Practical considerations of dietary therapies for epilepsy in adults

Abstract Despite the increasing number of anti-seizure medications becoming available, the proportion of patients with drug-resistant epilepsy remains unchanged. Dietary therapy for epilepsy is well-established practice in paediatric care, but relatively underutilised in adults. Recently, international recommendations have been published to guide the treatment of adults receiving dietary therapy for epilepsy. This review focuses on the specific aspects of care unique to the management of adults receiving dietary therapy for epilepsy, including patient selection, diet composition, initiation, monitoring and cessation of dietary treatment. We emphasise the need for a multidisciplinary team approach with appropriately trained neurologists and dietitians to provide holistic care while the patients are receiving dietary therapy. Future research should focus on the optimal diet composition and meeting the psychosocial needs of adults with epilepsy to maximise efficacy and adherence to dietary treatment.

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Multimodal connectome biomarkers of cognitive and affective dysfunction in the common epilepsies

10.31234/osf.io/edbax ◽

2021 ◽

Author(s):

raul rodriguez-cruces ◽

Jessica Royer ◽

Sara Lariviere ◽

Danielle S Bassett ◽

Lorenzo Caciagli ◽

...

Keyword(s):

Future Research ◽

Drug Resistant ◽

Cortical Circuits ◽

Idiopathic Generalized Epilepsy ◽

Behavioral Challenges ◽

Cognitive Domains ◽

The Common ◽

Neurological Conditions ◽

Drug Resistant Epilepsy ◽

Generalized Epilepsy

Epilepsy is one of the most common chronic neurological conditions, traditionally defined as a disorder of recurrent seizures. Cognitive and affective dysfunctions are increasingly recognized as core disease dimensions and can affect patient wellbeing sometimes more than the seizures themselves. Connectome- based approaches hold immense promise for revealing mechanisms that contribute to dysfunction, and to identify biomarkers. Our review discusses emerging multimodal neuroimaging and connectomics studies that highlight network substrates of cognitive/affective dysfunction in the common epilepsies. We first overview work in drug-resistant epilepsy syndromes i.e., temporal lobe epilepsy related to mesiotemporal sclerosis (TLE) and extratemporal epilepsy (ETE) related to malformations of cortical development. While these are traditionally conceptualized as ‘focal’ epilepsies, many patients present with broad structural and functional anomalies. Moreover, the extent of distributed changes contributes to difficulties in multiple cognitive domains as well as affective-behavioral challenges. We will also review work in idiopathic generalized epilepsy (IGE), a class of generalized epilepsy syndromes that involve subcortico-cortical circuits. Overall, neuroimaging and network neuroscience studies point to both shared and syndrome specific connectome signatures of dysfunction across TLE, ETE, and IGE. Lastly, we point to current gaps in the literature and formulate recommendations for future research.

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Rationale for using intermittent calorie restriction as a dietary treatment for drug resistant epilepsy

Epilepsy & Behavior ◽

10.1016/j.yebeh.2014.02.026 ◽

2014 ◽

Vol 33 ◽

pp. 110-114 ◽

Cited By ~ 29

Author(s):

Alan W.C. Yuen ◽

Josemir W. Sander

Keyword(s):

Calorie Restriction ◽

Dietary Treatment ◽

Drug Resistant ◽

Drug Resistant Epilepsy

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Potassium citrate supplementation with ketogenic dietary therapy for drug‐resistant epilepsy

Developmental Medicine & Child Neurology ◽

10.1111/dmcn.14418 ◽

2019 ◽

Vol 62 (1) ◽

pp. 8-8

Author(s):

NE Schoeler

Keyword(s):

Potassium Citrate ◽

Dietary Therapy ◽

Drug Resistant ◽

Drug Resistant Epilepsy

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The Clinical Research Landscape of Pediatric Drug-Resistant Epilepsy

Journal of Child Neurology ◽

10.1177/0883073820931255 ◽

2020 ◽

Vol 35 (11) ◽

pp. 763-766 ◽

Cited By ~ 1

Author(s):

K. Julia Kaal ◽

Magda Aguiar ◽

Mark Harrison ◽

Patrick J. McDonald ◽

Judy Illes

Keyword(s):

Clinical Practice ◽

Clinical Research ◽

Primary Outcome ◽

Diagnostic Procedures ◽

Dietary Therapy ◽

Drug Resistant ◽

Pediatric Drug ◽

Drug Resistant Epilepsy ◽

Age Range ◽

Deep Brain

Objective: To characterize the clinical research landscape of pediatric drug-resistant epilepsy (DRE) with a focus on neurotechnology. Method: We searched the ClinicalTrials.gov registry using the terms “epilepsy” and “drug resistant” for studies including participants age 0-17 years. Returns were grouped by intervention (eg, neurotechnological, drug). Key trial features such as age range, trial status and outcomes were compared across interventions. Results: We identified 101 registered trials with pediatric DRE patients. Thirty-two (32%) investigate neurotechnological interventions, devices, or diagnostic procedures; 13 (41%) are currently active. Among neurotechnology trials, 15 (46%) investigate vagus nerve stimulation, transcranial direct current stimulation, or deep brain stimulation; few are specific to children. Of the remaining 69 trials, 37 investigate a drug, 17 investigate a dietary therapy, and 15 investigate another intervention. Seizure frequency is the most frequent primary outcome measured in the trials identified. Significance: The landscape of registered trials pertaining to pediatric DRE reflects a lag between clinical research and clinical practice, and highlights the need for timely evidence before novel neurotechnological interventions are widely adopted into clinical practice.

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