scholarly journals Efficacy and Safety of a Ketogenic Diet in Children and Adolescents with Refractory Epilepsy—A Review

Nutrients ◽  
2020 ◽  
Vol 12 (6) ◽  
pp. 1809 ◽  
Author(s):  
Jana Wells ◽  
Arun Swaminathan ◽  
Jenna Paseka ◽  
Corrine Hanson
Keyword(s):  
Ketogenic Diet ◽  
Medium Chain Triglyceride ◽  
Epileptic Seizures ◽  
Diet Therapy ◽  
Direct Result ◽  
Individual Response ◽  
Modified Atkins Diet ◽  
Patients With Epilepsy ◽  
The Brain

Epilepsy in the pediatric and adolescent populations is a devastating condition where individuals are prone to recurrent epileptic seizures or changes in behavior or movement that is the direct result of a primary change in the electrical activity in the brain. Although many children with epilepsy will have seizures controlled with antiseizure medications (ASMs), a large percentage of patients are refractory to drug therapy and may consider initiating a ketogenic diet. The term Ketogenic Diet or Ketogenic Diet Therapy (KDT) refers to any diet therapy in which dietary composition results in a ketogenic state of human metabolism. Currently, there are 4 major Ketogenic diet therapies—the classic ketogenic diet (cKD), the modified Atkins diet (MAD), the medium chain triglyceride ketogenic diet (MCTKD) and the low glycemic index treatment (LGIT). The compositions of the 4 main KDTs differ and limited evidence to distinguish the efficacy among different diets currently exists. Although it is apparent that more randomized controlled trials (RCTs) and long-term studies are needed to evaluate efficacy, side effects and individual response to the diet, it is imperative to study and understand the metabolic profiles of patients with epilepsy in order to isolate which dietary restrictions are necessary to maximize clinical benefit.

Alternative Therapies for Epilepsy

2017 ◽  
Author(s):  
Carl E. Stafstrom
Keyword(s):  
Ketogenic Diet ◽  
Medium Chain Triglyceride ◽  
Dietary Therapy ◽  
Promising Alternative ◽  
Seizure Reduction ◽  
Modified Atkins Diet ◽  
Dietary Restrictions ◽  
Patients With Epilepsy ◽  
Low Glycemic Index

Up to one third of patients with epilepsy suffer from seizures that are refractory to medications. For these patients, many of whom are not surgical candidates, dietary therapies provide a promising alternative. The best known dietary therapy is the ketogenic diet, which was developed in the 1920s; newer variants of the ketogenic diet, such as the medium-chain triglyceride diet, modified Atkins diet, and low glycemic index treatment, afford excellent seizure control with fewer dietary restrictions. Together, dietary approaches offer drug-resistant patients hope for seizure reduction and an improved quality of life.

scholarly journals Therapeutic Use of the Ketogenic Diet in Refractory Epilepsy: What We Know and What Still Needs to Be Learned

Nutrients ◽  
2020 ◽  
Vol 12 (9) ◽  
pp. 2616
Author(s):  
Iwona Maria Zarnowska
Keyword(s):  
Ketogenic Diet ◽  
Refractory Epilepsy ◽  
Epileptic Activity ◽  
Clinical Settings ◽  
Modified Atkins Diet ◽  
Current State ◽  
Wide Range ◽  
Low Carbohydrate ◽  
The Brain

Ketogenic diet (KD) has been used to treat epilepsy for 100 years. It is a high-fat, low-carbohydrate, and sufficient-protein-for-growth diet that mimics the metabolic changes occurring during starvation. Except for classic KD, its modified counterparts, including modified Atkins diet and low-glycemic-index treatment, have gained grounds to increase palatability and adherence. Strong evidence exists that the KD offers protection against seizures in difficult-to-treat epilepsy and possesses long-lasting anti-epileptic activity, improving long-term disease outcome. The KD can also provide symptomatic and disease-modifying activity in a wide range of neurodegenerative diseases. In an era of highly available new anti-seizure medications (ASMs), the challenge of refractory epilepsy has still not been solved. This metabolic therapy is increasingly considered due to unique mechanisms and turns out to be a powerful tool in the hands of a skillful team. Despite decades of extensive research to explain the mechanism of its efficacy, the precise mechanism of action is to date still largely unknown. The key feature of this successful diet is the fact that energy is derived largely from fat but not from carbohydrates. Consequently, fundamental change occurs regarding the method of energy production that causes alterations in numerous biochemical pathways, thus restoring energetic and metabolic homeostasis of the brain. There are barriers during the use of this special and individualized therapy in many clinical settings worldwide. The aim of this review is to revisit the current state of the art of therapeutic application of KD in refractory epilepsy.

scholarly journals Positive Impact of a Modified Atkins Diet on Cognition, Seizures Control and Abnormal Movements in an Adult With Glucose Transporter Type 1 Deficiency Syndrome Deficiency Syndrome

2021 ◽  
Author(s):  
Luisa A. Diaz-Arias ◽  
Bobbie J. Henry-Barron ◽  
Alison Buchholz ◽  
Mackenzie C. Cervenka
Keyword(s):  
Ketogenic Diet ◽  
Glucose Transporter ◽  
Diet Therapy ◽  
Deficiency Syndrome ◽  
Newly Diagnosed ◽  
Modified Atkins Diet ◽  
Abnormal Movements ◽  
Atkins Diet ◽  
The Brain

Glucose is the primary energy fuel used by the brain and is transported across the blood-brain barrier (BBB) by the glucose transporter type 1 and 2.[1] A GLUT1 genetic defect is responsible for glucose transporter type 1 deficiency syndrome (GLUT1DS). Patients with GLUT1DS may present with pharmaco-resistant epilepsy, developmental delay, microcephaly, and/or abnormal movements, with tremendous phenotypic variability. Diagnosis is made by the presence of specific clinical features, hypoglycorrhachia and an SLC2A1 gene mutation. Treatment with a ketogenic diet therapy (KDT) is the standard of care as it results in production of ketone bodies which can readily cross the BBB and provide an alternate energy source to the brain in the absence of glucose. KDTs have been shown to reduce seizures and abnormal movements in children diagnosed with GLUT1DS. However, little is known about the impact of KDT on cognitive function, seizures and movement disorders in adults newly diagnosed with GLUT1DS and started on a KDT in adulthood, or the appropriate ketogenic diet therapy to administer. This case report demonstrates the potential benefits of using a modified Atkins diet (MAD), a less restrictive ketogenic diet therapy on cognition, seizure control and motor function in an adult with newly-diagnosed GLUT1SD.

The use of progesterone during pregnancy in women with epilepsy as an alternative to the correction of doses of anticonvulsants

GYNECOLOGY ◽  
2020 ◽  
Vol 21 (6) ◽  
pp. 12-15
Author(s):  
Elena V. Tsallagova ◽  
Vasily O. Generalov ◽  
Timur R. Sadykov
Keyword(s):  
Clinical Remission ◽  
Epileptic Seizures ◽  
Progesterone Concentration ◽  
Teratogenic Effects ◽  
Safe Alternative ◽  
Patients With Epilepsy

Pregnancy is the most dangerous period in terms of interruption of even persistent and long-term remission. At the same time increasing the dose of anticonvulsant increases the risk of teratogenic effects. Aim. to assess the possibility of using progesterone to prevent relapse of epileptic seizures during pregnancy. Materials and methods. 38 pregnant patients with epilepsy with clinical remission before pregnancy, with relapse of epileptic seizures in I trimester of pregnancy, age 31.81.4 years. Dydrogesterone in a dose of 10 to 60 mg/day was prescribed after the relapse of remission. Anticonvulsant dosage was not changed. The blood progesterone concentration and EEG control was carried out. Results. During pregnancy, the level of progesterone in the blood gradually increased from 77.8 nmol/l at 78 weeks of pregnancy to 521.1 nmol/l at 3637 weeks of pregnancy, without exceeding the limits. EEG results did not deteriorate. None of the patients had seizures during pregnancy. Conclusion. Progesterone therapy is an adequate and safe alternative to increasing the dose of anticonvulsants in case of recurrent seizures during pregnancy.

Long-term effectiveness and adverse effects of ketogenic diet therapy in infants with drug-resistant epilepsy treated at a single center in Argentina

2021 ◽  
pp. 106793
Author(s):  
Marisa Armeno ◽  
Antonella Verini ◽  
Eugenia Caballero ◽  
Araceli Cresta ◽  
Gabriela Reyes Valenzuela ◽  
...  
Keyword(s):  
Adverse Effects ◽  
Ketogenic Diet ◽  
Diet Therapy ◽  
Drug Resistant ◽  
Single Center ◽  
Drug Resistant Epilepsy

Ketogenic diet, seizure control, and cardiometabolic risk in adult patients with pharmacoresistant epilepsy: a review

2020 ◽  
Author(s):  
Gabriela S Neves ◽  
Mariana S Lunardi ◽  
Katia Lin ◽  
Débora Kurrle Rieger ◽  
Letícia C Ribeiro ◽  
...  
Keyword(s):  
Ketogenic Diet ◽  
Cardiometabolic Risk ◽  
Medium Chain Triglyceride ◽  
General Term ◽  
Adult Patients ◽  
Pharmacoresistant Epilepsy ◽  
Medium Chain ◽  
Modified Atkins Diet ◽  
Comprehensive Information ◽  
Cholesterol Intake

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.

scholarly journals Platelet counts in epileptic children receiving valproic acid

2020 ◽  
Vol 60 (1) ◽  
pp. 13-7
Author(s):  
Lilik Indrayati ◽  
Fadhilah Tia Nur ◽  
Bambang Soebagyo
Keyword(s):  
Valproic Acid ◽  
Epileptic Seizures ◽  
Term Treatment ◽  
Common Adverse Event ◽  
Platelet Counts ◽  
Central Java ◽  
Long Term Treatment ◽  
Epileptic Children ◽  
The Brain

Background Epileptic seizures are a transient occurrence resulting from abnormal, excessive, or synchronous neural activity in the brain. Epilepsy requires long-term treatment, increasingly larger doses, and combination therapy. Anti-epileptic drugs (AEDs), especially valproic acid (VPA), are the main treatment of choice. Thrombocytopenia is the most common adverse event from AEDs. Objective To evaluate platelet counts in epileptic children receiving valproic acid monotherapy vs. polytherapy. Methods This analytic, observational, retrospective cohort study was conducted in children with epilepsy below 18 years of age and treated in Dr. Moewardi Hospital, Surakarta, Central Java. Subjects had received VPA treatment for at least 6 months, either as monotherapy or polytherapy. There were 40 subjects in each group (VPA monotherapy vs. VPA polytherapy). The exclusion criteria were patients who had thrombocytopenia and did not take valproic acid regularly. The data was taken from laboratory and the outcome assessed was decreasing of platelet count. Results  Administration of VPA as monotherapy vs. polytherapy was not significantly associated with incidence of thrombocytopenia. However, duration of VPA use > 2 years was associated with significantly greater proportion of thrombocytopenia, with OR 33.0 (95%CI 4.157 to 261.962; P=0.001) compared to VPA use < 2 years. Similarly, VPA dose of >30 mg/kg/day was significantly associated with greater proportion of thrombocytopenia, with OR 4.081 (95%CI 1.337 to 12.458; P=0.013) compared to <30 mg/kg/day dosage. Conclusion Incidence of thrombocytopenia is not significantly different between VPA as a  monotherapy and polytherapy. However, higher VPA dose and longer VPA duration are associated with higher proportion of thrombocytopenia.

scholarly journals Management of patients with single and rare epileptic seizures

2020 ◽  
Vol 15 (2) ◽  
pp. 12-16
Author(s):  
A. S. Kotov
Keyword(s):  
Magnetic Resonance ◽  
Epileptic Seizures ◽  
Resonance Imaging ◽  
Medical Problems ◽  
Unprovoked Seizure ◽  
Life Study ◽  
History Of ◽  
Patients With Epilepsy ◽  
The Brain

Objective: to study the structure of the disease and develop tactics of treatment of patients with single and rare epileptic seizures. Materials and methods. 1200 patients with epilepsy were examined, 103 patients were identified who had no more than 3 seizures throughout their life. Study included evaluation of anamnesis, clinical and neurological examination, routine electroencephalography and/or videoelectroencephalographic monitoring, magnetic resonance imaging of the brain. Results. Relapse of seizures in individuals with a history of follow-up occurred in 32 % of cases; epileptogenic changes in magnetic resonance image and, especially, anatomical and electro-clinical correlation of the epilepsy focus were associated with the risk of relapse. Conclusions. The decision on drug therapy after the first unprovoked seizure should be based on the ratio of the risk of repeated seizures and the risk of side effects. This solution should be individual and take into account not only medical problems, but also the preferences of the patient and his family members.

scholarly journals Persistent intrathecal interleukin-8 production in a patient with SARS-CoV-2-related encephalopathy presenting aphasia: a case report.

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Takuya Kudo ◽  
Yuichi Hayashi ◽  
Kenjiro Kunieda ◽  
Nobuaki Yoshikura ◽  
Akio Kimura ◽  
...  
Keyword(s):  
Epileptic Seizures ◽  
Neurological Deficits ◽  
Central Nervous System Inflammation ◽  
Focal Neurological Deficit ◽  
Case Presentation ◽  
Monocyte Chemoattractant Protein 1 ◽  
Monocyte Chemoattractant ◽  
Consciousness Disturbance ◽  
The Brain

Abstract Background Neurological manifestations of coronavirus disease 2019 (COVID-19) are increasingly recognized and include encephalopathy, although direct infection of the brain by SARS-CoV-2 remains controversial. We herein report the clinical course and cytokine profiles of a patient with severe SARS-CoV-2-related encephalopathy presenting aphasia. Case presentation An 81-year-old man developed acute consciousness disturbance and status epileptics several days after SARS-CoV-2 infection. Following treatment with remdesivir and dexamethasone, his consciousness and epileptic seizures improved; however, amnestic aphasia and agraphia remained. Two months after methylprednisolone pulse and intravenous immunoglobulin, his neurological deficits improved. We found increased levels of interleukin (IL)-6, IL-8, and monocyte chemoattractant protein-1 (MCP-1), but not IL-2 and IL-10 in the serum and cerebrospinal fluid (CSF), and the levels of serum IL-6 and MCP-1 were much higher than those in the CSF. The level of IL-8 in the CSF after immunotherapy was four times higher than that before immunotherapy. Conclusion The cytokine profile of our patient was similar to that seen in severe SARS-CoV-2-related encephalopathy. We demonstrated (i) that the characteristic aphasia can occur as a focal neurological deficit associated with SARS-CoV-2-related encephalopathy, and (ii) that IL8-mediated central nervous system inflammation follows systemic inflammation in SARS-CoV-2-related encephalopathy and can persist and worsen even after immunotherapy. Monitoring IL-8 in CSF, and long-term corticosteroids may be required for treating SARS-CoV-2-related encephalopathy.

scholarly journals Motor neurorehabilitation in patients with epileptic seizures: limitations of methods with proven efficacy in stroke

2021 ◽  
Vol 13 (1) ◽  
pp. 51-64
Author(s):  
R. Kh. Lyukmanov ◽  
A. A. Rimkevichus ◽  
E. V. Shalimanova ◽  
K. V. Voronkova ◽  
N. A. Suponeva ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Traumatic Brain Injury ◽  
Cerebral Cortex ◽  
Safety Data ◽  
Epileptic Seizures ◽  
Motor Rehabilitation ◽  
Proven Efficacy ◽  
Patients With Epilepsy ◽  
Motor Alterations

Patients with epilepsy may require a neurorehabilitation aid particularly due to developing motor alterations related to stroke, sequelae of traumatic brain injury, multiple sclerosis and  other brain damage. Modern neurorehabilitation approaches  directly or indirectly affect neuroplastic processes altering cerebral cortex excitability, stimulate the afferentation systems,  and result in fatigue and may act as factors provoking seizures or  aggravated epilepsy. In addition, developing seizures may  temporarily coincide but unrelated to the neurorehabilitation  activities: e.g., while omitting antiepileptic drug administration,  sleep deprivation or long-term stress occurring to patient etc. Here we present a review on recent studies aimed at  investigating epilepsy triggers by aligning them with the factors  of interventions used in motor rehabilitation. We also emphasize  the safety data for routine use of the main neurorehabilitation methods as well as propose actions to reduce the risk of developing epileptic seizure.

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