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Gogou M, Pujar S, Nemani T, Chiang C, Simpson Z, Hardy I, Schoeler N, Cross JH, Eltze C. Antiseizure medication reduction and withdrawal in children with drug-resistant epilepsy after starting the ketogenic diet. Dev Med Child Neurol 2023; 65:424-430. [PMID: 35971594 DOI: 10.1111/dmcn.15377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 07/16/2022] [Accepted: 07/18/2022] [Indexed: 11/30/2022]
Abstract
AIM To investigate the rate of successful withdrawal of antiseizure medication (ASM) after starting the ketogenic diet in children and identify predictive factors. METHOD We retrospectively reviewed data of children with epilepsy, who were treated with the ketogenic diet for 6 months or longer at our institution, over a 5-year period. We defined successful withdrawal of one or more medications as a time period of 3 months or more off this medication without restarting it or starting a new agent. Predictive clinical factors were investigated using binary multivariable logistic regression. RESULTS Seventy-one children were included (28 females, 43 males; median age at seizure onset 5 months, median age at diet initiation 58.5 months, median duration of ketogenic diet 27.7 months). Reduction of one or more ASMs was attempted in 54 out of 71 (76%) children and was successful in 34 out of 54 (63%), including discontinuation of all ASMs in 13. Younger age at the start of the ketogenic diet was associated with higher odds of successful ASM withdrawal. ASM withdrawal was successful in 11 out of 19 children with less than 50% seizure reduction at 3 months. INTERPRETATION Reduction of ASM was achieved in two-thirds of patients after the start of the ketogenic diet, where attempted, and can be successful even with little or unchanged seizure frequency while on the diet.
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Affiliation(s)
- Maria Gogou
- Neurology Department, Great Ormond Street Hospital for Children NHS Trust, London, UK.,Neurology Department, Evelina London Children's Hospital NHS Trust, London, UK
| | - Suresh Pujar
- Neurology Department, Great Ormond Street Hospital for Children NHS Trust, London, UK.,Developmental Neurosciences, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Tarishi Nemani
- Neurology Department, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - Chunyi Chiang
- Developmental Neurosciences, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Zoe Simpson
- Neurology Department, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - Isobel Hardy
- Neurology Department, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - Natasha Schoeler
- Developmental Neurosciences, UCL Great Ormond Street Institute of Child Health, London, UK
| | - J Helen Cross
- Neurology Department, Great Ormond Street Hospital for Children NHS Trust, London, UK.,Developmental Neurosciences, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Christin Eltze
- Neurology Department, Great Ormond Street Hospital for Children NHS Trust, London, UK.,Developmental Neurosciences, UCL Great Ormond Street Institute of Child Health, London, UK
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Silaghi CN, Farcaș M, Crăciun AM. Sirtuin 3 (SIRT3) Pathways in Age-Related Cardiovascular and Neurodegenerative Diseases. Biomedicines 2021; 9:biomedicines9111574. [PMID: 34829803 PMCID: PMC8615405 DOI: 10.3390/biomedicines9111574] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 10/22/2021] [Accepted: 10/27/2021] [Indexed: 01/08/2023] Open
Abstract
Age-associated cardiovascular and neurodegenerative diseases lead to high morbidity and mortality around the world. Sirtuins are vital enzymes for metabolic adaptation and provide protective effects against a wide spectrum of pathologies. Among sirtuins, mitochondrial sirtuin 3 (SIRT3) is an essential player in preserving the habitual metabolic profile. SIRT3 activity declines as a result of aging-induced changes in cellular metabolism, leading to increased susceptibility to endothelial dysfunction, hypertension, heart failure and neurodegenerative diseases. Stimulating SIRT3 activity via lifestyle, pharmacological or genetic interventions could protect against a plethora of pathologies and could improve health and lifespan. Thus, understanding how SIRT3 operates and how its protective effects could be amplified, will aid in treating age-associated diseases and ultimately, in enhancing the quality of life in elders.
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Onyango IG, Bennett JP, Stokin GB. Regulation of neuronal bioenergetics as a therapeutic strategy in neurodegenerative diseases. Neural Regen Res 2021; 16:1467-1482. [PMID: 33433460 PMCID: PMC8323696 DOI: 10.4103/1673-5374.303007] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Neurodegenerative diseases such as Alzheimer's disease, Parkinson's disease, Huntington's disease, and amyotrophic lateral sclerosis are a heterogeneous group of debilitating disorders with multifactorial etiologies and pathogeneses that manifest distinct molecular mechanisms and clinical manifestations with abnormal protein dynamics and impaired bioenergetics. Mitochondrial dysfunction is emerging as an important feature in the etiopathogenesis of these age-related neurodegenerative diseases. The prevalence and incidence of these diseases is on the rise with the increasing global population and average lifespan. Although many therapeutic approaches have been tested, there are currently no effective treatment routes for the prevention or cure of these diseases. We present the current status of our knowledge and understanding of the involvement of mitochondrial dysfunction in these diseases and highlight recent advances in novel therapeutic strategies targeting neuronal bioenergetics as potential approach for treating these diseases.
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Affiliation(s)
- Isaac G Onyango
- Center for Translational Medicine, International Clinical Research Centre (ICRC), St. Anne's University Hospital, Brno, Czech Republic
| | - James P Bennett
- Neurodegeneration Therapeutics, 3050A Berkmar Drive, Charlottesville, VA, USA
| | - Gorazd B Stokin
- Center for Translational Medicine, International Clinical Research Centre (ICRC), St. Anne's University Hospital, Brno, Czech Republic
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Fomin DA, McDaniel B, Crane J. The promising potential role of ketones in inflammatory dermatologic disease: a new frontier in treatment research. J DERMATOL TREAT 2017; 28:484-487. [PMID: 28043175 DOI: 10.1080/09546634.2016.1276259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The ketogenic diet has been shown to be beneficial for numerous diseases across different organ systems, but a dearth of information exists regarding these benefits for skin disease. Here, we searched the literature for known mechanisms behind inflammation in dermatologic disease and correlated that with suggested mechanisms of anti-inflammatory activity of ketones and a ketogenic state in the human body to observe how ketones and ketosis might aid in the treatment of inflammatory skin diseases based on these mechanisms. Specifically, we found that ketones modulate the NRPL3 inflammasome, augment anti-oxidation against reactive oxygen species through various direct and indirect means, and may influence mTOR activity, which are all involved in inflammatory dermatologic diseases to an extent. This evidence shows that ketones and the ketogenic diet may have a promising role in the dermatologist's disease treatment repertoire. Our goal is to provide a novel direction for research in the role of a ketogenic diet and even exogenous ketone therapy in the treatment of inflammatory dermatologic disease.
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Affiliation(s)
- Daren A Fomin
- a MS-IV, Campbell University School of Osteopathic Medicine , Lillington , NC , USA
| | - Brianna McDaniel
- b Dermatology Resident, PGY-3, Sampson Regional Medical Center , Clinton , NC , USA
| | - Jonathan Crane
- c DermOne of N.C. and V.A. Medical Director, Campbell University School of Osteopathic Medicine Dermatology Co-Course Director, Sampson Regional Medical Center Dermatology Residency Director , Clinton , NC , USA
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Lauritzen KH, Hasan-Olive MM, Regnell CE, Kleppa L, Scheibye-Knudsen M, Gjedde A, Klungland A, Bohr VA, Storm-Mathisen J, Bergersen LH. A ketogenic diet accelerates neurodegeneration in mice with induced mitochondrial DNA toxicity in the forebrain. Neurobiol Aging 2016; 48:34-47. [PMID: 27639119 DOI: 10.1016/j.neurobiolaging.2016.08.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 08/03/2016] [Accepted: 08/09/2016] [Indexed: 12/12/2022]
Abstract
Mitochondrial genome maintenance plays a central role in preserving brain health. We previously demonstrated accumulation of mitochondrial DNA damage and severe neurodegeneration in transgenic mice inducibly expressing a mutated mitochondrial DNA repair enzyme (mutUNG1) selectively in forebrain neurons. Here, we examine whether severe neurodegeneration in mutUNG1-expressing mice could be rescued by feeding the mice a ketogenic diet, which is known to have beneficial effects in several neurological disorders. The diet increased the levels of superoxide dismutase 2, and mitochondrial mass, enzymes, and regulators such as SIRT1 and FIS1, and appeared to downregulate N-methyl-D-aspartic acid (NMDA) receptor subunits NR2A/B and upregulate γ-aminobutyric acid A (GABAA) receptor subunits α1. However, unexpectedly, the ketogenic diet aggravated neurodegeneration and mitochondrial deterioration. Electron microscopy showed structurally impaired mitochondria accumulating in neuronal perikarya. We propose that aggravation is caused by increased mitochondrial biogenesis of generally dysfunctional mitochondria. This study thereby questions the dogma that a ketogenic diet is unambiguously beneficial in mitochondrial disorders.
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Affiliation(s)
- Knut H Lauritzen
- Synaptic Neurochemistry Laboratory, Division of Anatomy and CMBN/SERTA Healthy Brain Ageing Centre, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway; Brain and Muscle Energy Group, Electron Microscopy Laboratory, Institute of Oral Biology, University of Oslo, Oslo, Norway
| | - Md Mahdi Hasan-Olive
- Synaptic Neurochemistry Laboratory, Division of Anatomy and CMBN/SERTA Healthy Brain Ageing Centre, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway; Brain and Muscle Energy Group, Electron Microscopy Laboratory, Institute of Oral Biology, University of Oslo, Oslo, Norway
| | - Christine E Regnell
- Synaptic Neurochemistry Laboratory, Division of Anatomy and CMBN/SERTA Healthy Brain Ageing Centre, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway; Brain and Muscle Energy Group, Electron Microscopy Laboratory, Institute of Oral Biology, University of Oslo, Oslo, Norway; Center for Healthy Aging and Department of Neuroscience and Pharmacology, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Liv Kleppa
- Synaptic Neurochemistry Laboratory, Division of Anatomy and CMBN/SERTA Healthy Brain Ageing Centre, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway; Brain and Muscle Energy Group, Electron Microscopy Laboratory, Institute of Oral Biology, University of Oslo, Oslo, Norway
| | - Morten Scheibye-Knudsen
- Laboratory of Molecular Gerontology, National Institute on Aging, National Institutes of Health, Baltimore, MD, USA
| | - Albert Gjedde
- Center for Healthy Aging and Department of Neuroscience and Pharmacology, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Arne Klungland
- Institute of Medical Microbiology, Oslo University Hospital and University of Oslo, Oslo, Norway; Department of Molecular Medicine, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Vilhelm A Bohr
- Laboratory of Molecular Gerontology, National Institute on Aging, National Institutes of Health, Baltimore, MD, USA
| | - Jon Storm-Mathisen
- Synaptic Neurochemistry Laboratory, Division of Anatomy and CMBN/SERTA Healthy Brain Ageing Centre, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Linda H Bergersen
- Synaptic Neurochemistry Laboratory, Division of Anatomy and CMBN/SERTA Healthy Brain Ageing Centre, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway; Brain and Muscle Energy Group, Electron Microscopy Laboratory, Institute of Oral Biology, University of Oslo, Oslo, Norway; Center for Healthy Aging and Department of Neuroscience and Pharmacology, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark.
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