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Cameron T, Allan K, Kay Cooper. The use of ketogenic diets in children living with drug-resistant epilepsy, glucose transporter 1 deficiency syndrome and pyruvate dehydrogenase deficiency: A scoping review. J Hum Nutr Diet 2024. [PMID: 38838079 DOI: 10.1111/jhn.13324] [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: 11/13/2023] [Accepted: 05/10/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND The ketogenic diet (KD) is a high fat, moderate protein and very low carbohydrate diet. It can be used as a medical treatment for drug-resistant epilepsy (DRE), glucose transporter 1 deficiency syndrome and pyruvate dehydrogenase deficiency. The aim of this scoping review was to map the KD literature, with a focus on epilepsy and associated metabolic conditions, to summarise the current evidence-base and identify any gaps. METHODS This review was conducted using JBI scoping review methodological guidance and the PRISMA extension for scoping reviews reporting guidance. A comprehensive literature search was conducted in September 2021 and updated in February 2024 using MEDLINE, CINAHL, AMED, EmBASE, CAB Abstracts, Scopus and Food Science Source databases. RESULTS The initial search yielded 2721 studies and ultimately, data were extracted from 320 studies that fulfilled inclusion criteria for the review. There were five qualitative studies, and the remainder were quantitative, including 23 randomised controlled trials (RCTs) and seven quasi-experimental studies. The USA published the highest number of KD studies followed by China, South Korea and the UK. Most studies focused on the classical KD and DRE. The studies key findings suggest that the KD is efficacious, safe and tolerable. CONCLUSIONS There are opportunities available to expand the scope of future KD research, particularly to conduct high-quality RCTs and further qualitative research focused on the child's needs and family support to improve the effectiveness of KDs.
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Affiliation(s)
- Tracy Cameron
- Royal Aberdeen Children's Hospital, NHS Grampian, Aberdeen, Scotland, UK
- School of Health Sciences, Robert Gordon University, Aberdeen, Scotland, UK
| | - Karen Allan
- School of Health Sciences, Robert Gordon University, Aberdeen, Scotland, UK
| | - Kay Cooper
- School of Health Sciences, Robert Gordon University, Aberdeen, Scotland, UK
- Scottish Centre for Evidence-based, Multi-professional Practice: A JBI Centre of Excellence, Aberdeen, Scotland, UK
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Iyer SH, Yeh MY, Netzel L, Lindsey MG, Wallace M, Simeone KA, Simeone TA. Dietary and Metabolic Approaches for Treating Autism Spectrum Disorders, Affective Disorders and Cognitive Impairment Comorbid with Epilepsy: A Review of Clinical and Preclinical Evidence. Nutrients 2024; 16:553. [PMID: 38398876 PMCID: PMC10893388 DOI: 10.3390/nu16040553] [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: 12/24/2023] [Revised: 02/09/2024] [Accepted: 02/14/2024] [Indexed: 02/25/2024] Open
Abstract
Epilepsy often occurs with other neurological disorders, such as autism, affective disorders, and cognitive impairment. Research indicates that many neurological disorders share a common pathophysiology of dysfunctional energy metabolism, neuroinflammation, oxidative stress, and gut dysbiosis. The past decade has witnessed a growing interest in the use of metabolic therapies for these disorders with or without the context of epilepsy. Over one hundred years ago, the high-fat, low-carbohydrate ketogenic diet (KD) was formulated as a treatment for epilepsy. For those who cannot tolerate the KD, other diets have been developed to provide similar seizure control, presumably through similar mechanisms. These include, but are not limited to, the medium-chain triglyceride diet, low glycemic index diet, and calorie restriction. In addition, dietary supplementation with ketone bodies, polyunsaturated fatty acids, or triheptanoin may also be beneficial. The proposed mechanisms through which these diets and supplements work to reduce neuronal hyperexcitability involve normalization of aberrant energy metabolism, dampening of inflammation, promotion of endogenous antioxidants, and reduction of gut dysbiosis. This raises the possibility that these dietary and metabolic therapies may not only exert anti-seizure effects, but also reduce comorbid disorders in people with epilepsy. Here, we explore this possibility and review the clinical and preclinical evidence where available.
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Affiliation(s)
| | | | | | | | | | | | - Timothy A. Simeone
- Department of Pharmacology & Neuroscience, Creighton University School of Medicine, Omaha, NE 68178, USA; (S.H.I.); (K.A.S.)
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Chinna-Meyyappan A, Gomes FA, Koning E, Fabe J, Breda V, Brietzke E. Effects of the ketogenic diet on cognition: a systematic review. Nutr Neurosci 2023; 26:1258-1278. [PMID: 36354157 DOI: 10.1080/1028415x.2022.2143609] [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] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Ketogenic diet (KD) therapy has been used as a dietary intervention in drug-resistant epilepsy for several years. Research currently suggests that KD therapy may carry neuroprotective and cognition enhancing effects for individuals with non-epileptic conditions as well as for healthy individuals. Therefore, KD may have potential as a non-invasive, nutritional treatment approach for difficult to manage conditions such as neurodegenerative illnesses or mood disorders. The aim of this review is to summarize the available evidence on ketogenic interventions and the resulting cognitive outcomes. MATERIALS AND METHODS The paper was based on PRISMA 2020 guidelines. The search was conducted in June 2021 on the following databases: CENTRAL, PubMed, EMBASE, PsycInfo, Web of Science. The search yielded 2014 studies, of which 49 were included. RESULTS There were 22 animal studies assessing murine models and 27 studies on humans. The primary indications in these studies were epileptic conditions, neurodegenerative disorders, cognitive impairment, and healthy populations. DISCUSSION Administration of KD seems to confer cognitive-enhancing effects in areas such as working memory, reference memory and attention. Studies found that KD treatment in animals has the potential to alleviate age-related cognitive decline. Over 80% of the 27 human studies reported a favourable effect of intervention, and none reported a detrimental effect of KD. While these findings suggest that KD may improve the functioning of certain cognitive domains, definitive conclusions were limited by studies with small sample sizes, the absence of controls and randomization, and the lack of objective measures of cognition.
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Affiliation(s)
| | - Fabiano Alves Gomes
- Department of Psychiatry, Queen's University School of Medicine, Kingston, Canada
- Centre for Neuroscience Studies (CNS), Queen's University, Kingston, Canada
| | - Elena Koning
- Department of Psychiatry, Queen's University School of Medicine, Kingston, Canada
| | | | - Vitor Breda
- Department of Psychiatry, Queen's University School of Medicine, Kingston, Canada
- Centre for Neuroscience Studies (CNS), Queen's University, Kingston, Canada
| | - Elisa Brietzke
- Department of Psychiatry, Queen's University School of Medicine, Kingston, Canada
- Centre for Neuroscience Studies (CNS), Queen's University, Kingston, Canada
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Ono KE, Bearden DJ, Lee SM, Moss C, Kheder A, Cernokova I, Drane DL, Gedela S. Interventions for ADHD in children & adolescents with epilepsy: A review and decision tree to guide clinicians. Epilepsy Behav 2022; 135:108872. [PMID: 36037580 PMCID: PMC10084711 DOI: 10.1016/j.yebeh.2022.108872] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 08/01/2022] [Accepted: 08/02/2022] [Indexed: 11/29/2022]
Abstract
Attention Deficit Hyperactivity Disorder (ADHD) is one of the most common pediatric epilepsy comorbidities. Treating ADHD in the context of epilepsy can be overwhelming for parents and clinicians. Current frontline treatment for ADHD is stimulant medication. However, some parents of pediatric patients with epilepsy have concerns about adding additional medication to their child's epilepsy regimen and/or about adverse effects of stimulant medication. Non-medication ADHD treatments including psychosocial interventions and ketogenic diet have also shown success in improving ADHD symptoms. Our focused review provides an easy-to-use guide for clinicians on ADHD interventions and combinations of interventions for pediatric patients with epilepsy and ADHD. Our guide includes information from 8 electronic databases for peer-reviewed, English language studies of psychosocial treatments for youth with epilepsy and ADHD. One hundred eight studies were selected based on inclusion criteria (21 systematic reviews, 12 meta-analyses, 8 literature reviews, 6 population surveys, 31 clinical trials, 20 cross-sectional studies, and 10 retrospective reviews). Results indicated that stimulant medication is a frontline treatment for ADHD symptoms in youth with epilepsy, with important caveats and alternatives.
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Affiliation(s)
- Kim E Ono
- Department of Neuropsychology, Children's Healthcare of Atlanta, Atlanta, GA, United States; Department of Neurology, Emory University School of Medicine, Atlanta, GA, United States.
| | - Donald J Bearden
- Department of Neuropsychology, Children's Healthcare of Atlanta, Atlanta, GA, United States; Department of Neurology, Emory University School of Medicine, Atlanta, GA, United States
| | - Susan M Lee
- Department of Neuropsychology, Children's Healthcare of Atlanta, Atlanta, GA, United States; Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA, U United States
| | - Cierra Moss
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
| | - Ammar Kheder
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, United States; Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
| | - Ivana Cernokova
- Department of Clinical Psychology, University of North Texas, Denton, TX, United States
| | - Daniel L Drane
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, United States; Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States; Department of Neurology University of Washington School of Medicine, Seattle, WA, United States
| | - Satyanarayana Gedela
- Department of Neuropsychology, Children's Healthcare of Atlanta, Atlanta, GA, United States; Department of Neurology, Emory University School of Medicine, Atlanta, GA, United States
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Armeno M, Caraballo R. The evolving indications of KD therapy. Epilepsy Res 2020; 163:106340. [PMID: 32330835 DOI: 10.1016/j.eplepsyres.2020.106340] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 03/14/2020] [Accepted: 04/08/2020] [Indexed: 02/06/2023]
Abstract
Despite the rapid increase of clinical and basic-science knowledge on ketogenic diet therapies over the past years, it has not always been easy to determine the adequate indications of this treatment. Over the nearly 100 years of use, from being a last resource in the therapeutic algorithm, the diet has become one of the four main treatments for patients with difficult-to-control epilepsy together with antiepileptic drugs, surgery, and vagus nerve stimulation. The use of the diet has also changed. The current paper will briefly discuss the history of the diet together with a review of the literature regarding its most important indications and how they have evolved. The concept of the importance of defining the type of seizure, type of syndrome, and etiology in the selection of patients and timing of diet initiation has been gaining importance. This paper explores how the indications of the diet changed together with the shifting focus of epilepsy teams towards its use in different types of epilepsy and epilepsy syndromes and according to etiologies and as an alternative option in refractory and superrefractory status epilepticus.
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Affiliation(s)
- Marisa Armeno
- Department of Nutrition, Hospital de Pediatria Juan P Garrahan, Combate de los Pozos 1881, C1245 CABA, Buenos Aires, Argentina.
| | - Roberto Caraballo
- Department of Neurology, Hospital de Pediatria Juan P Garrahan, Combate de los Pozos 1881, C1245 CABA, Buenos Aires, Argentina
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Francis HM, Stevenson RJ. Potential for diet to prevent and remediate cognitive deficits in neurological disorders. Nutr Rev 2019; 76:204-217. [PMID: 29346658 DOI: 10.1093/nutrit/nux073] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
The pathophysiology of many neurological disorders involves oxidative stress, neuroinflammation, and mitochondrial dysfunction. There is now substantial evidence that diet can decrease these forms of pathophysiology, and an emerging body of literature relatedly suggests that diet can also prevent or even remediate the cognitive deficits observed in neurological disorders that exhibit such pathology (eg, Alzheimer's disease, multiple sclerosis, age-related cognitive decline, epilepsy). The current review summarizes the emerging evidence in relation to whole diets prominent in the scientific literature-ketogenic, caloric restriction, high polyphenol, and Mediterranean diets-and provides a discussion of the possible underlying neurophysiological mechanisms.
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Affiliation(s)
- Heather M Francis
- Psychology Department, Faculty of Human Sciences, Macquarie University, North Ryde, New South Wales, Australia
| | - Richard J Stevenson
- Psychology Department, Faculty of Human Sciences, Macquarie University, North Ryde, New South Wales, Australia
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Koo CM, Kim SH, Kim HD, Lee JS, Kang HC. Treatment Response to Acquired Aphasia with Seizures and Prognosis through Electroencephalogram on Cognitive Function. ANNALS OF CHILD NEUROLOGY 2019. [DOI: 10.26815/acn.2019.00059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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van Berkel AA, IJff DM, Verkuyl JM. Cognitive benefits of the ketogenic diet in patients with epilepsy: A systematic overview. Epilepsy Behav 2018; 87:69-77. [PMID: 30173019 DOI: 10.1016/j.yebeh.2018.06.004] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 06/01/2018] [Accepted: 06/01/2018] [Indexed: 01/28/2023]
Abstract
The ketogenic diet (KD) has been found to be effective in reducing seizures in patients with treatment-refractory epilepsy. Less attention has been paid to additional cognitive benefits of KD. The aim of the present paper was to provide a comprehensive overview of the studies reporting effects on cognition after KD treatment in adults and children with epilepsy. To address this aim, the clinical literature on cognitive effects of KD in patients with epilepsy was reviewed using a systematic approach. We conclude that using subjective assessments of the patient's experience, cognitive improvements are frequently reported during KD treatment in the domains of alertness, attention, and global cognition. Studies that used objective neuropsychological tests confirmed benefits on alertness but found no improvement in global cognition. There are indications that these improvements are caused by both seizure reduction and direct effects of KD on cognition. The improvements appear to be unrelated to medication reduction, age when KD is started, type of KD, and sleep improvement. The findings in the present overview contribute to a better understanding of the beneficial effects of KD in patients with epilepsy.
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Affiliation(s)
- Annemiek A van Berkel
- Department of Functional Genomics, Center for Neurogenomics and Cognitive Research, VU University Amsterdam and VU Medical Center, 1081 HV Amsterdam, The Netherlands
| | - Dominique M IJff
- Epilepsy Center Kempenhaeghe, Sterkselseweg 65, 5591 VE Heeze, The Netherlands
| | - Jan Martin Verkuyl
- Danone Nutricia Research, Uppsalalaan 12, 3584 CT Utrecht, The Netherlands.
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Kelley SA, Kossoff EH. How effective is the ketogenic diet for electrical status epilepticus of sleep? Epilepsy Res 2016; 127:339-343. [PMID: 27710878 DOI: 10.1016/j.eplepsyres.2016.09.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 09/16/2016] [Accepted: 09/22/2016] [Indexed: 02/07/2023]
Abstract
Electrical status epilepticus of sleep (ESES), with the activation of profuse amounts of epileptiform discharges in sleep, may lead to intractable epilepsy and neurocognitive decline in children. Numerous varied treatments including antiseizure medications, steroids, and surgery have been investigated as possible treatment options. The ketogenic diet (KD) is an additional treatment option which may add to our treatment armamentarium for ESES. The KD may theoretically improve ESES by affecting GABA systems and reducing inflammation. Clinical reports of the KD for ESES have been heterogeneous, but to date 38 children have been described in six publications. Overall, 53% had EEG improvement, 41% had>50% seizure reduction, 45% had cognitive improvement, but only 9% had EEG normalization. This review will assess the efficacy of the KD in the treatment of ESES based on known data as well as possible mechanisms of action and the need for future study.
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Affiliation(s)
- Sarah Aminoff Kelley
- Johns Hopkins Hospital, 600 North Wolfe Street, Meyer 2-147, Baltimore, MD 21287, United States.
| | - Eric Heath Kossoff
- Johns Hopkins Hospital, 200 North Wolfe Street, Baltimore, MD 21287, United States.
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Carosella CM, Greiner HM, Byars AW, Arthur TM, Leach JL, Turner M, Holland KD, Mangano FT, Arya R. Vagus Nerve Stimulation for Electrographic Status Epilepticus in Slow-Wave Sleep. Pediatr Neurol 2016; 60:66-70. [PMID: 27068060 DOI: 10.1016/j.pediatrneurol.2016.02.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 02/25/2016] [Accepted: 02/25/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND Electrographic status epilepticus in slow sleep or continuous spike and waves during slow-wave sleep is an epileptic encephalopathy characterized by seizures, neurocognitive regression, and significant activation of epileptiform discharges during nonrapid eye movement sleep. There is no consensus on the diagnostic criteria and evidence-based optimal treatment algorithm for children with electrographic status epilepticus in slow sleep. PATIENT DESCRIPTION We describe a 12-year-old girl with drug-resistant electrographic status epilepticus in slow wave sleep that was successfully treated with vagus nerve stimulation. Her clinical presentation, presurgical evaluation, decision-making, and course after vagus nerve stimulator implantation are described in detail. FINDINGS After vagus nerve stimulator implantation, the girl remained seizure free for more than a year, resolved the electrographic status epilepticus in slow sleep pattern on electroencephalography, and exhibited significant cognitive improvement. CONCLUSION Vagus nerve stimulation may be considered for electrographic status epilepticus in slow sleep.
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Affiliation(s)
| | - Hansel M Greiner
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Anna W Byars
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Todd M Arthur
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - James L Leach
- Division of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Michele Turner
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Katherine D Holland
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Francesco T Mangano
- Division of Pediatric Neurosurgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Ravindra Arya
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
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12
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Reyes G, Flesler S, Armeno M, Fortini S, Ariela A, Cresta A, Mestre G, Caraballo RH. Ketogenic diet in patients with epileptic encephalopathy with electrical status epilepticus during slow sleep. Epilepsy Res 2015; 113:126-31. [DOI: 10.1016/j.eplepsyres.2015.03.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Revised: 03/10/2015] [Accepted: 03/28/2015] [Indexed: 10/23/2022]
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Ville D, Chiron C, Laschet J, Dulac O. The ketogenic diet can be used successfully in combination with corticosteroids for epileptic encephalopathies. Epilepsy Behav 2015; 48:61-5. [PMID: 26057351 DOI: 10.1016/j.yebeh.2015.03.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Revised: 03/03/2015] [Accepted: 03/04/2015] [Indexed: 11/20/2022]
Abstract
Hormonal therapy or ketogenic diet often permits overcoming the challenging periods of many epileptic encephalopathies (West and Lennox-Gastaut syndromes and encephalopathy with continuous spike-waves in slow sleep), but relapse affects over 20% of patients. We report here a monocenter pilot series of 42 consecutive patients in whom we combined oral steroids with the ketogenic diet for corticosteroid-resistant or -dependent epileptic encephalopathy. We retrospectively evaluated the effect on seizure frequency, interictal spike activity, neuropsychological course, and steroid treatment course. Twenty-three patients had West syndrome (WS), 13 had encephalopathy with continuous spike-waves in slow sleep (CSWS), and six others had miscellaneous epileptic encephalopathies. All patients succeeded to reach 0.8 to 1.6g/l ketone bodies in the urine following the usual KD regimen. For at least 6 months, 14/42 responded to the addition of the ketogenic diet: 4/23 with WS, 8/13 with CSWS, and 2/6 with miscellaneous epileptic encephalopathies. The addition of the KD allowed withdrawing steroids in all responders. Among them, 10/15 had been patients with steroid-dependent epileptic encephalopathy and 4/27 patients with steroid-resistant epileptic encephalopathy. Therefore, the ketogenic diet can be used successfully in combination with corticosteroids for epileptic encephalopathies. Patients presenting with steroid-dependent CSWS seem to be the best candidates.
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Affiliation(s)
- Dorothée Ville
- Hospices Civils de Lyon, HFME, Paediatric Neurology Department and Centre of Reference for Tuberous Sclerosis and Rare Epileptic Disorders, F-69677 Bron, France.
| | - Catherine Chiron
- INSERM U1129 "Infantile Epilepsies and Brain Plasticity", Paris, France; University Paris Descartes, PRES Sorbonne Paris Cité, CEA, Gif sur Yvette, France; Neuropaediatrics Department, Necker Hospital, APHP, Paris, France
| | - Jacques Laschet
- INSERM U1129 "Infantile Epilepsies and Brain Plasticity", Paris, France; University Paris Descartes, PRES Sorbonne Paris Cité, CEA, Gif sur Yvette, France
| | - Olivier Dulac
- INSERM U1129 "Infantile Epilepsies and Brain Plasticity", Paris, France; University Paris Descartes, PRES Sorbonne Paris Cité, CEA, Gif sur Yvette, France; Fondation Ophtalmologique Rothschild, Paris, France
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Değerliyurt A, Yalnizoğlu D, Bakar EE, Topçu M, Turanli G. Electrical status epilepticus during sleep: a study of 22 patients. Brain Dev 2015; 37:250-64. [PMID: 24815826 DOI: 10.1016/j.braindev.2014.04.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Revised: 04/12/2014] [Accepted: 04/14/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the clinical and imaging characteristics, treatment results, and prognosis of patients with electrical status epilepticus during sleep (ESES). METHOD A total of 22 patients with ESES pattern on EEG were retrospectively studied. RESULTS The first neurological symptoms were seen at a mean age of 4.4years. The first symptoms in 77% of the patients were seizures. Other symptoms were hyperactivity, restlessness, insomnia, disinhibition, autistic behavior, speech retardation and deterioration in school performance. Diagnosis of ESES was made at a mean age of 7.45years, approximately 3years after the first symptom. Magnetic resonance imaging (MRI) was abnormal in 36% of the patients. Single photon emission computed tomography (SPECT) showed focal hypoperfusion after resolution of ESES involving left temporoparietal and right posterior temporal areas in four patients including three with normal MRI, and one with periventricular leukomalacia without focal cortical lesion. First line treatment with valproic acid monotherapy was not effective. Electrical status epilepticus during sleep disappeared in 82% of the patients on clobazam and 70% of the patients on clonazepam in combination with valproic acid within a few months. Topiramate was not found to be effective. A significant decrease in intelligence quotient (IQ) scores was found in 66% of the patients compared to the baseline. CONCLUSIONS ESES should be considered in children with new onset behavioral, cognitive, and speech problems with or without seizures. The high frequency of focal seizures and focal findings on SPECT suggest a focal origin. Clonazepam and clobazam were most effective in our cohort.
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Affiliation(s)
- Aydan Değerliyurt
- Hacettepe University, Department of Pediatric Neurology, Ankara, Turkey.
| | - Dilek Yalnizoğlu
- Hacettepe University, Department of Pediatric Neurology, Ankara, Turkey
| | | | - Meral Topçu
- Hacettepe University, Department of Pediatric Neurology, Ankara, Turkey
| | - Güzide Turanli
- Hacettepe University, Department of Pediatric Neurology, Ankara, Turkey
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Bhat S, Ming X, Dekermenjian R, Chokroverty S. Continuous spike and wave in slow-wave sleep in a patient with Rett syndrome and in a patient with Lhermitte-Duclos syndrome and neurofibromatosis 1. J Child Neurol 2014; 29:NP176-80. [PMID: 24262385 DOI: 10.1177/0883073813509888] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Continuous spike and wave in slow-wave sleep (CSWS) is an electroencephalographic (EEG) pattern characterized by generalized spike-wave discharges occurring for at least 85% of non-rapid eye movement (non-REM) sleep, with marked attenuation during rapid eye movement (REM) sleep. It has been described in a large number of structural and nonstructural neurologic conditions and is associated with epilepsy, behavioral disturbances, and severe neuropsychiatric impairment. We describe continuous spike and wave in slow-wave sleep in 2 patients (one with Rett syndrome and the other with Lhermitte-Duclos syndrome). To our knowledge, continuous spike and wave in slow-wave sleep has not been previously described in these conditions.
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Affiliation(s)
- Sushanth Bhat
- NJ Neuroscience Institute at JFK Medical Center/Seton Hall University, Edison, NJ, USA
| | - Xue Ming
- NJ Neuroscience Institute at JFK Medical Center/Seton Hall University, Edison, NJ, USA Department of Neurology and Neurosciences, New Jersey Medical School UMDNJ Newark, Newark, NJ, USA
| | - Rony Dekermenjian
- NJ Neuroscience Institute at JFK Medical Center/Seton Hall University, Edison, NJ, USA
| | - Sudhansu Chokroverty
- NJ Neuroscience Institute at JFK Medical Center/Seton Hall University, Edison, NJ, USA
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Ebus SCM, Lambrechts DAJE, Herraets IJT, Majoie MJM, de Louw AJ, Boon PJ, Aldenkamp AP, Arends JB. Can an early 24-hour EEG predict the response to the ketogenic diet? A prospective study in 34 children and adults with refractory epilepsy treated with the ketogenic diet. Seizure 2014; 23:468-74. [PMID: 24768269 DOI: 10.1016/j.seizure.2014.03.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Revised: 03/11/2014] [Accepted: 03/15/2014] [Indexed: 01/03/2023] Open
Abstract
PURPOSE We examined whether early EEG changes in a 24-h EEG at 6 weeks of treatment were related to the later clinical response to the ketogenic diet (KD) in a 6-month period of treatment. METHODS We examined 34 patients with heterogeneous epilepsy syndromes (21 children, 13 adults) and found 9 clinical responders (≥50% seizure reduction); this is a responder rate of 26%. We visually counted the interictal epileptic discharge index (IED index) in % during 2h of wakefulness and in the first hour of sleep (method 1), and also globally reviewed EEG changes (method 2), while blinded to the effect of the KD. RESULTS At group level we saw a correlation between nocturnal reduction of IED-index at 6 weeks and seizure reduction in the follow-up period. A proportional reduction in IED index of 30% from baseline in the sleep EEG, was associated with being a responder to the diet (Pearson Chi-square p=0.04). EEG scoring method 2 observed a significantly larger proportion of patients with EEG-improvement in sleep in KD responders than in non-responders (p=0.03). At individual level, however, EEG changes did not correlate very strongly to the response to the diet, as IED reduction in sleep was also seen in 15% (method 1) to 26% (method 2) of the non-responders. CONCLUSION Nocturnal reduction of IEDs is related to the response to the KD, however in daily clinical practice, an early EEG to predict seizure reduction should not be advised for individual patients.
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Affiliation(s)
- Saskia C M Ebus
- Department of Neurology, Epilepsy Centre Kempenhaeghe, Heeze, The Netherlands
| | | | - Ingrid J T Herraets
- Department of Neurology, Epilepsy Centre Kempenhaeghe, Heeze, The Netherlands
| | - Marian J M Majoie
- Department of Neurology, Epilepsy Centre Kempenhaeghe, Heeze, The Netherlands; Research School of Mental Health & Neuroscience, Maastricht University, The Netherlands
| | - Anton J de Louw
- Department of Neurology, Epilepsy Centre Kempenhaeghe, Heeze, The Netherlands
| | - Paul J Boon
- Department of Neurology, Epilepsy Centre Kempenhaeghe, Heeze, The Netherlands; Department of Neurology, Ghent University Hospital, Belgium
| | - Albert P Aldenkamp
- Research School of Mental Health & Neuroscience, Maastricht University, The Netherlands; Department of Behavioural Sciences, Epilepsy Centre Kempenhaeghe, Heeze, The Netherlands; Department of Neurology, Maastricht University Medical Centre, The Netherlands
| | - Johan B Arends
- Department of Neurology, Epilepsy Centre Kempenhaeghe, Heeze, The Netherlands; Department of Electrical Engineering (Signal Processing Systems Group), University of Technology, Eindhoven, The Netherlands
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Chen XQ, Zhang WN, Yang ZX, Zhao M, Cai FC, Huang SP, Gao L, Pang BD, Chen X, Zou LP. Efficacy of levetiracetam in electrical status epilepticus during sleep of children: a multicenter experience. Pediatr Neurol 2014; 50:243-9. [PMID: 24316167 DOI: 10.1016/j.pediatrneurol.2013.10.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Revised: 10/15/2013] [Accepted: 10/28/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Electrical status epilepticus during sleep is characterized by epilepsy, a specific electroencephalographic pattern, and neuropsychological impairment. This study aims to evaluate the efficacy and safety of levetiracetam in treating children with electrical status epilepticus during sleep. METHODS A multicenter, retrospective, open-label study enrolled 73 children (mean age: 8 years) affected by electrical status epilepticus during sleep. The efficacy was rated according to the seizure frequency and electroencephalography response. RESULTS After a mean treatment period of 19 months (range: 6 to 24 months), 33 (63.5%) of 52 patients became seizure-free or had experienced remarkable reduction in seizures. The electrical status epilepticus of 41 (56.2%) of 73 patients disappeared off their electroencephalography. The electroencephalography efficacy of levetiracetam treatment was noted in the monotherapy (61.9%) and add-on (53.9%) groups. The clinical (67.7%) and electroencephalography (64.3%) response rates of the idiopathic group were better than those of the symptomatic group (57.1% and 45.2%, respectively). No patient discontinued the trial because of intolerability of side effects. CONCLUSIONS Levetiracetam is effective in individuals with electrical status epilepticus during sleep with tolerable side effects.
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Affiliation(s)
- Xiao-Qiao Chen
- Department of Pediatrics, Chinese PLA General Hospital, Beijing, China
| | - Wei-Na Zhang
- Department of Pediatrics, Chinese PLA General Hospital, Beijing, China
| | - Zhi-Xian Yang
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Meng Zhao
- Department of Pediatrics, Chinese PLA General Hospital, Beijing, China
| | - Fang-Cheng Cai
- Department of Neurology, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Shao-Ping Huang
- Department of Pediatrics, the Second Affiliated Hospital of Medical College, Xi'an Jiao Tong University, Xi'an, China
| | - Li Gao
- Department of Pediatrics, Henan provincial People's Hospital, Zhengzhou, China
| | - Bao-Dong Pang
- Department of Pediatrics, Tangshan Maternal and Health Care Hospital, Tangshan, China
| | - Xi Chen
- Department of Neurology, Urumqi Children's Hospital, Urumqi, China
| | - Li-Ping Zou
- Department of Pediatrics, Chinese PLA General Hospital, Beijing, China.
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Continuous Spike-Wave during Slow Wave Sleep and Related Conditions. ISRN NEUROLOGY 2014; 2014:619079. [PMID: 24634784 PMCID: PMC3929187 DOI: 10.1155/2014/619079] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Accepted: 12/05/2013] [Indexed: 11/25/2022]
Abstract
Continuous spike and wave during slow wave sleep (CSWS) is an epileptic encephalopathy that presents with neurocognitive regression and clinical seizures, and that demonstrates an electroencephalogram (EEG) pattern of electrical status epilepticus during sleep, as defined by the Commission on Classification and Terminology of the International League Against Epilepsy 1989. CSWS is an age-related condition, typically presenting in children around 5 years of age, with clinical seizures which progress within 2 years to a severe epileptic encephalopathy. The pathophysiology of CSWS is not completely understood, but the corticothalamic neuronal network involved in sleep patterns is thought to be involved. Genetic predisposition and injury in early development are thought to play etiological roles. Treatment strategies have involved traditional anticonvulsants, hormonal therapies, and other newer techniques. Outcomes are fair, and the thought is that earlier diagnosis and intervention preserve neurocognitive development, as in the case of other epileptic encephalopathies. Further understanding of the mechanisms of CSWS may lead to improved therapeutic options and thus outcomes of children with CSWS.
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20
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Diagnosis and management of epileptic encephalopathies in children. EPILEPSY RESEARCH AND TREATMENT 2013; 2013:501981. [PMID: 23970964 PMCID: PMC3736403 DOI: 10.1155/2013/501981] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Revised: 06/04/2013] [Accepted: 06/18/2013] [Indexed: 11/20/2022]
Abstract
Epileptic encephalopathies refer to a group of disorders in which the unremitting epileptic activity contributes to severe cognitive and behavioral impairments above and beyond what might be expected from the underlying pathology alone, and these can worsen over time leading to progressive cerebral dysfunction. Several syndromes have been described based on their electroclinical features (age of onset, seizure type, and EEG pattern). This review briefly describes the clinical evaluation and management of commonly encountered epileptic encephalopathies in children.
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Sharma S, Tripathi M. Ketogenic diet in epileptic encephalopathies. EPILEPSY RESEARCH AND TREATMENT 2013; 2013:652052. [PMID: 23936641 PMCID: PMC3723152 DOI: 10.1155/2013/652052] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Accepted: 06/24/2013] [Indexed: 11/25/2022]
Abstract
The ketogenic diet is a medically supervised high-fat, low-carbohydrate diet that has been found useful in patients with refractory epilepsy. It has been shown to be effective in treating multiple seizure types and epilepsy syndromes. In this paper, we review the use of the ketogenic diet in epileptic encephalopathies such as Ohtahara syndrome, West syndrome, Dravet syndrome, epilepsy with myoclonic atonic seizures, and Lennox-Gastaut syndrome.
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Affiliation(s)
- Suvasini Sharma
- Department of Pediatrics, Lady Hardinge Medical College and Associated Kalawati Saran Children's Hospital, New Delhi 110001, India
| | - Manjari Tripathi
- Department of Neurology, Neurosciences Centre, All India Institute of Medical Sciences, New Delhi 110029, India
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Encephalopathy with status epilepticus during sleep or continuous spikes and waves during slow sleep syndrome: A multicenter, long-term follow-up study of 117 patients. Epilepsy Res 2013; 105:164-73. [DOI: 10.1016/j.eplepsyres.2013.02.010] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Revised: 01/14/2013] [Accepted: 02/19/2013] [Indexed: 11/19/2022]
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Lambrechts DAJE, Bovens MJM, de la Parra NM, Hendriksen JGM, Aldenkamp AP, Majoie MJM. Ketogenic diet effects on cognition, mood, and psychosocial adjustment in children. Acta Neurol Scand 2013; 127:103-8. [PMID: 22690843 DOI: 10.1111/j.1600-0404.2012.01686.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2012] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The ketogenic diet (KD) is increasingly used for the treatment of refractory epilepsy. The aim of this study was to evaluate possible adverse effects of the diet on cognition, behavior, psychosocial adjustment, and quality of life in school-aged children and adolescents. METHOD Fifteen subjects were assessed before diet initiation. After approximately 6 months, on diet treatment 11 patients (73%) were reassessed. We used a combination of individually administered psychological tests for the children and parent report questionnaires. RESULTS Five of 15 patients had a seizure reduction of more than 50%. Cognition showed a small trend toward improvement in most patients. Psychosocial adjustment, on the other hand, showed small trends toward worsening. For mood, two areas showed a larger change, revealing more mood problems although this was not on a statistically significant level. CONCLUSION In this small group of children, there is no indication that the KD has a negative impact on cognition or social adaptation at short term. There is a tendency toward an increase in mood problems.
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Affiliation(s)
| | | | - N. M. de la Parra
- Department of Behavioral Sciences; Epilepsy Centre Kempenhaeghe; Heeze; The Netherlands
| | - J. G. M. Hendriksen
- Department of Behavioral Sciences; Epilepsy Centre Kempenhaeghe; Heeze; The Netherlands
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25
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Epileptic Encephalopathies with Status Epilepticus during Sleep: New Techniques for Understanding Pathophysiology and Therapeutic Options. EPILEPSY RESEARCH AND TREATMENT 2012; 2012:642725. [PMID: 22934163 PMCID: PMC3420558 DOI: 10.1155/2012/642725] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/19/2012] [Revised: 07/09/2012] [Accepted: 07/09/2012] [Indexed: 11/17/2022]
Abstract
Encephalopathy with status epilepticus during sleep (ESES) is an epileptic encephalopathy, as defined by the International League Against Epilepsy (ILAE) Task Force on Classification and Terminology, that is, a condition in which the epileptic processes themselves are believed to contribute to the disturbance in cerebral function. Clinical manifestations of ESES are heterogeneous: apart from different seizure types, they consist in combinations of cognitive, motor, and behavioural disturbances associated with a peculiar electroencephalographic pattern of paroxysmal activity significantly activated during slow sleep, which culminates in a picture of continuous spikes and waves during sleep (CSWS). The pathophysiological mechanisms underlying this condition are still incompletely understood. Establishing a clear-cut correlation between EEG abnormalities and clinical data, though interesting, is very complex. Computer-assisted EEG analyses especially if combined with functional magnetic resonance imaging (EEG-fMRI) and metabolic neuroimaging have recently emerged as useful approaches to better understand the pathophysiological processes underlying ESES. Treatment of ESES is not just limited to seizures control but it should be focused on controlling neuropsychological outcome through an improvement of the continuous epileptiform activity. General agreement on treatment guidelines is still lacking. Implementation of new techniques might allow a better understanding of the pathophysiology of ESES and could enhance therapeutics options.
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Fejerman N, Caraballo R, Cersósimo R, Ferraro SM, Galicchio S, Amartino H. Sulthiame add-on therapy in children with focal epilepsies associated with encephalopathy related to electrical status epilepticus during slow sleep (ESES). Epilepsia 2012; 53:1156-61. [PMID: 22509732 DOI: 10.1111/j.1528-1167.2012.03458.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE In children with symptomatic or idiopathic focal epilepsies, their disease may evolve into an epileptic encephalopathy related to continuous spike and wave during slow sleep (CSWS) or electrical status epilepticus during slow sleep (ESES). ESES syndrome implies serious risks of neuropsychologic impairment, and its treatment has frequently been disappointing. The aim of this study is to present our experience using sulthiame as add-on treatment in 53 patients with ESES syndrome that was refractory to other antiepileptic drugs (AEDs). METHODS Neurologic examinations, cerebral magnetic resonance imaging (MRI), and repeated prolonged sleep electroencephalography (EEG) studies were performed in all cases. Data about school achievements and or neuropsychological evaluations were obtained repeatedly during the follow-up of 1.5-16 years. Sulthiame was added in doses ranging between 5 and 30 mg/kg/day. KEY FINDINGS Since add-on of sulthiame, 10 of 28 patients in the symptomatic group became seizure free: 4 patients with normal EEG studies and 6 with residual spikes. Nine of 28 patients showed a significant reduction in number of seizures and presented spikes but no ESES on EEG. The other nine cases showed neither clinical nor EEG improvement. A striking result was that 3 of 11 children with unilateral polymicrogyria and ESES syndrome became seizure free, and in another six a significant improvement in frequency of seizures and in EEG abnormalities seemed to be related to the add-on of sulthiame. Twenty-one of the 25 patients in the idiopathic group became seizure free and without ESES in <3 months after add on of sulthiame. In two of the patients the changes were seen in a few days. SIGNIFICANCE We understand that sulthiame may be effective as add-on treatment in children with ESES syndrome.
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Affiliation(s)
- Natalio Fejerman
- Department of Neurology, Juan P. Garrahan Pediatric Hospital, Buenos Aires, Argentina.
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27
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Hartman AL. Neuroprotection in metabolism-based therapy. Epilepsy Res 2011; 100:286-94. [PMID: 21872441 DOI: 10.1016/j.eplepsyres.2011.04.016] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2011] [Revised: 04/20/2011] [Accepted: 04/25/2011] [Indexed: 12/21/2022]
Abstract
Metabolism-based therapy has been used successfully in the treatment of seizures but study of its use in other neurodegenerative disorders is growing. Data demonstrating the use of different forms of metabolism-based therapy in human trials of Alzheimer disease and Parkinson disease are discussed. Animal and in vitro studies have shed light on metabolism-based therapy's mechanisms in these diseases, as well as ALS, aging, ischemia, trauma and mitochondrial cytopathies. Additional insights may be obtained by considering the role of metabolism-based therapy in cell disability and death (specifically apoptosis, excitotoxicity, and autophagy).
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Affiliation(s)
- Adam L Hartman
- Johns Hopkins University, Neurology, 600 N. Wolfe St., Meyer 2-147, Baltimore, MD 21287, USA.
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28
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Early EEG improvement after ketogenic diet initiation. Epilepsy Res 2011; 94:94-101. [PMID: 21345653 DOI: 10.1016/j.eplepsyres.2011.01.012] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2010] [Revised: 01/17/2011] [Accepted: 01/23/2011] [Indexed: 01/01/2023]
Abstract
PURPOSE This study examines electroencephalographic (EEG) changes in children with medication resistant epilepsy treated with the ketogenic diet (KD). METHODS Routine EEGs were obtained prior to KD initiation, then one month and three months later. Changes in EEG background slowing and frequency of interictal epileptiform discharges (IEDs) were evaluated using power spectrum analysis and manual determination of spike index. KD responders were compared to non-responders to determine if baseline or early EEG characteristics predicted treatment response (>50% seizure reduction) at three months. RESULTS Thirty-seven patients were evaluated. No differences in baseline EEG features were found between responder groups. Frequency of IEDs declined in 65% of patients as early as one month, by a median of 13.6% (IQR 2-33). Those with a ten percent or greater improvement in IED frequency at one month were greater than six times more likely to be KD responders (OR 6.5 95% CI 0.85-75 p=0.03). Qualitative and quantitative measures of EEG background slowing improved in the whole cohort, but did not predict responder status. CONCLUSION Baseline predictors of KD response remain elusive. Most patients experienced a reduction in IEDs and improvement in EEG background slowing after KD initiation. Reduction of IEDs at one month strongly predicted KD responder status at three months.
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Tuchman R, Alessandri M, Cuccaro M. Autism spectrum disorders and epilepsy: moving towards a comprehensive approach to treatment. Brain Dev 2010; 32:719-30. [PMID: 20558021 DOI: 10.1016/j.braindev.2010.05.007] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2010] [Revised: 05/15/2010] [Accepted: 05/17/2010] [Indexed: 11/29/2022]
Abstract
The biological and phenotypic heterogeneity of children with autism spectrum disorders (ASD) and epilepsy presents a significant challenge to the development of effective treatment protocols. There is no single treatment or treatment protocol for children with ASD or epilepsy. Children with co-occurring ASD and epilepsy should undergo a comprehensive assessment that includes investigation of underlying biological etiologies as well assessment of cognitive, language, affective, social and behavioral function prior to initiating treatment. The comprehensive treatment of children with ASD is based on a combination of therapeutic psychosocial interventions in combination with pharmacological agents. A process-oriented approach to assessment and intervention allows careful analysis of the child's response to treatment such that treatment protocols may be revised secondary to any changes in developmental trajectory of the child with ASD and epilepsy. The possibility of developing pharmacological interventions that target both ASD and epilepsy awaits definitive evidence. The best hope for good developmental outcomes in children with ASD and epilepsy is early recognition and comprehensive treatment of both the ASD and epilepsy.
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Affiliation(s)
- Roberto Tuchman
- Department of Neurology, Miami Children's Hospital, Dan Marino Center, Weston, FL, USA.
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Lagae L. Rational treatment options with AEDs and ketogenic diet in Landau-Kleffner syndrome: still waiting after all these years. Epilepsia 2009; 50 Suppl 7:59-62. [PMID: 19682054 DOI: 10.1111/j.1528-1167.2009.02222.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Antiepileptic drugs (AEDs) remain a first treatment approach in Landau-Kleffner syndrome (LKS) and related syndromes. In the current literature, only class IV evidence is available. Inclusion criteria and outcome parameters are ill-defined. Most commonly, valproate, ethosuximide, and/or benzodiazepines are used. More recent case series show that sulthiame and especially levetiracetam can be considered as effective drugs. Smaller studies also point to the ketogenic diet as a valuable treatment option in LKS.
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Affiliation(s)
- Lieven Lagae
- Department of Pediatric Neurology, University Hospitals KULeuven, Herestraat 49, Leuven, Belgium.
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