scholarly journals Applications of Ketogenic Diets in Patients with Headache: Clinical Recommendations

Nutrients ◽  
2021 ◽  
Vol 13 (7) ◽  
pp. 2307
Author(s):  
Cherubino Di Lorenzo ◽  
Giovanna Ballerini ◽  
Piero Barbanti ◽  
Andrea Bernardini ◽  
Giacomo D’Arrigo ◽  
...  
Keyword(s):  
Neurological Disorders ◽  
Unmet Needs ◽  
Therapeutic Option ◽  
Drug Resistant ◽  
Pharmacological Treatments ◽  
Ketogenic Diets ◽  
Neurologic Disorders ◽  
Clinical Recommendation ◽  
Potential Benefits ◽  
Drug Resistant Epilepsy

Headaches are among the most prevalent and disabling neurologic disorders and there are several unmet needs as current pharmacological options are inadequate in treating patients with chronic headache, and a growing interest focuses on nutritional approaches as non-pharmacological treatments. Among these, the largest body of evidence supports the use of the ketogenic diet (KD). Exactly 100 years ago, KD was first used to treat drug-resistant epilepsy, but subsequent applications of this diet also involved other neurological disorders. Evidence of KD effectiveness in migraine emerged in 1928, but in the last several year’s different groups of researchers and clinicians began utilizing this therapeutic option to treat patients with drug-resistant migraine, cluster headache, and/or headache comorbid with metabolic syndrome. Here we describe the existing evidence supporting the potential benefits of KDs in the management of headaches, explore the potential mechanisms of action involved in the efficacy in-depth, and synthesize results of working meetings of an Italian panel of experts on this topic. The aim of the working group was to create a clinical recommendation on indications and optimal clinical practice to treat patients with headaches using KDs. The results we present here are designed to advance the knowledge and application of KDs in the treatment of headaches.

Vagus nerve stimulation for drug-resistant epilepsy

2019 ◽  
Vol 20 (3) ◽  
pp. 189-198 ◽  
Author(s):  
Laura Pérez-Carbonell ◽  
Howard Faulkner ◽  
Sean Higgins ◽  
Michalis Koutroumanidis ◽  
Guy Leschziner
Keyword(s):  
Vagus Nerve ◽  
Seizure Frequency ◽  
Nerve Stimulation ◽  
Vagus Nerve Stimulation ◽  
Therapeutic Option ◽  
Drug Resistant ◽  
Drug Resistant Epilepsy ◽  
Randomised Controlled

Vagus nerve stimulation (VNS) is a neuromodulatory therapeutic option for drug-resistant epilepsy. In randomised controlled trials, VNS implantation has resulted in over 50% reduction in seizure frequency in 26%–40% of patients within 1 year. Long-term uncontrolled studies suggest better responses to VNS over time; however, the assessment of other potential predictive factors has led to contradictory results. Although initially designed for managing focal seizures, its use has been extended to other forms of drug-resistant epilepsy. In this review, we discuss the evidence supporting the use of VNS, its impact on seizure frequency and quality of life, and common adverse effects of this therapy. We also include practical guidance for the approach to and the management of patients with VNS in situ.

scholarly journals Ketogenic Diet Therapies for Seizures and Status Epilepticus

2020 ◽  
Vol 40 (06) ◽  
pp. 719-729
Author(s):  
Tanya J. W. McDonald ◽  
Mackenzie C. Cervenka
Keyword(s):  
Status Epilepticus ◽  
Ketogenic Diet ◽  
Care Setting ◽  
Drug Resistant ◽  
Anesthetic Agents ◽  
Ketogenic Diets ◽  
Potential Efficacy ◽  
Low Carbohydrate ◽  
History Of ◽  
Drug Resistant Epilepsy

AbstractKetogenic diet therapies are high-fat, low-carbohydrate diets designed to mimic a fasting state. Although initially developed nearly one century ago for seizure management, most clinical trials for the management of drug-resistant epilepsy in children as well as adults have been conducted over the last 3 decades. Moreover, ketogenic diets offer promising new adjunctive strategies in the critical care setting for the resolution of acute status epilepticus when traditional antiseizure drugs and anesthetic agents fail. Here, we review the history of ketogenic diet development, the clinical evidence supporting its use for the treatment of drug-resistant epilepsy in children and adults, and the early evidence supporting ketogenic diet feasibility, safety, and potential efficacy in the management of status epilepticus.

scholarly journals Ketogenic Diets for Adults with Highly Refractory Epilepsy

2017 ◽  
Vol 17 (6) ◽  
pp. 346-350 ◽  
Author(s):  
Tanya J. W. McDonald ◽  
Mackenzie C. Cervenka
Keyword(s):  
Status Epilepticus ◽  
Side Effects ◽  
Ketogenic Diet ◽  
Refractory Epilepsy ◽  
Diet Therapy ◽  
Drug Resistant ◽  
Ketogenic Diets ◽  
Current Review ◽  
Drug Resistant Epilepsy

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.

scholarly journals Ketogenic diets for drug-resistant epilepsy

2020 ◽  
Author(s):  
Kirsty J Martin-McGill ◽  
Rebecca Bresnahan ◽  
Robert G Levy ◽  
Paul N Cooper
Keyword(s):  
Drug Resistant ◽  
Ketogenic Diets ◽  
Drug Resistant Epilepsy

scholarly journals Keto-on-the-Clock: A Survey of Dietetic Care Contact Time Taken to Provide Ketogenic Diets for Drug-Resistant Epilepsy in the UK

Nutrients ◽  
2021 ◽  
Vol 13 (8) ◽  
pp. 2484
Author(s):  
Bridget Lambert ◽  
Kathryn Lightfoot ◽  
Rachel Meskell ◽  
Victoria J. Whiteley ◽  
Kirsty J. Martin-McGill ◽  
...  
Keyword(s):  
Contact Time ◽  
Online Survey ◽  
Treatment Options ◽  
Oral Intake ◽  
Drug Resistant ◽  
Patient Journey ◽  
Ketogenic Diets ◽  
Language Difficulties ◽  
Drug Resistant Epilepsy ◽  
The Uk

Medical ketogenic diets (KDs) are effective yet resource-intensive treatment options for drug-resistant epilepsy (DRE). We investigated dietetic care contact time, as no recent data exist. An online survey was circulated to ketogenic dietitians in the UK and Ireland. Data were collected considering feeding route, KD variant and type of ketogenic enteral feed (KEF), and the estimated number of hours spent on patient-related activities during the patient journey. Fifteen dietitians representing nine KD centres responded. Of 335 patients, 267 (80%) were 18 years old or under. Dietitians spent a median of 162 h (IQR 54) of care contact time per patient of which a median of 48% (IQR 6) was direct contact. Most time was required for the classical KD taken orally (median 193 h; IQR 213) as a combined tube and oral intake (median 211 h; IQR 172) or a blended food KEF (median 189 h; IQR 148). Care contact time per month was higher for all KDs during the three-month initial trial compared to the two-year follow-up stage. Patients and caregivers with characteristics such as learning or language difficulties were identified as taking longer. Twelve out of fifteen (80%) respondents managed patients following the KD for more than two years, requiring an estimated median contact care time of 2 h (IQR 2) per patient per month. Ten out of fifteen (67%) reported insufficient official hours for dietetic activities. Our small survey gives insight into estimated dietetic care contact time, with potential application for KD provision and service delivery

scholarly journals Focal Cortical Resection and Hippocampectomy in a Cat With Drug-Resistant Structural Epilepsy

2021 ◽  
Vol 8 ◽  
Author(s):  
Daisuke Hasegawa ◽  
Rikako Asada ◽  
Yuji Hamamoto ◽  
Yoshihiko Yu ◽  
Takayuki Kuwabara ◽  
...  
Keyword(s):  
Veterinary Medicine ◽  
Epilepsy Surgery ◽  
Therapeutic Option ◽  
Occipital Cortex ◽  
Epileptogenic Zone ◽  
Drug Resistant ◽  
Naturally Occurring ◽  
Alternative Treatment Option ◽  
Drug Resistant Epilepsy ◽  
The Right

Epilepsy surgery is a common therapeutic option in humans with drug-resistant epilepsy. However, there are few reports of intracranial epilepsy surgery for naturally occurring epilepsy in veterinary medicine. A 12-year-old neutered female domestic shorthair cat with presumed congenital cortical abnormalities (atrophy) in the right temporo-occipital cortex and hippocampus had been affected with epilepsy from 3 months of age. In addition to recurrent epileptic seizures, the cat exhibited cognitive dysfunction, bilateral blindness, and right forebrain signs. Seizures had been partially controlled (approximately 0.3–0.7 seizures per month) by phenobarbital, zonisamide, diazepam, and gabapentin until 10 years of age; however, they gradually became uncontrollable (approximately 2–3 seizures per month). In order to plan epilepsy surgery, presurgical evaluations including advanced structural magnetic resonance imaging and long-term intracranial video-electroencephalography monitoring were conducted to identify the epileptogenic zone. The epileptogenic zone was suspected in the right atrophied temporo-occipital cortex and hippocampus. Two-step surgery was planned, and a focal cortical resection of that area was performed initially. After the first surgery, seizures were not observed for 2 months, but they then recurred. The second surgery was performed to remove the right atrophic hippocampus and extended area of the right cortex, which showed spikes on intraoperative electrocorticography. After the second operation, although epileptogenic spikes remained in the contralateral occipital lobe, which was suspected as the second epileptogenic focus, seizure frequency decreased to <0.3 seizure per month under treatment with antiseizure drugs at 1.5 years after surgery. There were no apparent complications associated with either operation, although the original neurological signs were unchanged. This is the first exploratory study of intracranial epilepsy surgery for naturally occurring epilepsy, with modern electroclinical and imaging evidence, in veterinary medicine. Along with the spread of advanced diagnostic modalities and neurosurgical devices in veterinary medicine, epilepsy surgery may be an alternative treatment option for drug-resistant epilepsy in cats.

scholarly journals Rational Approach to Children with Drug-Resistant Epilepsy

2021 ◽  
Vol 1 (1) ◽  
Author(s):  
Elaine Wirrell
Keyword(s):  
Quality Of Life ◽  
Psychiatric Disorders ◽  
Neurological Disorders ◽  
Poor Quality ◽  
Rational Approach ◽  
Drug Resistant ◽  
Unexpected Death ◽  
Increased Risk ◽  
Drug Resistant Epilepsy

Epilepsy is one of the most common neurological disorders to affect children, and has its highest incidence in infancy. Approximately one-quarter of children have seizures which are drug-resistant, and place the child at increased risk of cognitive delays, attention, behavior and psychiatric disorders, injury, sudden unexpected death and poor quality of life. This article presents a rational approach to the investigation and management of children with drug-resistant epilepsy.    

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