scholarly journals Ketogenic diet: a promising alternative nonpharmacology treatment for pediatric epilepsy

2019 ◽  
Vol 6 (4) ◽  
pp. 1773
Author(s):  
Bella Kurnia
Keyword(s):  
Ketogenic Diet ◽  
Refractory Epilepsy ◽  
Epileptic Seizures ◽  
Brain Dysfunction ◽  
Pediatric Epilepsy ◽  
Promising Alternative ◽  
Anti Epileptic Drug ◽  
Low Carbohydrate ◽  
The Brain ◽  
Restricted Protein Diet

Epilepsy is a syndrome of brain dysfunction induced by the aberrant excitability of certain neurons. Despite advances in surgical technique and anti-epileptic drug in recent years, recurrent epileptic seizures remain intractable and lead to a serious morbidity in the world. The ketogenic diet (KD) is a nonpharmacologic treatment that has been used for refractory epilepsy since 1921. The KD is a high-fat, low-carbohydrate, and restricted protein diet, which is calculated and weighed for each individual patient. The goal of the KD treatment is to bring the brain into a state of ketosis to control seizures. Many studies have shown that ketogenic diet was very useful in controlling refractory epilepsy.

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.

Metabolic regulation of synaptic activity

2018 ◽  
Vol 29 (8) ◽  
pp. 825-835 ◽  
Author(s):  
Sergei V. Fedorovich ◽  
Tatyana V. Waseem
Keyword(s):  
Metabolic Disease ◽  
Ketogenic Diet ◽  
Neuronal Death ◽  
Metabolic Regulation ◽  
Glutamate Release ◽  
Epileptic Seizures ◽  
Brain Dysfunction ◽  
Synaptic Activity ◽  
Brain Diseases ◽  
The Brain

AbstractBrain tissue is bioenergetically expensive. In humans, it composes approximately 2% of body weight and accounts for approximately 20% of calorie consumption. The brain consumes energy mostly for ion and neurotransmitter transport, a process that occurs primarily in synapses. Therefore, synapses are expensive for any living creature who has brain. In many brain diseases, synapses are damaged earlier than neurons start dying. Synapses may be considered as vulnerable sites on a neuron. Ischemic stroke, an acute disturbance of blood flow in the brain, is an example of a metabolic disease that affects synapses. The associated excessive glutamate release, called excitotoxicity, is involved in neuronal death in brain ischemia. Another example of a metabolic disease is hypoglycemia, a complication of diabetes mellitus, which leads to neuronal death and brain dysfunction. However, synapse function can be corrected with “bioenergetic medicine”. In this review, a ketogenic diet is discussed as a curative option. In support of a ketogenic diet, whereby carbohydrates are replaced for fats in daily meals, epileptic seizures can be terminated. In this review, we discuss possible metabolic sensors in synapses. These may include molecules that perceive changes in composition of extracellular space, for instance, ketone body and lactate receptors, or molecules reacting to changes in cytosol, for instance, KATPchannels or AMP kinase. Inhibition of endocytosis is believed to be a universal synaptic mechanism of adaptation to metabolic changes.

scholarly journals The use of a formula-based ketogenic diet in children with refractory epilepsy

2017 ◽  
Vol 75 (4) ◽  
pp. 234-237 ◽  
Author(s):  
Letícia Pereira de Brito Sampaio ◽  
Cristina Takakura ◽  
Maria Luiza Giraldes de Manreza
Keyword(s):  
Adverse Events ◽  
Ketogenic Diet ◽  
Seizure Frequency ◽  
Refractory Epilepsy ◽  
Protein Diet ◽  
High Fat ◽  
Low Carbohydrate ◽  
Nonpharmacologic Treatment ◽  
Long Time ◽  
Restricted Protein Diet

ABSTRACT The ketogenic diet (KD) is a nonpharmacologic treatment that has been used for refractory epilepsy since 1921. The KD is a high-fat, low-carbohydrate, and restricted protein diet, which is calculated and weighed for each individual patient. Introducing and maintaining the diet for a long time remains a challenge. In this study, we evaluated the acceptability, tolerance, and efficacy of a formula-based KD in 10 children with refractory epilepsy. The ketogenic formula tested herein caused only mild KD-related adverse events and adequate adherence. Moreover, 60% of patients had more than 50% seizure frequency reduction and 10% were seizure-free.

scholarly journals Dietary therapies for epilepsy in low resource settings: challenges and successes

2021 ◽  
Vol 1 (1) ◽  
Author(s):  
Suvasini Sharma
Keyword(s):  
Ketogenic Diet ◽  
Refractory Epilepsy ◽  
Low Cost ◽  
Low Resource Settings ◽  
Low Resource ◽  
Modified Atkins Diet ◽  
Atkins Diet ◽  
Low Carbohydrate ◽  
Drug Resistant Epilepsy ◽  
Restricted Protein Diet

The Ketogenic Diet (KD) is a high fat, low carbohydrate and restricted protein diet which has been used for the treatment of drug resistant epilepsy in children. It is considered the treatment of choice for refractory nonsurgical epilepsy in children. However, despite this being a very useful and relatively simple treatment, children from developing countries have not been able to benefit as much as their counterparts in more privileged settings. In this article, the challenges faced by pediatric neurologists and parents who wish to use the diet in children with refractory epilepsy are discussed, and also the simple low cost innovations which can be used to overcome these challenges are suggested. The evolution from the use of the classic ketogenic diet to the flexible use of the modified Atkins diet in low resource settings will be discussed.

Ketogenic Diet and PPARgamma

2016 ◽  
Author(s):  
Timothy A. Simeone
Keyword(s):  
Ketogenic Diet ◽  
Refractory Epilepsy ◽  
Ketone Bodies ◽  
Peroxisome Proliferator ◽  
Potential Therapeutic Target ◽  
Peroxisome Proliferator Activated Receptor ◽  
Nuclear Transcription Factor ◽  
Inflammatory Processes ◽  
The Brain

The ketogenic diet (KD) is an effective therapy for many patients with refractory epilepsy. It engages a wide array of antioxidant and anti-inflammatory processes and improves mitochondrial function, which is thought to underlie its neuroprotective, antiseizure, and disease-modifying effects. Potential roles of ketone bodies in these mechanisms are discussed elsewhere in this volume. This chapter focuses on the role of KD fatty acids as potential ligands for the nutritionally regulated nuclear transcription factor peroxisome proliferator activated receptor gamma (PPARgamma). PPARgamma regulates many of the pathways identified in the mechanism of the KD and, in recent years, has become a potential therapeutic target for neurodegenerative diseases. This chapter reviews what is known concerning PPARgamma in the brain, the evidence that PPARgamma has neuroprotective and antiseizure properties, and the evidence suggesting that PPARgamma may be involved in the antiseizure mechanisms of the ketogenic diet.

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.

Effective surgical treatment of cerebral cavernous malformations: a multicenter study of 79 pediatric patients

2011 ◽  
Vol 8 (5) ◽  
pp. 522-525 ◽  
Author(s):  
Michael Hugelshofer ◽  
Nicola Acciarri ◽  
Ulrich Sure ◽  
Dimitrios Georgiadis ◽  
Ralf W. Baumgartner ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Refractory Epilepsy ◽  
Epileptic Seizures ◽  
Neurological Deficits ◽  
Vascular Lesions ◽  
Cerebral Cavernous Malformations ◽  
Cavernous Malformations ◽  
Persistent Symptoms ◽  
The Mean ◽  
The Brain

Object Cerebral cavernous malformations (CCMs) are common vascular lesions in the brain, affecting approximately 0.5% of the population and representing 10%–20% of all cerebral vascular lesions. One-quarter of all CCMs affect pediatric patients, and CCMs are reported as one of the main causes of brain hemorrhage in this age group. Symptoms include epileptic seizures, headache, and focal neurological deficits. Patients with symptomatic CCMs can be treated either conservatively or with resection if lesions cause medically refractory epilepsy or other persistent symptoms. Methods The authors retrospectively analyzed 79 pediatric patients (41 boys and 38 girls) from 3 different centers, who were surgically treated for their symptomatic CCMs between 1974 and 2004. The mean age of the children at first manifestation was 9.7 years, and the mean age at operation was 11.3 years. The main goal was to compare the clinical outcomes with respect to the location of the lesion of children who preoperatively suffered from epileptic seizures. Results Of these patients, 77.3% were seizure free (Engel Class I) after the resection of the CCM. Significant differences in the outcome between children who harbored CCMs at different locations were not found. Conclusions Resection seems to be the favorable treatment of symptomatic CCMs not only in adults but also in children.

scholarly journals Ketogenic diet for epilepsy treatment

2016 ◽  
Vol 74 (10) ◽  
pp. 842-848 ◽  
Author(s):  
Letícia Pereira de Brito Sampaio
Keyword(s):  
Ketogenic Diet ◽  
Refractory Epilepsy ◽  
Medium Chain Triglyceride ◽  
Modified Atkins Diet ◽  
The Past ◽  
Atkins Diet ◽  
Low Carbohydrate ◽  
History Of ◽  
Index Treatment ◽  
Low Glycemic Index

ABSTRACT The ketogenic diet (KD), a high-fat, low-carbohydrate, and adequate-protein diet is an established, effective nonpharmacologic treatment option for intractable childhood epilepsy. The KD was developed in 1921 and even though it has been increasingly used worldwide in the past decade, many neurologists are not familiar with this therapeutic approach. In the past few years, alternative and more flexible KD variants have been developed to make the treatment easier and more palatable while reducing side effects and making it available to larger group of refractory epilepsy patients. This review summarizes the history of the KD and the principles and efficacy of the classic ketogenic diet, medium-chain triglyceride(s) (MCT) ketogenic diet, modified Atkins diet, and low glycemic index treatment.

Ketogenic Diet, Adenosine, Epigenetics, and Antiepileptogenesis

2016 ◽  
Author(s):  
Theresa A. Lusardi ◽  
Detlev Boison
Keyword(s):  
Dna Methylation ◽  
Ketogenic Diet ◽  
Adenosine Receptor ◽  
Refractory Epilepsy ◽  
Current Therapies ◽  
Permanent Remission ◽  
The Brain ◽  
Drug Refractory Epilepsy ◽  
Seizure Suppression

Epilepsy is common, affecting about 1% of the population. Conventional treatments are ineffective in about one third of patients, and current therapies do not prevent epilepsy or its progression. For individuals with drug-refractory epilepsy the ketogenic diet (KD) can provide seizure relief in approximately fifty percent of patients, with complete and permanent remission in some cases, suggesting possible antiepileptogenic effects of the diet. Whereas mechanisms underlying antiseizure effects of KD have been identified, mechanistic links between KD therapy and antiepileptogenesis constitute a novel area of research. An adenosine receptor-mediated role of KD therapy in seizure suppression is well established, and recent evidence demonstrates that the KD regulates adenosine homeostasis in the brain. Adenosine in turn has previously unappreciated epigenetic functions as a regulator of DNA methylation. This chapter discusses recent evidence that KD influences the epigenome through modulation of adenosine metabolism as a plausible antiepileptogenic mechanism of the diet.

scholarly journals Differential ketogenic diet-induced shift in CSF lipid/carbohydrate metabolome of pediatric epilepsy patients with optimal vs. no anticonvulsant response: a pilot study

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Susan A. Masino ◽  
David N. Ruskin ◽  
Natalie R. Freedgood ◽  
Marie Lindefeldt ◽  
Maria Dahlin
Keyword(s):  
Cerebrospinal Fluid ◽  
Ketogenic Diet ◽  
Metabolic Response ◽  
Ketone Bodies ◽  
Pediatric Epilepsy ◽  
Pharmacoresistant Epilepsy ◽  
Diet Treatment ◽  
Low Carbohydrate ◽  
Anticonvulsant Treatment ◽  
Age Range

Abstract Background The low carbohydrate, high fat ketogenic diet can be an effective anticonvulsant treatment in some pediatric patients with pharmacoresistant epilepsy. Its mechanism(s) of action, however, remain uncertain. Direct sampling of cerebrospinal fluid before and during metabolic therapy may reveal key changes associated with differential clinical outcomes. We characterized the relationship between seizure responsiveness and changes in lipid and carbohydrate metabolites. Methods We performed metabolomic analysis of cerebrospinal fluid samples taken before and during ketogenic diet treatment in patients with optimal response (100% seizure remission) and patients with no response (no seizure improvement) to search for differential diet effects in hallmark metabolic compounds in these two groups. Optimal responders and non-responders were similar in age range and included males and females. Seizure types and the etiologies or syndromes of epilepsy varied but did not appear to differ systematically between responders and non-responders. Results Analysis showed a strong effect of ketogenic diet treatment on the cerebrospinal fluid metabolome. Longitudinal and between-subjects analyses revealed that many lipids and carbohydrates were changed significantly by ketogenic diet, with changes typically being of larger magnitude in responders. Notably, responders had more robust changes in glucose and the ketone bodies β-hydroxybutyrate and acetoacetate than non-responders; conversely, non-responders had significant increases in fructose and sorbose, which did not occur in responders. Conclusions The data suggest that a differential and stronger metabolic response to the ketogenic diet may predict a better anticonvulsant response, and such variability is likely due to inherent biological factors of individual patients. Strategies to boost the metabolic response may be beneficial.

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