Ketogenic Diets for Adult Neurological Disorders

McDonald, Tanya J.W.; Cervenka, Mackenzie C.

doi:10.1007/s13311-018-0666-8

Cited by 98 publications

(90 citation statements)

References 166 publications

(162 reference statements)

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“…66,67 Lastly, ketogenic diet is increasingly used as an effective treatment for refractory seizures in adults, 68 another treatment modality thought to alter metabolic substrate availability even though the basic underlying mechanism is not completely understood. 69,70 Perhaps most importantly, our findings in conjunction with emerging clinical trials of neuroimaging markers of structural integrity in post-cardiac arrest comatose patients 17,18 also support the broad use of structural imaging protocols (including MRIs) in such patients. Lack of neuroimaging evidence for overwhelming neuronal injury in persistently comatose patients should prompt a vigorous attempt to promote brain activation and aggressive treatment of ongoing seizures or other varying persistent functional abnormalities seen after cardiac arrest.…”

Section: Discussionsupporting

confidence: 65%

“…In addition, recent studies have shown that super‐refractory status epilepticus, as seen in Patient 1, may remit with the use of ketamine, another NMDA‐antagonist agent . Lastly, ketogenic diet is increasingly used as an effective treatment for refractory seizures in adults, another treatment modality thought to alter metabolic substrate availability even though the basic underlying mechanism is not completely understood …”

Section: Discussionmentioning

confidence: 99%

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Independent Functional Outcomes after Prolonged Coma following Cardiac Arrest: A Mechanistic Hypothesis

Forgács

Devinsky

Schiff

2020

Annals of Neurology

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Objective Survivors of prolonged (>2 weeks) post–cardiac arrest (CA) coma are expected to remain permanently disabled. We aimed to investigate 3 outlier patients who ultimately achieved independent functional outcomes after prolonged post‐CA coma to identify electroencephalographic (EEG) markers of their recovery potential. For validation purposes, we also aimed to evaluate these markers in an independent cohort of post‐CA patients. Methods We identified 3 patients with late recovery from coma (17–37 days) following CA who recovered to functionally independent behavioral levels. We performed spectral power analyses of available EEGs during prominent burst suppression patterns (BSP) present in all 3 patients. Using identical methods, we also assessed the relationship of intraburst spectral power and outcomes in a prospectively enrolled cohort of post‐CA patients. We performed chart reviews of common clinical, imaging, and EEG prognostic variables and clinical outcomes for all patients. Results All 3 patients with late recovery from coma lacked evidence of overwhelming cortical injury but demonstrated prominent BSP on EEG. Spectral analyses revealed a prominent theta (~4–7Hz) feature dominating the bursts during BSP in these patients. In the prospective cohort, similar intraburst theta spectral features were evident in patients with favorable outcomes; patients with BSP and unfavorable outcomes showed either no features, transient burst features, or decreasing intraburst frequencies with time. Interpretation BSP with theta (~4–7Hz) peak intraburst spectral power after CA may index a recovery potential. We discuss our results in the context of optimizing metabolic substrate availability and stimulating the corticothalamic system during recovery from prolonged post‐CA coma. ANN NEUROL 2020;87:618–632

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Section: Discussionsupporting

confidence: 65%

Section: Discussionmentioning

confidence: 99%

Independent Functional Outcomes after Prolonged Coma following Cardiac Arrest: A Mechanistic Hypothesis

Forgács

Devinsky

Schiff

2020

Annals of Neurology

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“…Ketogenic diets (KDs) for the dietary management of epilepsy and neurometabolic conditions have undergone a worldwide renaissance and a reported increase in use over recent decades . Clinical and scientific research has confirmed degrees of efficacy , revealed possible mechanistic insights and, more recently, indicated their potential as adjunctive treatments for an ever‐widening range of other medical conditions . However, acceptability of KDs and adherence to the requisite, habitual, very low‐carbohydrate, very high‐fat intake is known to be variable and problematic, particularly for adults .…”

Section: Introductionmentioning

confidence: 99%

Understanding the core principles of a ‘modified ketogenic diet’: aUKand Ireland perspective

Martin‐McGill

Lambert²,

Whiteley

et al. 2019

J Human Nutrition Diet

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Background Many centres across the UK and Ireland anecdotally report using a ‘modified ketogenic diet’ (MKD) as a treatment for refractory epilepsy. Although a MKD is within the spectrum of ketogenic diets (KDs), there is little literature reporting upon its definition, use or clinical effectiveness. We aimed to understand the core principles of MKD practice and to assess whether and how the MKD differs from other KD protocols. Methods An online survey, designed by a consensus group of ketogenic dietitians, was circulated to 39 KD centres across the UK and Ireland. It consisted of 35 questions regarding dietetic practice when providing MKD. Results Eighteen centres completed the questionnaire: 13 paediatric, three adult and two combined centres. All dietitians based MKD ‘prescriptions’ on estimated total energy requirements. The average macronutrient profile was 75% fat and 5% carbohydrate, with protein ad libitum. Carbohydrate and fat targets were implemented via weighed portions (carbohydrate lists n = 18; fat lists n = 13) and ‘household measures’ (carbohydrate lists n = 2; fat lists n = 3). Of the centres, 94% (n = 17) adjusted macronutrients over time; these decisions were based on ketone levels and seizures in most cases (83%; n = 14). Ketogenic nutritional products available on prescription were used by 10 centres (56%) when initiating and by all centres when ‘fine‐tuning’ the MKD. Conclusions A modified ketogenic diet in the UK and Ireland is a hybrid KD, adopting principles from other established KD protocols and defining new elements unique to the MKD. Further research into the clinical and cost‐effectiveness of MKD would be of benefit.

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“…A high-fat, low-carbohydrate, ketogenic diet can alleviate symptoms including generalized pain and headache in a wide variety of neurological diseases, e.g., brain cancer, multiple sclerosis, neurotrauma, Alzheimer, and Parkinson disease [89]. Over the past decade, investigators have demonstrated the neuroprotective role of ketogenic diet [89][90][91].…”

Section: Enriched Polyunsaturated Fatty Acid Dietsmentioning

confidence: 99%

Dietary Patterns and Interventions to Alleviate Chronic Pain

et al. 2020

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Pain is one of the main problems for modern society and medicine, being the most common symptom described by almost all patients. When pain becomes chronic, the life of the patients is dramatically affected, being associated with significant emotional distress and/or functional disability. A complex biopsychosocial evaluation is necessary to better understand chronic pain, where good results can be obtained through interconnected biological, psychological, and social factors. The aim of this study was to find the most relevant articles existent in the PubMed database, one of the most comprehensive databases for medical literature, comprising dietary patterns to alleviate chronic pain. Through a combined search using the keywords “chronic pain” and “diet” limited to the last 10 years we obtained 272 results containing the types of diets used for chronic pain published in the PubMed database. Besides classical and alternative methods of treatment described in literature, it was observed that different diets are also a valid solution, due to many components with antioxidant and anti-inflammatory qualities capable to influence chronic pain and to improve the quality of life. Thirty-eight clinical studies and randomized controlled trials are analyzed, in an attempt to characterize present-day dietary patterns and interventions to alleviate chronic pain.

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Ketogenic Diets for Adult Neurological Disorders

Cited by 98 publications

References 166 publications

Independent Functional Outcomes after Prolonged Coma following Cardiac Arrest: A Mechanistic Hypothesis

Independent Functional Outcomes after Prolonged Coma following Cardiac Arrest: A Mechanistic Hypothesis

Understanding the core principles of a ‘modified ketogenic diet’: aUKand Ireland perspective

Dietary Patterns and Interventions to Alleviate Chronic Pain

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