hauenstein Neurosciences (AT), Grand Rapids, MI; Department of Dietetics and Foodservices (CW), Mater Group, South Brisbane, QLD, Australia; and The Charlie Foundation for Ketogenic Therapies (BZ-K), Santa Monica, CA
| | - Orrin Devinsky
- Department of Neurology (MCC), Johns Hopkins University School of Medicine, Baltimore, MD; Matthew's Friends Clinics for Ketogenic Dietary Therapies (SW), Lingfield, Surrey, United Kingdom; Complex Epilepsy and Sleep Service (MB, JM), The Barberry, Birmingham, United Kingdom; Department of Neurology (AB, KR), Rush University Medical Center, Chicago, IL; Department of Neurology (EB), University of Toronto, Ontario, Canada; Department of Neurology (M-GB), University of Colorado, Denver; Department of Neurology (OD), New York University School of Medicine; Department of Medico-Surgical Sciences and Biotechnologies (CDL), Sapienza University of Rome Polo Pontino, Italy; Academic Unit of Neurology (CPD), Trinity College Dublin & FutureNeuro, Ireland; Department of Neurology (EF), UW Health, Madison; Department of Clinical Nutrition (LAH), St James' Hospital, Dublin, Ireland; Mid-Atlantic Epilepsy and Sleep Center (PK), Bethesda, MD; National Center for Epilepsy (MK), Oslo, Norway; Department of Neurology (DL), Academic Center for Epileptology, Kempenhaeghe and Maastricht University Medical Center, Heeze, The Netherlands; Department of Neurology (JL), University of Virginia, Charlottesville; Department of Neurology (JN), Shushrusha Hospital, Mumbai, India; Charles Dent Metabolic Unit (PN), University College London Hospitals NHS Foundation Trust, United Kingdom; Department of Neurology (MP), Waikato Hospital, Hamilton, New Zealand; Mercy Health Hauenstein Neurosciences (AT), Grand Rapids, MI; Department of Dietetics and Foodservices (CW), Mater Group, South Brisbane, QLD, Australia; and The Charlie Foundation for Ketogenic Therapies (BZ-K), Santa Monica, CA
| | - Cherubino Di Lorenzo
- Department of Neurology (MCC), Johns Hopkins University School of Medicine, Baltimore, MD; Matthew's Friends Clinics for Ketogenic Dietary Therapies (SW), Lingfield, Surrey, United Kingdom; Complex Epilepsy and Sleep Service (MB, JM), The Barberry, Birmingham, United Kingdom; Department of Neurology (AB, KR), Rush University Medical Center, Chicago, IL; Department of Neurology (EB), University of Toronto, Ontario, Canada; Department of Neurology (M-GB), University of Colorado, Denver; Department of Neurology (OD), New York University School of Medicine; Department of Medico-Surgical Sciences and Biotechnologies (CDL), Sapienza University of Rome Polo Pontino, Italy; Academic Unit of Neurology (CPD), Trinity College Dublin & FutureNeuro, Ireland; Department of Neurology (EF), UW Health, Madison; Department of Clinical Nutrition (LAH), St James' Hospital, Dublin, Ireland; Mid-Atlantic Epilepsy and Sleep Center (PK), Bethesda, MD; National Center for Epilepsy (MK), Oslo, Norway; Department of Neurology (DL), Academic Center for Epileptology, Kempenhaeghe and Maastricht University Medical Center, Heeze, The Netherlands; Department of Neurology (JL), University of Virginia, Charlottesville; Department of Neurology (JN), Shushrusha Hospital, Mumbai, India; Charles Dent Metabolic Unit (PN), University College London Hospitals NHS Foundation Trust, United Kingdom; Department of Neurology (MP), Waikato Hospital, Hamilton, New Zealand; Mercy Health Hauenstein Neurosciences (AT), Grand Rapids, MI; Department of Dietetics and Foodservices (CW), Mater Group, South Brisbane, QLD, Australia; and The Charlie Foundation for Ketogenic Therapies (BZ-K), Santa Monica, CA
| | - Colin P Doherty
- Department of Neurology (MCC), Johns Hopkins University School of Medicine, Baltimore, MD; Matthew's Friends Clinics for Ketogenic Dietary Therapies (SW), Lingfield, Surrey, United Kingdom; Complex Epilepsy and Sleep Service (MB, JM), The Barberry, Birmingham, United Kingdom; Department of Neurology (AB, KR), Rush University Medical Center, Chicago, IL; Department of Neurology (EB), University of Toronto, Ontario, Canada; Department of Neurology (M-GB), University of Colorado, Denver; Department of Neurology (OD), New York University School of Medicine; Department of Medico-Surgical Sciences and Biotechnologies (CDL), Sapienza University of Rome Polo Pontino, Italy; Academic Unit of Neurology (CPD), Trinity College Dublin & FutureNeuro, Ireland; Department of Neurology (EF), UW Health, Madison; Department of Clinical Nutrition (LAH), St James' Hospital, Dublin, Ireland; Mid-Atlantic Epilepsy and Sleep Center (PK), Bethesda, MD; National Center for Epilepsy (MK), Oslo, Norway; Department of Neurology (DL), Academic Center for Epileptology, Kempenhaeghe and Maastricht University Medical Center, Heeze, The Netherlands; Department of Neurology (JL), University of Virginia, Charlottesville; Department of Neurology (JN), Shushrusha Hospital, Mumbai, India; Charles Dent Metabolic Unit (PN), University College London Hospitals NHS Foundation Trust, United Kingdom; Department of Neurology (MP), Waikato Hospital, Hamilton, New Zealand; Mercy Health Hauenstein Neurosciences (AT), Grand Rapids, MI; Department of Dietetics and Foodservices (CW), Mater Group, South Brisbane, QLD, Australia; and The Charlie Foundation for Ketogenic Therapies (BZ-K), Santa Monica, CA
| | - Elizabeth Felton
- Department of Neurology (MCC), Johns Hopkins University School of Medicine, Baltimore, MD; Matthew's Friends Clinics for Ketogenic Dietary Therapies (SW), Lingfield, Surrey, United Kingdom; Complex Epilepsy and Sleep Service (MB, JM), The Barberry, Birmingham, United Kingdom; Department of Neurology (AB, KR), Rush University Medical Center, Chicago, IL; Department of Neurology (EB), University of Toronto, Ontario, Canada; Department of Neurology (M-GB), University of Colorado, Denver; Department of Neurology (OD), New York University School of Medicine; Department of Medico-Surgical Sciences and Biotechnologies (CDL), Sapienza University of Rome Polo Pontino, Italy; Academic Unit of Neurology (CPD), Trinity College Dublin & FutureNeuro, Ireland; Department of Neurology (EF), UW Health, Madison; Department of Clinical Nutrition (LAH), St James' Hospital, Dublin, Ireland; Mid-Atlantic Epilepsy and Sleep Center (PK), Bethesda, MD; National Center for Epilepsy (MK), Oslo, Norway; Department of Neurology (DL), Academic Center for Epileptology, Kempenhaeghe and Maastricht University Medical Center, Heeze, The Netherlands; Department of Neurology (JL), University of Virginia, Charlottesville; Department of Neurology (JN), Shushrusha Hospital, Mumbai, India; Charles Dent Metabolic Unit (PN), University College London Hospitals NHS Foundation Trust, United Kingdom; Department of Neurology (MP), Waikato Hospital, Hamilton, New Zealand; Mercy Health Hauenstein Neurosciences (AT), Grand Rapids, MI; Department of Dietetics and Foodservices (CW), Mater Group, South Brisbane, QLD, Australia; and The Charlie Foundation for Ketogenic Therapies (BZ-K), Santa Monica, CA
| | - Laura A Healy
- Department of Neurology (MCC), Johns Hopkins University School of Medicine, Baltimore, MD; Matthew's Friends Clinics for Ketogenic Dietary Therapies (SW), Lingfield, Surrey, United Kingdom; Complex Epilepsy and Sleep Service (MB, JM), The Barberry, Birmingham, United Kingdom; Department of Neurology (AB, KR), Rush University Medical Center, Chicago, IL; Department of Neurology (EB), University of Toronto, Ontario, Canada; Department of Neurology (M-GB), University of Colorado, Denver; Department of Neurology (OD), New York University School of Medicine; Department of Medico-Surgical Sciences and Biotechnologies (CDL), Sapienza University of Rome Polo Pontino, Italy; Academic Unit of Neurology (CPD), Trinity College Dublin & FutureNeuro, Ireland; Department of Neurology (EF), UW Health, Madison; Department of Clinical Nutrition (LAH), St James' Hospital, Dublin, Ireland; Mid-Atlantic Epilepsy and Sleep Center (PK), Bethesda, MD; National Center for Epilepsy (MK), Oslo, Norway; Department of Neurology (DL), Academic Center for Epileptology, Kempenhaeghe and Maastricht University Medical Center, Heeze, The Netherlands; Department of Neurology (JL), University of Virginia, Charlottesville; Department of Neurology (JN), Shushrusha Hospital, Mumbai, India; Charles Dent Metabolic Unit (PN), University College London Hospitals NHS Foundation Trust, United Kingdom; Department of Neurology (MP), Waikato Hospital, Hamilton, New Zealand; Mercy Health Hauenstein Neurosciences (AT), Grand Rapids, MI; Department of Dietetics and Foodservices (CW), Mater Group, South Brisbane, QLD, Australia; and The Charlie Foundation for Ketogenic Therapies (BZ-K), Santa Monica, CA
| | - Pavel Klein
- Department of Neurology (MCC), Johns Hopkins University School of Medicine, Baltimore, MD; Matthew's Friends Clinics for Ketogenic Dietary Therapies (SW), Lingfield, Surrey, United Kingdom; Complex Epilepsy and Sleep Service (MB, JM), The Barberry, Birmingham, United Kingdom; Department of Neurology (AB, KR), Rush University Medical Center, Chicago, IL; Department of Neurology (EB), University of Toronto, Ontario, Canada; Department of Neurology (M-GB), University of Colorado, Denver; Department of Neurology (OD), New York University School of Medicine; Department of Medico-Surgical Sciences and Biotechnologies (CDL), Sapienza University of Rome Polo Pontino, Italy; Academic Unit of Neurology (CPD), Trinity College Dublin & FutureNeuro, Ireland; Department of Neurology (EF), UW Health, Madison; Department of Clinical Nutrition (LAH), St James' Hospital, Dublin, Ireland; Mid-Atlantic Epilepsy and Sleep Center (PK), Bethesda, MD; National Center for Epilepsy (MK), Oslo, Norway; Department of Neurology (DL), Academic Center for Epileptology, Kempenhaeghe and Maastricht University Medical Center, Heeze, The Netherlands; Department of Neurology (JL), University of Virginia, Charlottesville; Department of Neurology (JN), Shushrusha Hospital, Mumbai, India; Charles Dent Metabolic Unit (PN), University College London Hospitals NHS Foundation Trust, United Kingdom; Department of Neurology (MP), Waikato Hospital, Hamilton, New Zealand; Mercy Health Hauenstein Neurosciences (AT), Grand Rapids, MI; Department of Dietetics and Foodservices (CW), Mater Group, South Brisbane, QLD, Australia; and The Charlie Foundation for Ketogenic Therapies (BZ-K), Santa Monica, CA
| | - Magnhild Kverneland
- Department of Neurology (MCC), Johns Hopkins University School of Medicine, Baltimore, MD; Matthew's Friends Clinics for Ketogenic Dietary Therapies (SW), Lingfield, Surrey, United Kingdom; Complex Epilepsy and Sleep Service (MB, JM), The Barberry, Birmingham, United Kingdom; Department of Neurology (AB, KR), Rush University Medical Center, Chicago, IL; Department of Neurology (EB), University of Toronto, Ontario, Canada; Department of Neurology (M-GB), University of Colorado, Denver; Department of Neurology (OD), New York University School of Medicine; Department of Medico-Surgical Sciences and Biotechnologies (CDL), Sapienza University of Rome Polo Pontino, Italy; Academic Unit of Neurology (CPD), Trinity College Dublin & FutureNeuro, Ireland; Department of Neurology (EF), UW Health, Madison; Department of Clinical Nutrition (LAH), St James' Hospital, Dublin, Ireland; Mid-Atlantic Epilepsy and Sleep Center (PK), Bethesda, MD; National Center for Epilepsy (MK), Oslo, Norway; Department of Neurology (DL), Academic Center for Epileptology, Kempenhaeghe and Maastricht University Medical Center, Heeze, The Netherlands; Department of Neurology (JL), University of Virginia, Charlottesville; Department of Neurology (JN), Shushrusha Hospital, Mumbai, India; Charles Dent Metabolic Unit (PN), University College London Hospitals NHS Foundation Trust, United Kingdom; Department of Neurology (MP), Waikato Hospital, Hamilton, New Zealand; Mercy Health Hauenstein Neurosciences (AT), Grand Rapids, MI; Department of Dietetics and Foodservices (CW), Mater Group, South Brisbane, QLD, Australia; and The Charlie Foundation for Ketogenic Therapies (BZ-K), Santa Monica, CA
| | - Danielle Lambrechts
- Department of Neurology (MCC), Johns Hopkins University School of Medicine, Baltimore, MD; Matthew's Friends Clinics for Ketogenic Dietary Therapies (SW), Lingfield, Surrey, United Kingdom; Complex Epilepsy and Sleep Service (MB, JM), The Barberry, Birmingham, United Kingdom; Department of Neurology (AB, KR), Rush University Medical Center, Chicago, IL; Department of Neurology (EB), University of Toronto, Ontario, Canada; Department of Neurology (M-GB), University of Colorado, Denver; Department of Neurology (OD), New York University School of Medicine; Department of Medico-Surgical Sciences and Biotechnologies (CDL), Sapienza University of Rome Polo Pontino, Italy; Academic Unit of Neurology (CPD), Trinity College Dublin & FutureNeuro, Ireland; Department of Neurology (EF), UW Health, Madison; Department of Clinical Nutrition (LAH), St James' Hospital, Dublin, Ireland; Mid-Atlantic Epilepsy and Sleep Center (PK), Bethesda, MD; National Center for Epilepsy (MK), Oslo, Norway; Department of Neurology (DL), Academic Center for Epileptology, Kempenhaeghe and Maastricht University Medical Center, Heeze, The Netherlands; Department of Neurology (JL), University of Virginia, Charlottesville; Department of Neurology (JN), Shushrusha Hospital, Mumbai, India; Charles Dent Metabolic Unit (PN), University College London Hospitals NHS Foundation Trust, United Kingdom; Department of Neurology (MP), Waikato Hospital, Hamilton, New Zealand; Mercy Health Hauenstein Neurosciences (AT), Grand Rapids, MI; Department of Dietetics and Foodservices (CW), Mater Group, South Brisbane, QLD, Australia; and The Charlie Foundation for Ketogenic Therapies (BZ-K), Santa Monica, CA
| | - Jennifer Langer
- Department of Neurology (MCC), Johns Hopkins University School of Medicine, Baltimore, MD; Matthew's Friends Clinics for Ketogenic Dietary Therapies (SW), Lingfield, Surrey, United Kingdom; Complex Epilepsy and Sleep Service (MB, JM), The Barberry, Birmingham, United Kingdom; Department of Neurology (AB, KR), Rush University Medical Center, Chicago, IL; Department of Neurology (EB), University of Toronto, Ontario, Canada; Department of Neurology (M-GB), University of Colorado, Denver; Department of Neurology (OD), New York University School of Medicine; Department of Medico-Surgical Sciences and Biotechnologies (CDL), Sapienza University of Rome Polo Pontino, Italy; Academic Unit of Neurology (CPD), Trinity College Dublin & FutureNeuro, Ireland; Department of Neurology (EF), UW Health, Madison; Department of Clinical Nutrition (LAH), St James' Hospital, Dublin, Ireland; Mid-Atlantic Epilepsy and Sleep Center (PK), Bethesda, MD; National Center for Epilepsy (MK), Oslo, Norway; Department of Neurology (DL), Academic Center for Epileptology, Kempenhaeghe and Maastricht University Medical Center, Heeze, The Netherlands; Department of Neurology (JL), University of Virginia, Charlottesville; Department of Neurology (JN), Shushrusha Hospital, Mumbai, India; Charles Dent Metabolic Unit (PN), University College London Hospitals NHS Foundation Trust, United Kingdom; Department of Neurology (MP), Waikato Hospital, Hamilton, New Zealand; Mercy Health Hauenstein Neurosciences (AT), Grand Rapids, MI; Department of Dietetics and Foodservices (CW), Mater Group, South Brisbane, QLD, Australia; and The Charlie Foundation for Ketogenic Therapies (BZ-K), Santa Monica, CA
| | - Janak Nathan
- Department of Neurology (MCC), Johns Hopkins University School of Medicine, Baltimore, MD; Matthew's Friends Clinics for Ketogenic Dietary Therapies (SW), Lingfield, Surrey, United Kingdom; Complex Epilepsy and Sleep Service (MB, JM), The Barberry, Birmingham, United Kingdom; Department of Neurology (AB, KR), Rush University Medical Center, Chicago, IL; Department of Neurology (EB), University of Toronto, Ontario, Canada; Department of Neurology (M-GB), University of Colorado, Denver; Department of Neurology (OD), New York University School of Medicine; Department of Medico-Surgical Sciences and Biotechnologies (CDL), Sapienza University of Rome Polo Pontino, Italy; Academic Unit of Neurology (CPD), Trinity College Dublin & FutureNeuro, Ireland; Department of Neurology (EF), UW Health, Madison; Department of Clinical Nutrition (LAH), St James' Hospital, Dublin, Ireland; Mid-Atlantic Epilepsy and Sleep Center (PK), Bethesda, MD; National Center for Epilepsy (MK), Oslo, Norway; Department of Neurology (DL), Academic Center for Epileptology, Kempenhaeghe and Maastricht University Medical Center, Heeze, The Netherlands; Department of Neurology (JL), University of Virginia, Charlottesville; Department of Neurology (JN), Shushrusha Hospital, Mumbai, India; Charles Dent Metabolic Unit (PN), University College London Hospitals NHS Foundation Trust, United Kingdom; Department of Neurology (MP), Waikato Hospital, Hamilton, New Zealand; Mercy Health Hauenstein Neurosciences (AT), Grand Rapids, MI; Department of Dietetics and Foodservices (CW), Mater Group, South Brisbane, QLD, Australia; and The Charlie Foundation for Ketogenic Therapies (BZ-K), Santa Monica, CA
| | - Jude Munn
- Department of Neurology (MCC), Johns Hopkins University School of Medicine, Baltimore, MD; Matthew's Friends Clinics for Ketogenic Dietary Therapies (SW), Lingfield, Surrey, United Kingdom; Complex Epilepsy and Sleep Service (MB, JM), The Barberry, Birmingham, United Kingdom; Department of Neurology (AB, KR), Rush University Medical Center, Chicago, IL; Department of Neurology (EB), University of Toronto, Ontario, Canada; Department of Neurology (M-GB), University of Colorado, Denver; Department of Neurology (OD), New York University School of Medicine; Department of Medico-Surgical Sciences and Biotechnologies (CDL), Sapienza University of Rome Polo Pontino, Italy; Academic Unit of Neurology (CPD), Trinity College Dublin & FutureNeuro, Ireland; Department of Neurology (EF), UW Health, Madison; Department of Clinical Nutrition (LAH), St James' Hospital, Dublin, Ireland; Mid-Atlantic Epilepsy and Sleep Center (PK), Bethesda, MD; National Center for Epilepsy (MK), Oslo, Norway; Department of Neurology (DL), Academic Center for Epileptology, Kempenhaeghe and Maastricht University Medical Center, Heeze, The Netherlands; Department of Neurology (JL), University of Virginia, Charlottesville; Department of Neurology (JN), Shushrusha Hospital, Mumbai, India; Charles Dent Metabolic Unit (PN), University College London Hospitals NHS Foundation Trust, United Kingdom; Department of Neurology (MP), Waikato Hospital, Hamilton, New Zealand; Mercy Health Hauenstein Neurosciences (AT), Grand Rapids, MI; Department of Dietetics and Foodservices (CW), Mater Group, South Brisbane, QLD, Australia; and The Charlie Foundation for Ketogenic Therapies (BZ-K), Santa Monica, CA
| | - Patty Nguyen
- Department of Neurology (MCC), Johns Hopkins University School of Medicine, Baltimore, MD; Matthew's Friends Clinics for Ketogenic Dietary Therapies (SW), Lingfield, Surrey, United Kingdom; Complex Epilepsy and Sleep Service (MB, JM), The Barberry, Birmingham, United Kingdom; Department of Neurology (AB, KR), Rush University Medical Center, Chicago, IL; Department of Neurology (EB), University of Toronto, Ontario, Canada; Department of Neurology (M-GB), University of Colorado, Denver; Department of Neurology (OD), New York University School of Medicine; Department of Medico-Surgical Sciences and Biotechnologies (CDL), Sapienza University of Rome Polo Pontino, Italy; Academic Unit of Neurology (CPD), Trinity College Dublin & FutureNeuro, Ireland; Department of Neurology (EF), UW Health, Madison; Department of Clinical Nutrition (LAH), St James' Hospital, Dublin, Ireland; Mid-Atlantic Epilepsy and Sleep Center (PK), Bethesda, MD; National Center for Epilepsy (MK), Oslo, Norway; Department of Neurology (DL), Academic Center for Epileptology, Kempenhaeghe and Maastricht University Medical Center, Heeze, The Netherlands; Department of Neurology (JL), University of Virginia, Charlottesville; Department of Neurology (JN), Shushrusha Hospital, Mumbai, India; Charles Dent Metabolic Unit (PN), University College London Hospitals NHS Foundation Trust, United Kingdom; Department of Neurology (MP), Waikato Hospital, Hamilton, New Zealand; Mercy Health Hauenstein Neurosciences (AT), Grand Rapids, MI; Department of Dietetics and Foodservices (CW), Mater Group, South Brisbane, QLD, Australia; and The Charlie Foundation for Ketogenic Therapies (BZ-K), Santa Monica, CA
| | - Matthew Phillips
- Department of Neurology (MCC), Johns Hopkins University School of Medicine, Baltimore, MD; Matthew's Friends Clinics for Ketogenic Dietary Therapies (SW), Lingfield, Surrey, United Kingdom; Complex Epilepsy and Sleep Service (MB, JM), The Barberry, Birmingham, United Kingdom; Department of Neurology (AB, KR), Rush University Medical Center, Chicago, IL; Department of Neurology (EB), University of Toronto, Ontario, Canada; Department of Neurology (M-GB), University of Colorado, Denver; Department of Neurology (OD), New York University School of Medicine; Department of Medico-Surgical Sciences and Biotechnologies (CDL), Sapienza University of Rome Polo Pontino, Italy; Academic Unit of Neurology (CPD), Trinity College Dublin & FutureNeuro, Ireland; Department of Neurology (EF), UW Health, Madison; Department of Clinical Nutrition (LAH), St James' Hospital, Dublin, Ireland; Mid-Atlantic Epilepsy and Sleep Center (PK), Bethesda, MD; National Center for Epilepsy (MK), Oslo, Norway; Department of Neurology (DL), Academic Center for Epileptology, Kempenhaeghe and Maastricht University Medical Center, Heeze, The Netherlands; Department of Neurology (JL), University of Virginia, Charlottesville; Department of Neurology (JN), Shushrusha Hospital, Mumbai, India; Charles Dent Metabolic Unit (PN), University College London Hospitals NHS Foundation Trust, United Kingdom; Department of Neurology (MP), Waikato Hospital, Hamilton, New Zealand; Mercy Health Hauenstein Neurosciences (AT), Grand Rapids, MI; Department of Dietetics and Foodservices (CW), Mater Group, South Brisbane, QLD, Australia; and The Charlie Foundation for Ketogenic Therapies (BZ-K), Santa Monica, CA
| | - Kelly Roehl
- Department of Neurology (MCC), Johns Hopkins University School of Medicine, Baltimore, MD; Matthew's Friends Clinics for Ketogenic Dietary Therapies (SW), Lingfield, Surrey, United Kingdom; Complex Epilepsy and Sleep Service (MB, JM), The Barberry, Birmingham, United Kingdom; Department of Neurology (AB, KR), Rush University Medical Center, Chicago, IL; Department of Neurology (EB), University of Toronto, Ontario, Canada; Department of Neurology (M-GB), University of Colorado, Denver; Department of Neurology (OD), New York University School of Medicine; Department of Medico-Surgical Sciences and Biotechnologies (CDL), Sapienza University of Rome Polo Pontino, Italy; Academic Unit of Neurology (CPD), Trinity College Dublin & FutureNeuro, Ireland; Department of Neurology (EF), UW Health, Madison; Department of Clinical Nutrition (LAH), St James' Hospital, Dublin, Ireland; Mid-Atlantic Epilepsy and Sleep Center (PK), Bethesda, MD; National Center for Epilepsy (MK), Oslo, Norway; Department of Neurology (DL), Academic Center for Epileptology, Kempenhaeghe and Maastricht University Medical Center, Heeze, The Netherlands; Department of Neurology (JL), University of Virginia, Charlottesville; Department of Neurology (JN), Shushrusha Hospital, Mumbai, India; Charles Dent Metabolic Unit (PN), University College London Hospitals NHS Foundation Trust, United Kingdom; Department of Neurology (MP), Waikato Hospital, Hamilton, New Zealand; Mercy Health Hauenstein Neurosciences (AT), Grand Rapids, MI; Department of Dietetics and Foodservices (CW), Mater Group, South Brisbane, QLD, Australia; and The Charlie Foundation for Ketogenic Therapies (BZ-K), Santa Monica, CA
| | - Adrianna Tanner
- Department of Neurology (MCC), Johns Hopkins University School of Medicine, Baltimore, MD; Matthew's Friends Clinics for Ketogenic Dietary Therapies (SW), Lingfield, Surrey, United Kingdom; Complex Epilepsy and Sleep Service (MB, JM), The Barberry, Birmingham, United Kingdom; Department of Neurology (AB, KR), Rush University Medical Center, Chicago, IL; Department of Neurology (EB), University of Toronto, Ontario, Canada; Department of Neurology (M-GB), University of Colorado, Denver; Department of Neurology (OD), New York University School of Medicine; Department of Medico-Surgical Sciences and Biotechnologies (CDL), Sapienza University of Rome Polo Pontino, Italy; Academic Unit of Neurology (CPD), Trinity College Dublin & FutureNeuro, Ireland; Department of Neurology (EF), UW Health, Madison; Department of Clinical Nutrition (LAH), St James' Hospital, Dublin, Ireland; Mid-Atlantic Epilepsy and Sleep Center (PK), Bethesda, MD; National Center for Epilepsy (MK), Oslo, Norway; Department of Neurology (DL), Academic Center for Epileptology, Kempenhaeghe and Maastricht University Medical Center, Heeze, The Netherlands; Department of Neurology (JL), University of Virginia, Charlottesville; Department of Neurology (JN), Shushrusha Hospital, Mumbai, India; Charles Dent Metabolic Unit (PN), University College London Hospitals NHS Foundation Trust, United Kingdom; Department of Neurology (MP), Waikato Hospital, Hamilton, New Zealand; Mercy Health Hauenstein Neurosciences (AT), Grand Rapids, MI; Department of Dietetics and Foodservices (CW), Mater Group, South Brisbane, QLD, Australia; and The Charlie Foundation for Ketogenic Therapies (BZ-K), Santa Monica, CA
| | - Clare Williams
- Department of Neurology (MCC), Johns Hopkins University School of Medicine, Baltimore, MD; Matthew's Friends Clinics for Ketogenic Dietary Therapies (SW), Lingfield, Surrey, United Kingdom; Complex Epilepsy and Sleep Service (MB, JM), The Barberry, Birmingham, United Kingdom; Department of Neurology (AB, KR), Rush University Medical Center, Chicago, IL; Department of Neurology (EB), University of Toronto, Ontario, Canada; Department of Neurology (M-GB), University of Colorado, Denver; Department of Neurology (OD), New York University School of Medicine; Department of Medico-Surgical Sciences and Biotechnologies (CDL), Sapienza University of Rome Polo Pontino, Italy; Academic Unit of Neurology (CPD), Trinity College Dublin & FutureNeuro, Ireland; Department of Neurology (EF), UW Health, Madison; Department of Clinical Nutrition (LAH), St James' Hospital, Dublin, Ireland; Mid-Atlantic Epilepsy and Sleep Center (PK), Bethesda, MD; National Center for Epilepsy (MK), Oslo, Norway; Department of Neurology (DL), Academic Center for Epileptology, Kempenhaeghe and Maastricht University Medical Center, Heeze, The Netherlands; Department of Neurology (JL), University of Virginia, Charlottesville; Department of Neurology (JN), Shushrusha Hospital, Mumbai, India; Charles Dent Metabolic Unit (PN), University College London Hospitals NHS Foundation Trust, United Kingdom; Department of Neurology (MP), Waikato Hospital, Hamilton, New Zealand; Mercy Health Hauenstein Neurosciences (AT), Grand Rapids, MI; Department of Dietetics and Foodservices (CW), Mater Group, South Brisbane, QLD, Australia; and The Charlie Foundation for Ketogenic Therapies (BZ-K), Santa Monica, CA
| | - Beth Zupec-Kania
- Department of Neurology (MCC), Johns Hopkins University School of Medicine, Baltimore, MD; Matthew's Friends Clinics for Ketogenic Dietary Therapies (SW), Lingfield, Surrey, United Kingdom; Complex Epilepsy and Sleep Service (MB, JM), The Barberry, Birmingham, United Kingdom; Department of Neurology (AB, KR), Rush University Medical Center, Chicago, IL; Department of Neurology (EB), University of Toronto, Ontario, Canada; Department of Neurology (M-GB), University of Colorado, Denver; Department of Neurology (OD), New York University School of Medicine; Department of Medico-Surgical Sciences and Biotechnologies (CDL), Sapienza University of Rome Polo Pontino, Italy; Academic Unit of Neurology (CPD), Trinity College Dublin & FutureNeuro, Ireland; Department of Neurology (EF), UW Health, Madison; Department of Clinical Nutrition (LAH), St James' Hospital, Dublin, Ireland; Mid-Atlantic Epilepsy and Sleep Center (PK), Bethesda, MD; National Center for Epilepsy (MK), Oslo, Norway; Department of Neurology (DL), Academic Center for Epileptology, Kempenhaeghe and Maastricht University Medical Center, Heeze, The Netherlands; Department of Neurology (JL), University of Virginia, Charlottesville; Department of Neurology (JN), Shushrusha Hospital, Mumbai, India; Charles Dent Metabolic Unit (PN), University College London Hospitals NHS Foundation Trust, United Kingdom; Department of Neurology (MP), Waikato Hospital, Hamilton, New Zealand; Mercy Health Hauenstein Neurosciences (AT), Grand Rapids, MI; Department of Dietetics and Foodservices (CW), Mater Group, South Brisbane, QLD, Australia; and The Charlie Foundation for Ketogenic Therapies (BZ-K), Santa Monica, CA
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Bruxel EM, do Canto AM, Bruno DCF, Geraldis JC, Lopes-Cendes I. Multi-omic strategies applied to the study of pharmacoresistance in mesial temporal lobe epilepsy. Epilepsia Open 2021; 7 Suppl 1:S94-S120. [PMID: 34486831 PMCID: PMC9340306 DOI: 10.1002/epi4.12536] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 08/18/2021] [Accepted: 08/20/2021] [Indexed: 12/19/2022] Open
Abstract
Mesial temporal lobe epilepsy (MTLE) is the most common type of focal epilepsy in adults, and hippocampal sclerosis (HS) is a frequent histopathological feature in patients with MTLE. Pharmacoresistance is present in at least one-third of patients with MTLE with HS (MTLE+HS). Several hypotheses have been proposed to explain the mechanisms of pharmacoresistance in epilepsy, including the effect of genetic and molecular factors. In recent years, the increased knowledge generated by high-throughput omic technologies has significantly improved the power of molecular genetic studies to discover new mechanisms leading to disease and response to treatment. In this review, we present and discuss the contribution of different omic modalities to understand the basic mechanisms determining pharmacoresistance in patients with MTLE+HS. We provide an overview and a critical discussion of the findings, limitations, new approaches, and future directions of these studies to improve the understanding of pharmacoresistance in MTLE+HS. However, it is important to point out that, as with other complex traits, pharmacoresistance to anti-seizure medications is likely a multifactorial condition in which gene-gene and gene-environment interactions play an important role. Thus, studies using multidimensional approaches are more likely to unravel these intricate biological processes.
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Affiliation(s)
- Estela M Bruxel
- Departments of Translational Medicine, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil.,Brazilian Institute of Neuroscience and Neurotechnology (BRAINN), Campinas, Brazil
| | - Amanda M do Canto
- Departments of Translational Medicine, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil.,Brazilian Institute of Neuroscience and Neurotechnology (BRAINN), Campinas, Brazil
| | - Danielle C F Bruno
- Departments of Translational Medicine, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil.,Brazilian Institute of Neuroscience and Neurotechnology (BRAINN), Campinas, Brazil
| | - Jaqueline C Geraldis
- Departments of Translational Medicine, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil.,Brazilian Institute of Neuroscience and Neurotechnology (BRAINN), Campinas, Brazil
| | - Iscia Lopes-Cendes
- Departments of Translational Medicine, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil.,Brazilian Institute of Neuroscience and Neurotechnology (BRAINN), Campinas, Brazil
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50
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Serafini R. How much can medical management alone improve the outcome of adult drug-resistant epilepsy? An exploratory study on possibilities and limitations of combining multiple therapeutic actions. Epilepsy Behav 2021; 122:108065. [PMID: 34243142 DOI: 10.1016/j.yebeh.2021.108065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 05/03/2021] [Accepted: 05/08/2021] [Indexed: 11/17/2022]
Abstract
PURPOSE Failure to control epileptic seizures with two medications, adequately chosen and dosed, indicates drug-resistant epilepsy (DRE). The chance of pharmacologically controlling seizures is low for patients with DRE and uncontrolled seizures who are not candidates for surgery, who have already undergone surgery, or who already had a vagus nerve stimulator (VNS) placed. Patients experiencing these conditions must instead rely on medical management of their seizures, and there is no breakthrough solution on the horizon. Medical care of DRE might be optimized by systematically considering factors that promote and inhibit breakthrough seizures. For example, seizure control could be enhanced through measures such as increasing the frequency of follow-up visits, tracking treatment plan compliance, treating sleep disorders, rational polypharmacy, adjusting drug administration to achieve higher levels when seizures are more likely and educating patients on seizure triggers. A systematic and simultaneous implementation of all of these measures is likely to yield a sizable, clinically relevant, improvement. This paper presents an exploratory study on the effects of implementing such an approach, specifically evaluating this method's impact on seizure frequency. METHODS I performed a retrospective chart review of 659 consecutive adult patients with epilepsy followed up at the University of Utah and at the Salt Lake City VA Medical center using the multimodal approach described above. I identified 27 patients who had DRE and uncontrolled seizures and in whom a medical management optimization protocol was implemented. I measured these patients' seizure frequency at the beginning and the end of the study period and compared the results with those of a matching control group of 48 patients. RESULTS The optimization protocol did not increase the number of seizure-free patients with DRE; however, it was effective in minimizing seizure frequency in patients whose seizures remained uncontrolled. Among these patients, the median seizure frequency dropped by 64% in the optimization group but did not change in the control group. CONCLUSIONS Despite the high occurrence of DRE, there is no accepted protocol for the related medical management. This paper describes an effective approach that can be implemented in a clinically relevant and readily achievable manner.
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Affiliation(s)
- Ruggero Serafini
- Department of Neurology, University of Utah Clinical Neuroscience Center, George E. Wahlen VA Medical Center, 175 North Medical Drive East, 5th Floor, Salt Lake City, UT 84132, USA.
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