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Muller AL, Diaz-Arias L, Cervenka MC, McDonald TJW. The effect of the modified Atkins diet and anti-seizure medications on lipid marker levels in adults with epilepsy. Nutr Neurosci 2024:1-10. [PMID: 39230257 DOI: 10.1080/1028415x.2024.2397624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2024]
Abstract
OBJECTIVES Some anti-seizure medications (ASMs) are known to induce liver enzymes and impact lipid values that include total cholesterol (TC), low density lipoprotein cholesterol (LDL), high density lipoprotein cholesterol (HDL), and triglyceride (TG). In addition, use of ketogenic diet therapies, including the modified Atkins diet (MAD), has also influenced lipids. Here, we explored the combined impact of enzyme inducing ASMs (EIASMs) and MAD on lipid values in adults with epilepsy. METHODS Diet-naïve adults with epilepsy who began MAD were divided into three groups based on ASM use: EIASMs, non-EIASMs, and those on no ASMs. Demographic information, epilepsy-specific clinical history, anthropometrics and lipid values were obtained through retrospective chart review at baseline and after a minimum of 12 months of MAD use. RESULTS Forty-two adults on MAD had baseline and follow up 12-month lipid outcomes. There was a significant increase in median levels of TC, LDL, non-HDL, and HDL after 12 months of MAD use. There was no change in median levels of TG. When separated according to ASM category, adults on non-EIASMs showed significant elevations in TC, HDL, and LDL after 12 months of MAD use. In contrast, adults on EIASMs only showed a significant increase in HDL after 12 months of MAD use. DISCUSSION The increase in atherogenic cholesterol levels observed after 12 months of MAD use was most pronounced in adults with epilepsy on non-EIASMs and not observed in adults with epilepsy on EIASMs despite a higher proportion of abnormal cholesterol levels at baseline in those on EIASMs.
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Affiliation(s)
- Ashley L Muller
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Luisa Diaz-Arias
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mackenzie C Cervenka
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Tanya J W McDonald
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Huerta N, Lu M, Henry-Barron BJ, Cervenka MC, McDonald TJW. Factors associated with seizure response in adults with epilepsy on a modified Atkins diet. Seizure 2024; 121:147-151. [PMID: 39181013 DOI: 10.1016/j.seizure.2024.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2024] [Revised: 08/19/2024] [Accepted: 08/19/2024] [Indexed: 08/27/2024] Open
Abstract
PURPOSE This study investigated factors associated with improved seizure control in adults with epilepsy following a modified Atkins diet (MAD). METHODS Follow-up data collected from participants enrolled in a prospective study between March 2016 and November 2023 was analyzed. Demographic and clinical differences between diet responders and non-responders were evaluated. MAD response was defined as ≥ 50 % reduction in seizure frequency from baseline. RESULTS MAD use led to clinical response in 48 % of study participants with 2-3 month follow-up and in 56 % of study participants with 6 month follow-up. No significant differences were found for gender, age at diet initiation, age at epilepsy diagnosis, or for number of current or past medications tried. However, a significant relationship emerged between epilepsy type and diet response at 6 months with a response of 100 % seen in adults with generalized epilepsy and a response of only 42 % in adults with focal epilepsy (p = 0.004). Those who responded to the diet showed non-significant increases in many of the measured lipid biomarkers. Levels of apolipoprotein-B and small low-density lipoprotein particles showed significant increases from baseline after 3 months in responders compared to non-responders (p = 0.004 and 0.049, respectively). CONCLUSIONS These findings support the continued use of MAD particularly for seizure management in adults with generalized epilepsy and highlight potential mechanisms of clinical response involving lipoprotein and energy metabolism.
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Affiliation(s)
- Nicholas Huerta
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
| | - Mengyang Lu
- Institute for Clinical and Translational Research, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
| | - Bobbie J Henry-Barron
- Institute for Clinical and Translational Research, 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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Alanis Guevara MI, García de Alba García JE, López Alanis AL, González Ojeda A, Fuentes Orozco C. Prospective study of the modified Atkins diet in adult drug-resistant epilepsy: effectiveness, tolerability, and adherence. Neurologia 2024; 39:467-473. [PMID: 37120105 DOI: 10.1016/j.nrleng.2021.10.008] [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: 03/17/2021] [Accepted: 10/17/2021] [Indexed: 05/01/2023] Open
Abstract
INTRODUCTION Drug-resistant epilepsy presents high worldwide prevalence and is difficult to control despite the wide variety of available antiepileptic drugs (AED). The modified Atkins diet (MAD) is an additional treatment alternative. Several studies have addressed the use of the ketogenic diet and MAD in children with drug-resistant epilepsy, but insufficient research has been conducted into adults with the same condition. OBJECTIVE To evaluate the effectiveness and tolerability of, and adherence to, the MAD in adults with drug-resistant epilepsy. MATERIAL AND METHODS We conducted a 6-month pre-post prospective study at a reference hospital. Patients were prescribed the MAD with limited carbohydrate intake and unlimited fat intake. We conducted clinical and electroencephalographic follow-up according to the relevant guidelines, and assessed adverse effects changes in laboratory findings, and adherence. RESULTS Thirty-two patients with drug-resistant epilepsy were included in the study. Patients' mean age was 30 years, mean disease progression time was 22 years, and all patients had focal or multifocal epilepsy. Thirty-four percent of patients presented > 50% decreases in overall seizure frequency (P = .001); seizure control was greater in the first month and subsequently declined. These patients presented weight loss (RR: 7.2; 95% CI, 1.3-39.5; P = .02), good to fair adherence only in the first and third months (RR: 9.4; 95% CI, 0.9-93.6; P = .04 and RR: 0.4; 95% CI, 0.30-0.69; P = .02, respectively). Tolerability data showed that the MAD is safe: adverse effects were minor and short-lived in most cases, with the exception of mild to moderate hyperlipidaemia in one-third of patients. The adherence rate was 50% at the end of the study. CONCLUSIONS In adults with drug-resistant focal epilepsy, the MAD showed adequate tolerability and moderate but decreasing effectiveness and adherence, probably due to a preference for a carbohydrate-based diet.
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Affiliation(s)
- M I Alanis Guevara
- Servicio de Neurología, Unidad Médica de Alta Especialidad, Hospital de Especialidades del Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, Jalisco, Mexico
| | - J E García de Alba García
- Departamento de Salud Pública, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Jalisco, Mexico
| | - A L López Alanis
- Servicio de Neurología, Unidad Médica de Alta Especialidad, Hospital de Especialidades del Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, Jalisco, Mexico
| | - A González Ojeda
- Unidad de Investigación Biomédica 02, Unidad Médica de Alta Especialidad, Hospital de Especialidades del Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, Jalisco, Mexico
| | - C Fuentes Orozco
- Unidad de Investigación Biomédica 02, Unidad Médica de Alta Especialidad, Hospital de Especialidades del Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, Jalisco, Mexico.
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Buchholz A, Deme P, Betz JF, Brandt J, Haughey N, Cervenka MC. A randomized feasibility trial of the modified Atkins diet in older adults with mild cognitive impairment due to Alzheimer's disease. Front Endocrinol (Lausanne) 2024; 15:1182519. [PMID: 38505743 PMCID: PMC10949529 DOI: 10.3389/fendo.2024.1182519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 02/05/2024] [Indexed: 03/21/2024] Open
Abstract
Background Alzheimer's disease (AD) is increasing in prevalence, but effective treatments for its cognitive impairment remain severely limited. This study investigates the impact of ketone body production through dietary manipulation on memory in persons with mild cognitive impairment due to early AD and explores potential mechanisms of action. Methods We conducted a 12-week, parallel-group, controlled feasibility trial of a ketogenic diet, the modified Atkins diet (MAD), compared to a control diet in patients with cognitive impairments attributed to AD. We administered neuropsychological assessments, including memory tests, and collected blood samples at baseline and after 12 weeks of intervention. We performed untargeted lipidomic and targeted metabolomic analyses on plasma samples to detect changes over time. Results A total of 839 individuals were screened to yield 38 randomized participants, with 20 assigned to receive MAD and 18 assigned to receive a control diet. Due to attrition, only 13 in the MAD arm and nine in the control arm were assessed for the primary endpoint, with two participants meeting ketosis levels used to define MAD adherence criteria. The average change from baseline in the Memory Composite Score was 1.37 (95% CI: -0.87, 4.90) points higher in the MAD group compared to the control group. The effect size of the intervention on baseline MAD change was moderate (Cohen's D = 0.57, 95% CI: -0.67, 1.33). In the 15 participants (nine MAD, six control) assessed for lipidomic and metabolomic-lipidomics and metabolomics, 13 metabolites and 10 lipids showed significant changes from baseline to 12 weeks, including triacylglycerols (TAGs, 50:5, 52:5, and 52:6), sphingomyelins (SM, 44:3, 46:0, 46:3, and 48:1), acetoacetate, fatty acylcarnitines, glycerol-3-phosphate, and hydroxy fatty acids. Conclusions Attrition was greatest between baseline and week 6. All participants retained at week 6 completed the study. Despite low rates of adherence by criteria defined a priori, lipidomic and metabolomic analyses indicate significant changes from baseline in circulating lipids and metabolites between MAD and control participants at 12-week postrandomization, and MAD participants showed greater, albeit nonsignificant, improvement in memory.
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Affiliation(s)
- Alison Buchholz
- Department of Psychiatry & Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Pragney Deme
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Joshua F. Betz
- Department of Biostatistics, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Jason Brandt
- Department of Psychiatry & Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Norman Haughey
- Department of Psychiatry & Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Mackenzie C. Cervenka
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
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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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Ferraris C, Guglielmetti M, Neri LDCL, Allehdan S, Mohsin Albasara JM, Fareed Alawadhi HH, Trentani C, Perna S, Tagliabue A. A Review of Ketogenic Dietary Therapies for Epilepsy and Neurological Diseases: A Proposal to Implement an Adapted Model to Include Healthy Mediterranean Products. Foods 2023; 12:foods12091743. [PMID: 37174282 PMCID: PMC10178865 DOI: 10.3390/foods12091743] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 04/14/2023] [Accepted: 04/20/2023] [Indexed: 05/15/2023] Open
Abstract
Based on the growing evidence of the therapeutic role of high-fat ketogenic dietary therapies (KDTs) for neurological diseases and on the protective effect of the Mediterranean diet (MD), it could be important to delineate a Mediterranean version of KDTs in order to maintain a high ketogenic ratio, and thus avoid side effects, especially in patients requiring long-term treatment. This narrative review aims to explore the existing literature on this topic and to elaborate recommendations for a Mediterranean version of the KDTs. It presents practical suggestions based on MD principles, which consist of key elements for the selection of foods (both from quantitative and qualitative prospective), and indications of the relative proportions and consumption frequency of the main food groups that constitute the Mediterranean version of the KDTs. We suggest the adoption of a Mediterranean version of ketogenic diets in order to benefit from the multiple protective effects of the MD. This translates to: (i) a preferential use of olive oil and vegetable fat sources in general; (ii) the limitation of foods rich in saturated fatty acids; (iii) the encouragement of high biological value protein sources; (iv) inserting fruit and vegetables at every meal possible, varying their choices according to seasonality.
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Affiliation(s)
- Cinzia Ferraris
- Ketogenic Metabolic Therapy Laboratory, Department of Public Health, Experimental and Forensics Medicine, University of Pavia, 27100 Pavia, Italy
- Laboratory of Food Education and Sport Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy
| | - Monica Guglielmetti
- Ketogenic Metabolic Therapy Laboratory, Department of Public Health, Experimental and Forensics Medicine, University of Pavia, 27100 Pavia, Italy
- Laboratory of Food Education and Sport Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy
| | - Lenycia de Cassya Lopes Neri
- Ketogenic Metabolic Therapy Laboratory, Department of Public Health, Experimental and Forensics Medicine, University of Pavia, 27100 Pavia, Italy
| | - Sabika Allehdan
- Department of Biology, College of Science, University of Bahrain, Sakhir P.O. Box 32038, Bahrain
| | | | | | - Claudia Trentani
- Ketogenic Metabolic Therapy Laboratory, Department of Public Health, Experimental and Forensics Medicine, University of Pavia, 27100 Pavia, Italy
| | - Simone Perna
- Division of Human Nutrition, Department of Food, Environmental and Nutritional Sciences (DeFENS), University of Milan, 20122 Milano, Italy
| | - Anna Tagliabue
- Ketogenic Metabolic Therapy Laboratory, Department of Public Health, Experimental and Forensics Medicine, University of Pavia, 27100 Pavia, Italy
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Lu G, Huang X, Lin C, Zou L, Pan H. A bibliometric and visual analysis of low carbohydrate diet. Front Nutr 2023; 10:1085623. [PMID: 36908904 PMCID: PMC9995895 DOI: 10.3389/fnut.2023.1085623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 02/06/2023] [Indexed: 02/25/2023] Open
Abstract
Introduction Numerous studies have confirmed the effects of low carbohydrate diet (LChD) on metabolism and chronic diseases. However, there were no bibliometric studies on LChD. This study was conducted through a bibliometric analysis to investigate the current status, hotspots and frontiers trends. Methods We searched all research publications related to LChD from 2002 to 2021 on the Web of Scientific Core Collection (WoSCC). CiteSpace and VOSviewer software was used to analyze countries/regions, institutions, journals, authors, references, and keywords. Results A total of 6938 papers were included, with an increasing trend of annual publication. LChD categories mainly included nutrition, endocrinology, and neurosciences which reflected the interdisciplinary characteristics. USA was with the largest number and the world science center in LChD field. Universities were main research institutions and five of the top 10 institutions were from USA. Eric Heath Kossoff had 101 publications and ranked first. Nutrients was the leading journal. "A randomized trial of a low-carbohydrate diet for obesity" and "Obesity" were considered to be the most co-cited and cited reference respectively. The hotspots of LChD are four aspects, "ketogenic diet", "metabolism disease", "cardiovascular disease" and "cancer". We summarized that "oxidative stress", "gut microbiota", and "inflammation factors" are becoming frontiers trends of LChD research in the future and deserve further study. Discussion Over the past 20 years research on LChD has gained great attention. To better explore LChD field, multilevel mechanism studies will be required in the future.
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Affiliation(s)
- Gang Lu
- Clinical Medical College of Acupuncture Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xin Huang
- School of Physical Education and Health, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Chun Lin
- School of Physical Education and Health, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Lijuan Zou
- School of Physical Education and Health, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Huashan Pan
- Science and Technology Division, Guangdong Food and Drug Vocational College, Guangzhou, China
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Operto FF, Pastorino GMG, Viggiano A, Dell’Isola GB, Dini G, Verrotti A, Coppola G. Epilepsy and Cognitive Impairment in Childhood and Adolescence: A Mini-Review. Curr Neuropharmacol 2023; 21:1646-1665. [PMID: 35794776 PMCID: PMC10514538 DOI: 10.2174/1570159x20666220706102708] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/28/2022] [Accepted: 04/26/2022] [Indexed: 11/22/2022] Open
Abstract
Managing epilepsy in people with an intellectual disability remains a therapeutic challenge and must take into account additional issues such as diagnostic difficulties and frequent drug resistance. Advances in genomic technologies improved our understanding of epilepsy and raised the possibility to develop patients-tailored treatments acting on the key molecular mechanisms involved in the development of the disease. In addition to conventional antiseizure medications (ASMs), ketogenic diet, hormone therapy and epilepsy surgery play an important role, especially in cases of drugresistance. This review aims to provide a comprehensive overview of the mainfactors influencing cognition in children and adolescents with epilepsy and the main therapeutic options available for the epilepsies associated with intellectual disability.
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Affiliation(s)
- Francesca Felicia Operto
- Child and Adolescent Neuropsychiatry Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, SA, Italy
| | - Grazia Maria Giovanna Pastorino
- Child and Adolescent Neuropsychiatry Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, SA, Italy
| | - Andrea Viggiano
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, Baronissi, SA, Italy
| | | | - Gianluca Dini
- Department of Pediatrics, University of Perugia, Giorgio Menghini Square, 06129 Perugia, Italy
| | - Alberto Verrotti
- Department of Pediatrics, University of Perugia, Giorgio Menghini Square, 06129 Perugia, Italy
| | - Giangennaro Coppola
- Child and Adolescent Neuropsychiatry Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, SA, Italy
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He F, Qiu J, Li H, Guo H, Wang S, Ding Y, Xu S, Wang Z, Feng J, Zhang P, Ding M, Wang S. Efficacy of the ketogenic diet in Chinese adults versus children with drug-resistant epilepsy: A pilot study. Epilepsy Behav 2022; 134:108820. [PMID: 35839644 DOI: 10.1016/j.yebeh.2022.108820] [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: 03/15/2022] [Revised: 06/21/2022] [Accepted: 06/23/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE We compared the efficacy and safety of ketogenic diet (KD) therapy as a treatment for Chinese adults versus children with drug-resistant epilepsy. METHODS The classic KD was initiated in 19 adults and 29 children with drug-resistant epilepsy. The KD ratio and the dosage of antiseizure medication (ASM) were delicately modulated by the ketogenic team. RESULTS At 12 months after diet initiation, 11 adults (8 on a KD ratio of 3:1 and 3 on a ratio of 2:1) and 20 children (9 on a ketogenic diet ratio of 3:1 and 11 on a ratio of 2:1) remained on the diet. The retention rate for adult KD therapy recipients was 79.0% at 6 months and 57.9% at 12 months after diet initiation, which was not significantly different from the retention rate for children (82.8% at 6 months and 68.9% at 12 months; P > 0.05). The efficacy rate of KD therapy (seizure freedom or ≥50% reduction in seizure frequency) did not significantly differ between adults (63.2%) and children (75.8%, P = 0.517). Alleviation of seizure severity was observed in 68.4% of adults and 63.6% of children who were not seizure free on KD therapy. Antiseizure medication was reduced in 34 out of all 48 individuals at the final follow-up. CONCLUSION Our study demonstrated that KD therapy is a safe and effective treatment for Chinese adults as well as children with drug-resistant epilepsy.
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Affiliation(s)
- Fang He
- Department of Nutrition, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jingjing Qiu
- Department of Neurology, Epilepsy Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Hong Li
- Department of Radiology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Huilan Guo
- Department of Nutrition, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Shan Wang
- Department of Neurology, Epilepsy Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yao Ding
- Department of Neurology, Epilepsy Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Sha Xu
- Department of Neurology, Epilepsy Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Zhongjin Wang
- Department of Neurology, Epilepsy Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jianhua Feng
- Department of Pediatrics, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Pianhong Zhang
- Department of Nutrition, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Meiping Ding
- Department of Neurology, Epilepsy Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Shuang Wang
- Department of Neurology, Epilepsy Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
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Estudio prospectivo de dieta Atkins modificada en epilepsia farmacorresistente de adultos: efectividad, tolerabilidad y adherencia. Neurologia 2022. [DOI: 10.1016/j.nrl.2021.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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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: 4] [Impact Index Per Article: 2.0] [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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Samia P, Naanyu V, Cross JH, Idro R, Boon P, Wilmshurst J, Luchters S. Qualitative exploration of feasibility and acceptability of the modified Atkins diet therapy for children with drug resistant epilepsy in Kenya. Epilepsy Behav 2021; 125:108362. [PMID: 34740092 DOI: 10.1016/j.yebeh.2021.108362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 09/20/2021] [Accepted: 09/25/2021] [Indexed: 01/01/2023]
Abstract
PURPOSE Approximately one-third of children with epilepsy have clinical syndromes characterized by drug resistance. Modified Atkins dietary therapy (MADT) can reduce seizures and improve health outcomes for these children. This intervention is yet to be consistently offered as standard of care in sub-Saharan Africa. OBJECTIVES This study aimed to assess feasibility and acceptability of MADT for children with drug-resistant epilepsy and identify enabling strategies for implementation and adherence to the MADT. METHODS This qualitative inquiry utilized in-depth interviews with purposively selected caregivers and adolescent patients having used MADT for drug-resistant epilepsy. A qualified team consisting of a social scientist and an interviewer carried out the interviews with consenting participants. Thematic analysis was done independent of the clinicians. RESULTS This study enrolled 17 participants including 14 caregivers of children aged 1-17 years, and three adolescents. Caregivers were predominantly trained professionals living in urban areas who had attended the epilepsy clinic for at least one year. Duration of continuous MADT use ranged from two weeks to two years. Among participants who indicated that they could afford to provide the MADT, it was less costly to provide for younger children and for those living in rural areas. At the time of the study, majority of the caregivers had ceased administration of the MADT, more than half of whom reported barriers including cost of food, child refusal of foods, and inconsistent dietician support. Social support was a key enabler to successful implementation and continuation of the diet. Majority of the participants considered MADT to be an effective and acceptable intervention for management of epilepsy. CONCLUSIONS Among participants in this focused Kenyan group, implementation of MADT was found to be feasible particularly for younger children living in rural areas. Majority of participants evaluated MADT to be an effective and acceptable intervention for management of epilepsy. Cultural factors did not influence feasibility or acceptability of MADT in this study.
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Affiliation(s)
- Pauline Samia
- Department of Paediatrics and Child Health, Medical College, Aga Khan University, Nairobi, Kenya; Brain and Mind Institute, Aga Khan University, Kenya; Department of Public Health and Primary Care, Ghent University, Belgium.
| | - Violet Naanyu
- School of Arts & Social Sciences, Moi University, Kenya; AMPATH Research, Eldoret, Kenya
| | - J Helen Cross
- UCL BRC NIHR Great Ormond Street, Institute of Child Health, London, United Kingdom
| | - Richard Idro
- Makerere University, Department of Paediatrics and Child Health, Kampala, Uganda
| | - Paul Boon
- Department of Neurology, Ghent University, Belgium
| | - Jo Wilmshurst
- Department of Paediatric Neurology, Red Cross War Memorial Children's Hospital, Cape Town, South Africa; Institute of Neurosciences, University of Cape Town, South Africa
| | - Stanley Luchters
- Department of Public Health and Primary Care, Ghent University, Belgium; Department of Population Health, Medical College, Aga Khan University, Nairobi, Kenya; Department of Epidemiology and Preventive Medicine, Monash University, Australia
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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: 28] [Impact Index Per Article: 9.3] [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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14
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Schreck KC, Hsu FC, Berrington A, Henry-Barron B, Vizthum D, Blair L, Kossoff EH, Easter L, Whitlow CT, Barker PB, Cervenka MC, Blakeley JO, Strowd RE. Feasibility and Biological Activity of a Ketogenic/Intermittent-Fasting Diet in Patients With Glioma. Neurology 2021; 97:e953-e963. [PMID: 34233941 DOI: 10.1212/wnl.0000000000012386] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 05/28/2021] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE To examine the feasibility, safety, systemic biological activity, and cerebral activity of a ketogenic dietary intervention in patients with glioma. METHODS 25 patients with biopsy-confirmed WHO Grade 2-4 astrocytoma with stable disease following adjuvant chemotherapy were enrolled in an 8-week GLioma Atkins-based Diet (GLAD). GLAD consisted of 2 fasting days (calories<20% calculated estimated needs) interleaved between 5 modified Atkins diet days (net carbohydrates≤20 gm/day) each week. The primary outcome was dietary adherence by food records. Markers of systemic and cerebral activity included weekly urine ketones, serum insulin, glucose, hemoglobin A1c, IGF-1, and MR spectroscopy at baseline and week 8. RESULTS 21 patients completed the study (84%). 80% of patients reached ≥40 mg/dL urine acetoacetate during the study. 48% of patients were adherent by food record. The diet was well-tolerated with two grade 3 adverse events (neutropenia, seizure). Measures of systemic activity including hemoglobin A1c, insulin, and fat body mass decreased significantly, while lean body mass increased. MR spectroscopy demonstrated increased ketone concentrations (β-hydroxybutyrate (bHB) and acetone (Ace)) in both lesional and contralateral brain, compared to baseline. Average ketonuria correlated with cerebral ketones in lesional (tumor) and contralateral brain (bHB Rs 0.52, p=0.05). Sub-group analysis of IDH-mutant glioma showed no differences in cerebral metabolites after controlling for ketonuria. CONCLUSIONS The GLAD dietary intervention, while demanding, produced meaningful ketonuria, and significant systemic and cerebral metabolic changes in participants. Ketonuria in participants correlated with cerebral ketone concentration and appear to be a better indicator of systemic activity than patient-reported food records.
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Affiliation(s)
- Karisa C Schreck
- Departments of Neurology, Oncology, and Neurosurgery Johns Hopkins University School of Medicine, Baltimore, MD
| | - Fang-Chi Hsu
- Department of Biostatistics and Data Science Wake Forest School of Medicine, Winston-Salem, NC
| | - Adam Berrington
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD.,Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, UK
| | - Bobbie Henry-Barron
- Institute for Clinical and Translational Research, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Diane Vizthum
- Institute for Clinical and Translational Research, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Lindsay Blair
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Eric H Kossoff
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Linda Easter
- Clinical Research Unit, Wake Forest School of Medicine, Winston-Salem, NC
| | - Christopher T Whitlow
- Departments of Radiology, Biostatistics and Data Science, Biomedical Engineering, and Clinical and Translational Science Institute, Wake Forest School of Medicine, Winston-Salem, NC
| | - Peter B Barker
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Mackenzie C Cervenka
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jaishri O Blakeley
- Departments of Neurology, Oncology, and Neurosurgery Johns Hopkins University School of Medicine, Baltimore, MD
| | - Roy E Strowd
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD; .,Departments of Neurology and Oncology, Wake Forest School of Medicine, Winston-Salem, NC
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15
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Beamer E, Kuchukulla M, Boison D, Engel T. ATP and adenosine-Two players in the control of seizures and epilepsy development. Prog Neurobiol 2021; 204:102105. [PMID: 34144123 DOI: 10.1016/j.pneurobio.2021.102105] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 04/07/2021] [Accepted: 06/09/2021] [Indexed: 02/08/2023]
Abstract
Despite continuous advances in understanding the underlying pathogenesis of hyperexcitable networks and lowered seizure thresholds, the treatment of epilepsy remains a clinical challenge. Over one third of patients remain resistant to current pharmacological interventions. Moreover, even when effective in suppressing seizures, current medications are merely symptomatic without significantly altering the course of the disease. Much effort is therefore invested in identifying new treatments with novel mechanisms of action, effective in drug-refractory epilepsy patients, and with the potential to modify disease progression. Compelling evidence has demonstrated that the purines, ATP and adenosine, are key mediators of the epileptogenic process. Extracellular ATP concentrations increase dramatically under pathological conditions, where it functions as a ligand at a host of purinergic receptors. ATP, however, also forms a substrate pool for the production of adenosine, via the action of an array of extracellular ATP degrading enzymes. ATP and adenosine have assumed largely opposite roles in coupling neuronal excitability to energy homeostasis in the brain. This review integrates and critically discusses novel findings regarding how ATP and adenosine control seizures and the development of epilepsy. This includes purine receptor P1 and P2-dependent mechanisms, release and reuptake mechanisms, extracellular and intracellular purine metabolism, and emerging receptor-independent effects of purines. Finally, possible purine-based therapeutic strategies for seizure suppression and disease modification are discussed.
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Affiliation(s)
- Edward Beamer
- Department of Physiology and Medical Physics, Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin D02 YN77, Ireland; Centre for Bioscience, Manchester Metropolitan University, John Dalton Building, All Saints Campus, Manchester M15 6BH, UK
| | - Manvitha Kuchukulla
- Department of Neurosurgery, Robert Wood Johnson & New Jersey Medical Schools, Rutgers University, Piscataway, NJ 08854, USA
| | - Detlev Boison
- Department of Neurosurgery, Robert Wood Johnson & New Jersey Medical Schools, Rutgers University, Piscataway, NJ 08854, USA.
| | - Tobias Engel
- Department of Physiology and Medical Physics, Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin D02 YN77, Ireland; FutureNeuro, Science Foundation Ireland Research Centre for Chronic and Rare Neurological Diseases, Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin D02 YN77, Ireland.
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16
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McDonald TJW, Diaz-Arias L, Vizthum D, Henry-Barron BJ, Schlechter H, Kossoff EH, Cervenka MC. Six-month effects of modified Atkins diet implementation on indices of cardiovascular disease risk in adults with epilepsy. Nutr Neurosci 2021; 25:1548-1557. [PMID: 33487129 DOI: 10.1080/1028415x.2021.1875301] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND/AIMS Ketogenic diet therapies (KDTs) offer a needed therapeutic option for patients with drug-resistant epilepsy. The current study investigated biochemical and anthropometric indices of cardiovascular disease (CVD) risk in adults with epilepsy treated with KDT over 6 months. METHOD 65 adults with epilepsy naïve to diet therapy were enrolled in a prospective longitudinal study and instructed on modified Atkins diet (MAD) use. Seizure frequency, anthropometric measures, blood levels of total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglycerides, apolipoproteins A1 and B, and lipoprotein sub-fractions were assessed at baseline, 3 months, and 6 months. RESULTS Subsequent to study enrollment, 34 participants were lost to follow-up, elected not to start, or stopped MAD prior to study completion, leaving a total of 31 participants in the study at 6 months. Compared to baseline, participants on MAD showed significant reductions in median seizure frequency/week, weight, body mass index, waist and hip circumference, and percent body fat at 3 and 6 months. Compared to baseline, participants on MAD for 3 months showed significantly increased levels of total, small and medium LDL particles, ApoB and ApoB/A1 ratio. At 6 months, only small LDL particles and ApoB levels remained elevated and levels of ApoA1 had risen, suggesting possible compensatory adaptation over time. CONCLUSIONS This study provides evidence demonstrating the efficacy and cardiovascular safety of 6 months of MAD use by adults with epilepsy. It also highlights an index of CVD risk - small LDL particles - that should be closely monitored..Trial registration: ClinicalTrials.gov identifier: NCT02694094..
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Affiliation(s)
- Tanya J W McDonald
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Luisa Diaz-Arias
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Diane Vizthum
- Institute for Clinical and Translational Research, Johns Hopkins University, Baltimore, MD, USA
| | - Bobbie J Henry-Barron
- Institute for Clinical and Translational Research, Johns Hopkins University, Baltimore, MD, USA
| | - Haley Schlechter
- Institute for Clinical and Translational Research, Johns Hopkins University, Baltimore, MD, USA
| | - Eric H Kossoff
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mackenzie C Cervenka
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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17
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Goldberg IJ, Ibrahim N, Bredefeld C, Foo S, Lim V, Gutman D, Huggins LA, Hegele RA. Ketogenic diets, not for everyone. J Clin Lipidol 2021; 15:61-67. [PMID: 33191194 PMCID: PMC7887024 DOI: 10.1016/j.jacl.2020.10.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 10/27/2020] [Accepted: 10/28/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND The adoption of low-carbohydrate diets can lead to weight loss in many patients. However, these now widespread diets also have the potential to exacerbate hypercholesterolemia. OBJECTIVE The objective of this study is to display the potentially harmful effects of the ketogenic diet on cholesterol levels in patients with or without underlying hyperlipidemia. METHODS We describe 5 patients who developed marked increases in plasma cholesterol on ketogenic diets and assessed whether they had a well-described underlying genetic hyperlipidemia. RESULTS Three out of 5 patients had extraordinary increases of blood cholesterol levels to over 500 mg/dL. The other 2 patients more than doubled their low-density lipoprotein cholesterol levels on a ketogenic diet. One patient had an APOE E2/E2 genotype. A higher burden of common genetic polymorphisms was found in 2 patients, with no major mutations found. No potential genetic cause was seen in a fourth patient, and the fifth patient had no genetic testing. Three patients, including the one who was most hypercholesterolemic, had a marked reduction in cholesterol after reverting to a more liberal diet. One refused to change his diet but had a satisfactory low-density lipoprotein cholesterol reduction on ezetimibe. CONCLUSION These cases should serve as a caution that high-fat low-carbohydrate diets have the potential to exacerbate or cause hypercholesterolemia in patients with or without underlying genetic hyperlipidemia.
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Affiliation(s)
- Ira J Goldberg
- Division of Endocrinology, Diabetes and Metabolism, NYU Langone Medical Center, New York, NY, USA.
| | - Nouran Ibrahim
- Division of Endocrinology, Diabetes and Metabolism, NYU Langone Medical Center, New York, NY, USA
| | - Cindy Bredefeld
- Winthrop Endocrinology, Diabetes and Metabolism, NYU Long Island School of Medicine, Mineola, NY, USA
| | - Sandra Foo
- Division of Endocrinology, Diabetes and Metabolism, NYU Langone Medical Center, New York, NY, USA
| | - Vivien Lim
- Queens Cardiovascular and Division of Cardiology, Long Island Jewish Hospital, Flushing, NY, USA
| | - Deborah Gutman
- Department of Emergency Medicine, Warren Alpert School of Medicine, Providence, RI, USA
| | - Lesley-Ann Huggins
- Division of Endocrinology, Diabetes and Metabolism, NYU Langone Medical Center, New York, NY, USA
| | - Robert A Hegele
- Departments of Medicine and Biochemistry, Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
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18
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Neves GS, Lunardi MS, Lin K, Rieger DK, Ribeiro LC, Moreira JD. Ketogenic diet, seizure control, and cardiometabolic risk in adult patients with pharmacoresistant epilepsy: a review. Nutr Rev 2020; 79:931-944. [PMID: 33230563 DOI: 10.1093/nutrit/nuaa112] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Pharmacoresistant epilepsy causes serious deleterious effects on the patient's health and quality of life. For this condition, a ketogenic diet (KD) is a treatment option. The KD is a general term for a set of diets that contain high amounts of fat and low content of carbohydrates. The most prominent KD treatments are classical KD (4:1 ratio of fat to carbohydrate), modified Atkins diet (2:1 to 1:1 ratio), medium-chain triglycerides KD (with medium-chain triglyceride as a part of the fat content), and low glycemic index KD (using low glycemic carbohydrates). KD has been widely prescribed for children with epilepsy but not for adult patients. One of the main concerns about adult use of KD is its cardiovascular risk associated with high-fat and cholesterol intake. Therefore, this narrative review provides comprehensive information of the current literature on the effects of KD on lipid profile, glycemic-control biomarkers, and other cardiometabolic risk factors in adult patients with pharmacoresistant epilepsy.
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Affiliation(s)
- Gabriela S Neves
- Postgraduate Program in Nutrition, Universidade Federal de Santa Catarina, Florianópolis, Santa Catarina, Brazil.,Translational Nutrition Neuroscience Working Group, CNPq Directory of Research Groups, Florianópolis, Santa Catarina, Brazil
| | - Mariana S Lunardi
- Postgraduate Program in Medical Sciences, Universidade Federal de Santa Catarina, Florianópolis, Santa Catarina, Brazil.,Translational Nutrition Neuroscience Working Group, CNPq Directory of Research Groups, Florianópolis, Santa Catarina, Brazil
| | - Katia Lin
- Postgraduate Program in Medical Sciences, Universidade Federal de Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Débora Kurrle Rieger
- Postgraduate Program in Nutrition, Universidade Federal de Santa Catarina, Florianópolis, Santa Catarina, Brazil.,Department of Nutrition, Universidade Federal de Santa Catarina, Florianópolis, Santa Catarina, Brazil.,Translational Nutrition Neuroscience Working Group, CNPq Directory of Research Groups, Florianópolis, Santa Catarina, Brazil
| | - Letícia C Ribeiro
- Department of Nutrition, Universidade Federal de Santa Catarina, Florianópolis, Santa Catarina, Brazil.,Translational Nutrition Neuroscience Working Group, CNPq Directory of Research Groups, Florianópolis, Santa Catarina, Brazil
| | - Júlia D Moreira
- Postgraduate Program in Nutrition, Universidade Federal de Santa Catarina, Florianópolis, Santa Catarina, Brazil.,Department of Nutrition, Universidade Federal de Santa Catarina, Florianópolis, Santa Catarina, Brazil.,Translational Nutrition Neuroscience Working Group, CNPq Directory of Research Groups, Florianópolis, Santa Catarina, Brazil
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19
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Testa F, Marchiò M, D’Amico R, Giovanella S, Ligabue G, Fontana F, Alfano G, Cappelli G, Biagini G, Magistroni R. GREASE II. A phase II randomized, 12-month, parallel-group, superiority study to evaluate the efficacy of a Modified Atkins Diet in Autosomal Dominant Polycystic Kidney Disease patients. PHARMANUTRITION 2020. [DOI: 10.1016/j.phanu.2020.100206] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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20
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Brandt J, Buchholz A, Henry-Barron B, Vizthum D, Avramopoulos D, Cervenka MC. Preliminary Report on the Feasibility and Efficacy of the Modified Atkins Diet for Treatment of Mild Cognitive Impairment and Early Alzheimer's Disease. J Alzheimers Dis 2020; 68:969-981. [PMID: 30856112 DOI: 10.3233/jad-180995] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Ketone bodies, the products of fat metabolism, are a source of energy for the brain and are available even when glucose supplies are inadequate (such as with severe carbohydrate deprivation) or its metabolism is faulty (as it is in Alzheimer's disease). This phase I/II randomized clinical trial examined the feasibility of using a modified Atkins diet (MAD) to induce ketogenesis in persons with mild cognitive impairment (MCI) or early AD, and the effect of this diet on memory and other clinical outcomes. In the first 2.5 years of active recruitment, only 27 eligible and willing patients enrolled. After extensive assessment and education, they and their study partners were randomly assigned for 12 weeks to either the MAD or the National Institute on Aging (NIA) recommended diet for seniors. As of April 2018, 9 patients in the MAD arm and 5 in the NIA arm have completed the trial. In spite of extensive teaching, coaching, and monitoring, adherence to both diets was only fair. Among those in the MAD arm who generated at least trace amounts of urinary ketones, there was a large (effect size = 0.53) and statistically significant (p = 0.03) increase in Memory Composite Score between the baseline and week-6 assessment. MAD participants also reported increased energy between baseline and week-6 assessment. Despite challenges to implementing this trial, resulting in a small sample, our preliminary data suggest that the generation of even trace ketones might enhance episodic memory and patient-reported vitality in very early AD.
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Affiliation(s)
- Jason Brandt
- Department of Psychiatry & Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Alison Buchholz
- Department of Psychiatry & Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Bobbie Henry-Barron
- Institute for Clinical and Translational Research, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Diane Vizthum
- Institute for Clinical and Translational Research, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Dimitrios Avramopoulos
- Department of Psychiatry & Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Institute of Genetic Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mackenzie C Cervenka
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Olgac A, İnci A, Okur İ, Biberoğlu G, Oğuz D, Ezgü FS, Kasapkara ÇS, Aktaş E, Tümer L. Beneficial Effects of Modified Atkins Diet in Glycogen Storage Disease Type IIIa. ANNALS OF NUTRITION AND METABOLISM 2020; 76:233-241. [DOI: 10.1159/000509335] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 06/07/2020] [Indexed: 11/19/2022]
Abstract
<b><i>Introduction:</i></b> Glycogen storage disease Type III (GSD III) is an autosomal recessive disease caused by the deficiency of glycogen debranching enzyme, encoded by the AGL gene. Two clinical types of the disease are most prevalent: GSD IIIa involves the liver and muscle, whereas IIIb affects only the liver. The classical dietetic management of GSD IIIa involves prevention of fasting, frequent feeds with high complex carbohydrates in small children, and a low-carb-high-protein diet in older children and adults. Recently, diets containing high amount of fat, including ketogenic and modified Atkins diet (MAD), have been suggested to have favorable outcome in GSD IIIa. <b><i>Methods:</i></b> Six patients, aged 3–31 years, with GSD IIIa received MAD for a duration of 3–7 months. Serum glucose, transaminases, creatine kinase (CK) levels, capillary ketone levels, and cardiac parameters were followed-up. <b><i>Results:</i></b> In all patients, transaminase levels dropped in response to MAD. Decrease in CK levels were detected in 5 out of 6 patients. Hypoglycemia was evident in 2 patients but was resolved by adding uncooked cornstarch to diet. <b><i>Conclusion:</i></b> Our study demonstrates that GSD IIIa may benefit from MAD both clinically and biochemically.
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Felix G, Kossoff E, Barron B, Krekel C, Testa EG, Scheimann A. The modified Atkins diet in children with Prader-Willi syndrome. Orphanet J Rare Dis 2020; 15:135. [PMID: 32493369 PMCID: PMC7268481 DOI: 10.1186/s13023-020-01412-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 05/18/2020] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Prader-Willi Syndrome (PWS) is the most common genetic cause of obesity. Various dietary strategies have been used for weight management for people with PWS. METHODS This was a clinical feasibility study to test the use of the Modified Atkins Diet (low carbohydrate and high fat) for children with PWS ages 6-12 years who were overweight/obese. Participants went on the Modified Atkins Diet for 4 months and then returned to have anthropometry repeated including repeat labs and behavior questionnaires. RESULTS Seven children (ages 6-12) were enrolled in the study. Four participants completed the 4-month diet trial; two were unable to comply with the diet and stopped prematurely. One patient lost 2.9 kg; the others maintained their weight. Adverse effects were increases in LDL (expected based on larger studies) and hypercalciuria (with no renal stones) for one patient. Positive effects on hyperphagia and behavior were noted subjectively by families. CONCLUSION The Modified Atkins Diet can be a feasible low carbohydrate option for children with Prader-Willi Syndrome for weight management. Long-term use of the diet in patients with Prader-Willi Syndrome needs to be studied further.
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Affiliation(s)
- Grace Felix
- Division of Pediatric Gastroenterology and Nutrition, Johns Hopkins School of Medicine, Baltimore, MD, USA.,Pediatric Specialists of Virginia/INOVA Children's Hospital, Fairfax, Virginia, USA
| | - Eric Kossoff
- Department of Pediatric Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Bobbie Barron
- Institute of Clinical and Translational Research, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Caitlin Krekel
- Institute of Clinical and Translational Research, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Elizabeth Getzoff Testa
- Department of Psychology, Center for Pediatric Weight Management & Healthy Living, Mt. Washington Pediatric Hospital, Baltimore, MD, USA
| | - Ann Scheimann
- Division of Pediatric Gastroenterology and Nutrition, Johns Hopkins School of Medicine, Baltimore, MD, USA. .,Division of Pediatric Gastroenterology and Nutrition, Johns Hopkins Hospital, 600 N. Wolfe Street Brady 320, Baltimore, MD, 21287-2631, USA.
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23
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Green SF, Nguyen P, Kaalund-Hansen K, Rajakulendran S, Murphy E. Effectiveness, retention, and safety of modified ketogenic diet in adults with epilepsy at a tertiary-care centre in the UK. J Neurol 2020; 267:1171-1178. [PMID: 31925498 PMCID: PMC7109193 DOI: 10.1007/s00415-019-09658-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 11/24/2019] [Accepted: 11/27/2019] [Indexed: 01/25/2023]
Abstract
With the rising demand for ketogenic diet therapy in adult epilepsy, there is a need for research describing the real-life effectiveness, retention, and safety of relevant services. In this 1-year prospective cohort study we present outcomes of the first 100 referrals for modified ketogenic diet (MKD) at the UK's largest tertiary-care epilepsy centre, where patients received dietetic review up to twice per week. Of the first 100 referrals, 42 (31 females, 11 males; mean age 36.8 [SD ± 11.4 years]) commenced MKD, having used a mean of 4 (SD ± 3) previous antiepileptic drugs. Retention rates were: 60% at 3 months, 43% at 6 months, and 29% at 12 months. 60% of patients reported an improvement in seizure frequency, 38% reported a > 50% reduction, and 13% reported a period of seizure freedom; 30% reported a worsening in seizure frequency at some point during MKD therapy. The most common reasons for discontinuing MKD were side effects and diet restrictiveness. The most common side effects were weight loss, gastrointestinal symptoms and low mood. The likelihood of discontinuing MKD was significantly decreased by experiencing an improvement in seizure frequency (p ≤ 0.001). This study demonstrates that MKD can be effective in adults, although, even with regular dietetic support, retention rates remain low, and periods of worsening seizure frequency are common.
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Affiliation(s)
- S F Green
- Epilepsy Department, The National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG, UK
| | - P Nguyen
- Charles Dent Metabolic Unit, The National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG, UK
| | - K Kaalund-Hansen
- Charles Dent Metabolic Unit, The National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG, UK
| | - S Rajakulendran
- Epilepsy Department, The National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG, UK
| | - Elaine Murphy
- Charles Dent Metabolic Unit, The National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG, UK.
- University College London, London, UK.
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Husari KS, Cervenka MC. The ketogenic diet all grown up-Ketogenic diet therapies for adults. Epilepsy Res 2020; 162:106319. [PMID: 32199222 DOI: 10.1016/j.eplepsyres.2020.106319] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 03/08/2020] [Accepted: 03/08/2020] [Indexed: 01/14/2023]
Abstract
The use of ketogenic diet therapies (KDT) in adults has expanded in the last two decades and has been accompanied by a surge of new retrospective as well as prospective studies evaluating its efficacy in adults with epilepsy. In this review article, we will highlight the recent clinical trials and advances in the use of the ketogenic diet therapy (KDT) in adult patients with epilepsy. We will analyze the responder rate in regard to the epilepsy syndrome (focal vs generalized) to identify adults who are optimal to consider for KDT. In addition to its role in treating patients with chronic epilepsy, we will explore the emerging use of the KDT in the critical care setting in adults with refractory and super-refractory status epilepticus as well as other neurologic disorders. Finally, we will discuss special considerations for the use of KDT in adults with epilepsy including its potential long-term effects on bone and cardiovascular health, and its use in pregnancy.
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Affiliation(s)
- Khalil S Husari
- Comprehensive Epilepsy Center, Department of Neurology, Johns Hopkins University, Baltimore, MD, USA
| | - Mackenzie C Cervenka
- Comprehensive Epilepsy Center, Department of Neurology, Johns Hopkins University, Baltimore, MD, USA.
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25
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de Souza Neves G, dos Santos Lunardi M, Papini Gabiatti M, Kurrle Rieger Venske D, Ribeiro LC, Lin K, Dubois Moreira J. Cardiometabolic risk and effectiveness of the modified Atkins Ketogenic Diet for adult patients with pharmacoresistant epilepsies in a middle-income country. Epilepsy Res 2020; 160:106280. [DOI: 10.1016/j.eplepsyres.2020.106280] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 01/07/2020] [Accepted: 01/16/2020] [Indexed: 12/14/2022]
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26
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Testa F, Marchiò M, Belli M, Giovanella S, Ligabue G, Cappelli G, Biagini G, Magistroni R. A pilot study to evaluate tolerability and safety of a modified Atkins diet in ADPKD patients. PHARMANUTRITION 2019. [DOI: 10.1016/j.phanu.2019.100154] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Food and Food Products on the Italian Market for Ketogenic Dietary Treatment of Neurological Diseases. Nutrients 2019; 11:nu11051104. [PMID: 31108981 PMCID: PMC6566354 DOI: 10.3390/nu11051104] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 05/12/2019] [Accepted: 05/15/2019] [Indexed: 12/17/2022] Open
Abstract
The ketogenic diet (KD) is the first line intervention for glucose transporter 1 deficiency syndrome and pyruvate dehydrogenase deficiency, and is recommended for refractory epilepsy. It is a normo-caloric, high-fat, adequate-protein, and low-carbohydrate diet aimed at switching the brain metabolism from glucose dependence to the utilization of ketone bodies. Several variants of KD are currently available. Depending on the variant, KDs require the almost total exclusion, or a limited consumption of carbohydrates. Thus, there is total avoidance, or a limited consumption of cereal-based foods, and a reduction in fruit and vegetable intake. KDs, especially the more restrictive variants, are characterized by low variability, palatability, and tolerability, as well as by side-effects, like gastrointestinal disorders, nephrolithiasis, growth retardation, hyperlipidemia, and mineral and vitamin deficiency. In recent years, in an effort to improve the quality of life of patients on KDs, food companies have started to develop, and commercialize, several food products specific for such patients. This review summarizes the foods themselves, including sweeteners, and food products currently available for the ketogenic dietary treatment of neurological diseases. It describes the nutritional characteristics and gives indications for the use of the different products, taking into account their metabolic and health effects.
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Roehl K, Falco-Walter J, Ouyang B, Balabanov A. Modified ketogenic diets in adults with refractory epilepsy: Efficacious improvements in seizure frequency, seizure severity, and quality of life. Epilepsy Behav 2019; 93:113-118. [PMID: 30867113 DOI: 10.1016/j.yebeh.2018.12.010] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 12/12/2018] [Accepted: 12/13/2018] [Indexed: 12/30/2022]
Abstract
OBJECTIVE This study evaluates the efficacy of a modified ketogenic diet (MKD) on seizure frequency, severity, and quality of life (QOL), as well as potential complications of MKD therapy among adults with drug-resistant epilepsy (DRE). METHODS Changes in seizure frequency, severity, QOL, and side effects were retrospectively examined among adults, ≥17 years of age, with DRE (≥2 antiepileptic drugs [AEDs]), after 3 months of MKD therapy. Attention was paid to medication or vagus nerve stimulator (VNS) changes as well to evaluate potential confounders. RESULTS A total of 60% (n = 33) of the 55 individuals reported ≥50% seizure frequency improvement, 42 (76%) reported improvement in seizure severity, and 48 (87%) reported improvement in QOL. More patients following a modified ketogenic diet - 15 g net carbohydrate daily (MKD-15) (95%) compared with a MKD-50 (69%) reported improvement in QOL (p = 0.02). Weight among the entire sample declined from 77.5 (20) kg to 73.9 (19.0) kg (p < 0.0001), and total cholesterol (TC), low density lipoprotein (LDL), and total cholesterol:high density lipoprotein (TC:HDL) increased significantly (p = 0.03, p = 0.04, and p = 0.02, respectively). Free carnitine values were available for a select number of patients, 26 (47%) at baseline, and 7 (13%) at follow-up, of which 8 (31%) at baseline, and 2 (29%) at follow-up had carnitine deficiency (<25 nmol/mL). Constipation was noted in 5 patients (9%), and no kidney stones were reported during the study period. There were no statistical differences in number or dose changes for AED or VNS during the study period. SIGNIFICANCE Modified ketogenic diet therapies reduce seizure frequency and severity and improve QOL among adults with DRE with few side effects outside of weight loss, a desired outcome among many adults with DRE. More restrictive MKDs may offer improved seizure severity and QOL. Modified ketogenic diet therapy increases LDL cholesterol, which may be cardioprotective if related to an increase in LDL particle size with high saturated fat intake; however, more research is needed examining LDL particle size changes among those receiving MKD therapy.
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Affiliation(s)
- Kelly Roehl
- Rush University Medical Center, 1725 West Harrison Street, Suite 885, Chicago, IL 60612, United States of America.
| | - Jessica Falco-Walter
- Rush University Medical Center, 1725 West Harrison Street, Suite 885, Chicago, IL 60612, United States of America; Stanford University, 213 Quarry Road, 4th Floor, Palo Alto, CA 94304, United States of America.
| | - Bichun Ouyang
- Rush University Medical Center, 1725 West Harrison Street, Suite 885, Chicago, IL 60612, United States of America.
| | - Antoaneta Balabanov
- Rush University Medical Center, 1725 West Harrison Street, Suite 885, Chicago, IL 60612, United States of America.
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Abstract
The current review highlights the evidence supporting the use of ketogenic diet therapies in the management of a growing number of neurological disorders in adults. An overview of the scientific literature supporting posited mechanisms of therapeutic efficacy is presented including effects on neurotransmission, oxidative stress, and neuro-inflammation. The clinical evidence supporting ketogenic diet use in the management of adult epilepsy, malignant glioma, Alzheimer's disease, migraine headache, motor neuron disease, and other neurologic disorders is highlighted and reviewed. Lastly, common adverse effects of ketogenic therapy in adults, including gastrointestinal symptoms, weight loss, and transient dyslipidemia are discussed.
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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, Maryland, 21287, USA
| | - Mackenzie C Cervenka
- Department of Neurology, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Meyer 2-147, Baltimore, Maryland, 21287, USA.
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31
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McDonald TJW, Cervenka MC. The Expanding Role of Ketogenic Diets in Adult Neurological Disorders. Brain Sci 2018; 8:E148. [PMID: 30096755 PMCID: PMC6119973 DOI: 10.3390/brainsci8080148] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 08/01/2018] [Accepted: 08/02/2018] [Indexed: 12/15/2022] Open
Abstract
The current review highlights the evidence supporting the use of ketogenic diet therapies in the management of adult epilepsy, adult malignant glioma and Alzheimer's disease. An overview of the scientific literature, both preclinical and clinical, in each area is presented and management strategies for addressing adverse effects and compliance are discussed.
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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, USA.
| | - Mackenzie C Cervenka
- Department of Neurology, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Meyer 2-147, Baltimore, MD 21287, USA.
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McDonald TJW, Henry-Barron BJ, Felton EA, Gutierrez EG, Barnett J, Fisher R, Lwin M, Jan A, Vizthum D, Kossoff EH, Cervenka MC. Improving compliance in adults with epilepsy on a modified Atkins diet: A randomized trial. Seizure 2018; 60:132-138. [PMID: 29960852 DOI: 10.1016/j.seizure.2018.06.019] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 06/16/2018] [Accepted: 06/22/2018] [Indexed: 12/13/2022] Open
Abstract
PURPOSE To determine whether use of a ketogenic formula during the first month of the modified Atkins diet (MAD) in adults with drug-resistant epilepsy (DRE) improves seizure reduction and compliance compared to MAD alone. METHODS Eighty adults (age ≥18 years) with DRE and ≥4 reliably quantifiable seizures/month were enrolled. All participants were trained to follow a 20 g/day net carbohydrate limit MAD. Patients were randomized to receive one 8-ounce (237 mL) tetrapak of KetoCal®, a 4:1 ketogenic ratio formula, daily in combination with MAD during the first month (treatment arm) or second month (control/cross-over arm). Patients recorded urine ketones, weight, and seizure frequency and followed up at 1 and 2 months. RESULTS By 1 month, 84% of patients achieved ketosis (median of 4-4.5 days). At 1 month, the treatment arm had a significantly higher ketogenic ratio and more patients with a ≥1:1 ketogenic ratio compared to the control arm. There was no difference in median seizure frequency, proportion of responders (≥50% seizure reduction), or median seizure reduction from baseline between groups. However, patients treated with KetoCal® during the first month were significantly more likely to continue MAD for 6 months or more. CONCLUSION Although supplementing MAD with a ketogenic formula in the first month did not increase the likelihood of reducing seizures compared to MAD alone, significantly more adults remained on MAD long-term with this approach. This suggests a potential strategy for encouraging compliance with MAD in adults with DRE.
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Affiliation(s)
- Tanya J W McDonald
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
| | - Bobbie J Henry-Barron
- Institute for Clinical and Translational Research, Johns Hopkins University, Baltimore, MD, United States.
| | - Elizabeth A Felton
- Department of Neurology, University of Wisconsin, Madison, WI, United States.
| | - Erie G Gutierrez
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
| | - Joanne Barnett
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
| | - Rebecca Fisher
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
| | - MonYi Lwin
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
| | - Amanda Jan
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
| | - Diane Vizthum
- Institute for Clinical and Translational Research, Johns Hopkins University, Baltimore, MD, United States.
| | - Eric H Kossoff
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States; Department of Pediatrics, 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.
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Traunmüller F. Atherosclerosis is a vascular stem cell disease caused by insulin. Med Hypotheses 2018; 116:22-27. [PMID: 29857902 DOI: 10.1016/j.mehy.2018.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 03/22/2018] [Indexed: 10/17/2022]
Abstract
The present article proposes the hypothesis that when multipotent vascular stem cells are exposed to excessive insulin in a rhythmic pattern of sharply rising and falling concentrations, their differentiation is misdirected toward adipogenic and osteogenic cell lineages. This results in plaque-like accumulation of adipocytes with fat and cholesterol deposition from adipocyte debris, and osteogenic (progenitor) cells with a calcified matrix in advanced lesions. The ingrowth of capillaries and infiltration with macrophages, which upon uptake of lipids turn into foam cells, are unspecific pro-resolving reactions. Epidemiological, histopathological, pharmacological, and experimental evidence in favour of this hypothesis is summarised.
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McDonald TJW, Ratchford EV, Henry-Barron BJ, Kossoff EH, Cervenka MC. Impact of the modified Atkins diet on cardiovascular health in adults with epilepsy. Epilepsy Behav 2018; 79:82-86. [PMID: 29253679 DOI: 10.1016/j.yebeh.2017.10.035] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 10/24/2017] [Accepted: 10/27/2017] [Indexed: 11/16/2022]
Abstract
AIM The current study investigated biochemical and vascular markers of cardiovascular health in adult patients with epilepsy treated with long-term (greater than 1year) ketogenic diet therapy compared with controls. METHOD Anthropometric measures, serum fasting lipid panel, apolipoproteins A-1 and B, lipoprotein sub-fractions as well as common carotid intima-media thickness (cIMT), and plaque presence were assessed in 20 adult patients with epilepsy on a modified Atkins diet (MAD) for >1year started as an adult compared with 21 adult patients with epilepsy naïve to diet therapy. RESULTS Patients treated with MAD had significantly lower weight, body mass index, waist and hip circumference, percent body fat, and serum triglyceride levels when compared with control patients. In contrast, they had significantly higher serum levels of small low-density-lipoprotein (LDL) particles and were significantly more likely to have LDL pattern B in which small LDL particles predominate when compared with controls. However, there was no significant difference in cIMT or plaque presence between groups. CONCLUSION Our results provide clinical evidence demonstrating the cardiovascular safety of a high-fat, low-carbohydrate diet used in adults with epilepsy for at least 12months. It also highlights potential markers of cardiovascular risk - small dense LDL particles - that should be closely monitored in adults treated with diet therapy long-term.
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Affiliation(s)
- Tanya J W McDonald
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
| | - Elizabeth V Ratchford
- Johns Hopkins Center for Vascular Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
| | - Bobbie J Henry-Barron
- Institute for Clinical and Translational Research, Johns Hopkins University, Baltimore, MD, United States.
| | - Eric H Kossoff
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States; Department of Pediatrics, 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.
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10 patients, 10 years - Long term follow-up of cardiovascular risk factors in Glut1 deficiency treated with ketogenic diet therapies: A prospective, multicenter case series. Clin Nutr 2017; 37:2246-2251. [PMID: 29199027 DOI: 10.1016/j.clnu.2017.11.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 11/05/2017] [Accepted: 11/07/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND AIMS Glut1 Deficiency (Glut1D) is caused by impaired glucose transport into brain. The resulting epileptic encephalopathy and movement disorders can be treated effectively by high-fat carbohydrate-restricted ketogenic diet therapies (KDT) mimicking fasting and providing ketones as an alternative cerebral fuel. Recently 6-24 months follow-ups of epileptic patients reported elevated blood lipids and intima thickening of the carotid artery raising concerns about potential cardiovascular risks by KDT. To clarify potential cardiovascular risks we performed a prospective 10 year follow up of 10 Glut1D patients. METHODS Between August 2001 and January 2016 we enrolled Glut1D patients on KDT at two hospitals in Germany in this prospective, multicenter case series. The minimal follow up was 10 years. Standard deviation scores (SDS) of body mass index (BMI), total cholesterol (TC), HDL-/LDL cholesterol, and triglycerides (TG) before initiation of KDT were compared with respective values at 6 months, 2, 5 years, and 10 years after initiation. After 10 years on KDT cardiovascular risk, assessed by BMI, carotid intima-media thickness (CIMT) measurement, and blood pressure, was compared to a healthy reference population (n = 550). RESULTS Baseline and 10 year follow-up investigations were available for 10 individuals with Glut1D on KDT. After two years on KDT BMI increased significantly, while total cholesterol, HDL-cholesterol, and LDL-cholesterol decreased. Within 3-5 years on KDT these differences disappeared, and after 10 years blood lipid parameters reflected the situation at initiation of KDT. Prior to KDT one child had dyslipidaemia, but no child after 10 years on KDT. No significant differences were observed with respect to BMI SDS (p = 0.26), CIMT (p = 0.63) or systolic and diastolic blood pressure (SDS p = 0.11 and p = 0.37, respectively) in Glut1D children treated with KDT for at least 10 years compared to healthy controls. CONCLUSIONS In contrast to previous short-term reports on adverse effects of KDT, 10-year follow-up did not identify cardiovascular risks of dietary treatment for Glut1D.
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Abstract
The current review highlights the evidence supporting the use of ketogenic diets in the management of drug-resistant epilepsy and status epilepticus in adults. Ketogenic diet variants are compared and advantages and potential side effects of diet therapy are discussed.
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Practice Paper of the Academy of Nutrition and Dietetics: Classic and Modified Ketogenic Diets for Treatment of Epilepsy. J Acad Nutr Diet 2017; 117:1279-1292. [DOI: 10.1016/j.jand.2017.06.006] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Indexed: 12/19/2022]
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Williams TJ, Cervenka MC. The role for ketogenic diets in epilepsy and status epilepticus in adults. Clin Neurophysiol Pract 2017; 2:154-160. [PMID: 30214989 PMCID: PMC6123874 DOI: 10.1016/j.cnp.2017.06.001] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 05/19/2017] [Accepted: 06/02/2017] [Indexed: 01/01/2023] Open
Abstract
Ketogenic diets offer adjunctive therapy for chronic epilepsy and refractory status epilepticus. Studies support feasibility and efficacy of the classic ketogenic diet and its variants in adults. Potential complications and side effects of diet therapy are often preventable and manageable. Strategies are needed to improve diet adherence.
Ketogenic diet (KD) therapies are high fat, low carbohydrate diets designed to mimic a fasting state. Although studies demonstrate KD’s success in reducing seizures stretching back nearly a century, the last 25 years have seen a resurgence in diet therapy for the management of drug-resistant epilepsy in children as well as adults. With ≥50% seizure reduction efficacy rates in adults of 22–55% for the classic KD and 12–67% for the modified Atkins diet, diet therapy may be in many instances comparable to a trial of an additional anti-epileptic medication and potentially with fewer side effects and other health benefits. Moreover, ketogenic diets offer promising new adjunctive strategies for the treatment of acute status epilepticus in the intensive care setting. Here, we review the efficacy and utility of ketogenic diets for the management of chronic epilepsy and refractory status epilepticus in adults and offer practical guidelines for diet implementation and maintenance.
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Affiliation(s)
- Tanya J Williams
- Department of Neurology, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Meyer 2-147, Baltimore, MD, USA
| | - Mackenzie C Cervenka
- Department of Neurology, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Meyer 2-147, Baltimore, MD, USA
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van der Louw EJ, Williams TJ, Henry-Barron BJ, Olieman JF, Duvekot JJ, Vermeulen MJ, Bannink N, Williams M, Neuteboom RF, Kossoff EH, Catsman-Berrevoets CE, Cervenka MC. Ketogenic diet therapy for epilepsy during pregnancy: A case series. Seizure 2017; 45:198-201. [DOI: 10.1016/j.seizure.2016.12.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Accepted: 12/20/2016] [Indexed: 10/20/2022] Open
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Strowd RE, Cervenka MC, Henry BJ, Kossoff EH, Hartman AL, Blakeley JO. Glycemic modulation in neuro-oncology: experience and future directions using a modified Atkins diet for high-grade brain tumors. Neurooncol Pract 2015; 2:127-136. [PMID: 26649186 DOI: 10.1093/nop/npv010] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Indexed: 02/05/2023] Open
Abstract
Dietary glycemic modulation through high-fat, low-carbohydrate diets, which induce a state of systemic ketosis and alter systemic metabolic signaling, have been incorporated into the clinical management of patients with neurological disease for more than a century. Mounting preclinical evidence supports the antitumor, proapoptotic, and antiangiogenic effects of disrupting glycolytic metabolism through dietary intervention. In recent years, interest in incorporating such novel therapeutic strategies in neuro-oncology has increased. To date, 3 published studies incorporating novel dietary therapies in oncology have been reported, including one phase I study in neuro-oncology, and have set the stage for further study in this field. In this article, we review the biochemical pathways, preclinical data, and early clinical translation of dietary interventions that modulate systemic glycolytic metabolism in the management of primary malignant brain tumors. We introduce the modified Atkins diet (MAD), a novel dietary alternative to the classic ketogenic diet, and discuss the critical issues facing future study.
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Affiliation(s)
- Roy E Strowd
- Department of Neurology , Johns Hopkins School of Medicine , Baltimore, Maryland (R.E.S., M.C.C., E.H.K., A.L.H., J.O.B.); Department of Pediatrics , Johns Hopkins School of Medicine , Baltimore, Maryland (E.H.K., A.L.H.); Department of Oncology , Johns Hopkins School of Medcine , Baltimore, Maryland (J.O.B.); Institute for Clinical and Translational Research , Johns Hopkins School of Medicine , Baltimore, Maryland (B.J.H.)
| | - Mackenzie C Cervenka
- Department of Neurology , Johns Hopkins School of Medicine , Baltimore, Maryland (R.E.S., M.C.C., E.H.K., A.L.H., J.O.B.); Department of Pediatrics , Johns Hopkins School of Medicine , Baltimore, Maryland (E.H.K., A.L.H.); Department of Oncology , Johns Hopkins School of Medcine , Baltimore, Maryland (J.O.B.); Institute for Clinical and Translational Research , Johns Hopkins School of Medicine , Baltimore, Maryland (B.J.H.)
| | - Bobbie J Henry
- Department of Neurology , Johns Hopkins School of Medicine , Baltimore, Maryland (R.E.S., M.C.C., E.H.K., A.L.H., J.O.B.); Department of Pediatrics , Johns Hopkins School of Medicine , Baltimore, Maryland (E.H.K., A.L.H.); Department of Oncology , Johns Hopkins School of Medcine , Baltimore, Maryland (J.O.B.); Institute for Clinical and Translational Research , Johns Hopkins School of Medicine , Baltimore, Maryland (B.J.H.)
| | - Eric H Kossoff
- Department of Neurology , Johns Hopkins School of Medicine , Baltimore, Maryland (R.E.S., M.C.C., E.H.K., A.L.H., J.O.B.); Department of Pediatrics , Johns Hopkins School of Medicine , Baltimore, Maryland (E.H.K., A.L.H.); Department of Oncology , Johns Hopkins School of Medcine , Baltimore, Maryland (J.O.B.); Institute for Clinical and Translational Research , Johns Hopkins School of Medicine , Baltimore, Maryland (B.J.H.)
| | - Adam L Hartman
- Department of Neurology , Johns Hopkins School of Medicine , Baltimore, Maryland (R.E.S., M.C.C., E.H.K., A.L.H., J.O.B.); Department of Pediatrics , Johns Hopkins School of Medicine , Baltimore, Maryland (E.H.K., A.L.H.); Department of Oncology , Johns Hopkins School of Medcine , Baltimore, Maryland (J.O.B.); Institute for Clinical and Translational Research , Johns Hopkins School of Medicine , Baltimore, Maryland (B.J.H.)
| | - Jaishri O Blakeley
- Department of Neurology , Johns Hopkins School of Medicine , Baltimore, Maryland (R.E.S., M.C.C., E.H.K., A.L.H., J.O.B.); Department of Pediatrics , Johns Hopkins School of Medicine , Baltimore, Maryland (E.H.K., A.L.H.); Department of Oncology , Johns Hopkins School of Medcine , Baltimore, Maryland (J.O.B.); Institute for Clinical and Translational Research , Johns Hopkins School of Medicine , Baltimore, Maryland (B.J.H.)
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