Polyunsaturated fatty acid supplementation for drug-resistant epilepsy

Vasconcelos, Vivian Sarmento; Macedo, Cristiane R; Pedrosa, Alexsandra de Souza; Morais, Edna Pereira Gomes de; Porfírio, Gustavo José Martiniano; Torloni, Maria Regina

doi:10.1002/14651858.cd011014.pub2

Cited by 12 publications

(10 citation statements)

References 38 publications

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“…Moreover, a search of the Cochrane library was also conducted to identify reviews regarding n -3 LCPUFA supplementation. The studies included in the Cochrane reviews were checked for inclusion in the current study [ 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 ]. Lastly, for all included articles, the “cited by” option of Web of Science was checked (this option gives all articles that cite that specific article).…”

Section: Methodsmentioning

confidence: 99%

A Review of Recruitment, Adherence and Drop-Out Rates in Omega-3 Polyunsaturated Fatty Acid Supplementation Trials in Children and Adolescents

2017

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Introduction: The influence of n-3 long-chain polyunsaturated fatty acids (n-3 LCPUFA) supplementation on health outcomes has been studied extensively with randomized controlled trials (RCT). In many research fields, difficulties with recruitment, adherence and high drop-out rates have been reported. However, what is unknown is how common these problems are in n-3 LCPUFA supplementation studies in children and adolescents. Therefore, this paper will review n-3 LCPUFA supplementation studies in children and adolescents with regard to recruitment, adherence and drop-out rates. Methods: The Web of Science, PubMed and Ovid databases were searched for papers reporting on RCT supplementing children and adolescents (2–18 years) with a form of n-3 LCPUFA (or placebo) for at least four weeks. As a proxy for abiding to CONSORT guidelines, we noted whether manuscripts provided a flow-chart and provided dates defining the period of recruitment and follow-up. Results: Ninety manuscripts (reporting on 75 studies) met the inclusion criteria. The majority of the studies did not abide by the CONSORT guidelines: 55% did not provide a flow-chart, while 70% did not provide dates. The majority of studies provided minimal details about the recruitment process. Only 25 of the 75 studies reported an adherence rate which was on average 85%. Sixty-five of the 75 studies included drop-out rates which were on average 17%. Conclusion: Less than half of the included studies abided by the CONSORT guidelines (45% included a flow chart, while 30% reported dates). Problems with recruitment and drop-out seem to be common in n-3 LCPUFA supplementation trials in children and adolescents. However, reporting about recruitment, adherence and dropout rates was very heterogeneous and minimal in the included studies. Some techniques to improve recruitment, adherence and dropout rates were identified from the literature, however these techniques may need to be tailored to n-3 LCPUFA supplementation studies in children and adolescents.

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Section: Methodsmentioning

confidence: 99%

A Review of Recruitment, Adherence and Drop-Out Rates in Omega-3 Polyunsaturated Fatty Acid Supplementation Trials in Children and Adolescents

2017

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“…Furthermore, 12 weeks of PUFA supplementation did not show significant differences compared to placebo in terms of patient seizure frequency [81]. Thus, further investigations will be necessary to define PUFA role in KD action and seizure control and the dose PUFA administered to patients might need to be refined [82].…”

Section: Biochemistry Of Kd Actionmentioning

confidence: 99%

Ketogenic Diet: A New Light Shining on Old but Gold Biochemistry

et al. 2019

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Diets low in carbohydrates and proteins and enriched in fat stimulate the hepatic synthesis of ketone bodies (KB). These molecules are used as alternative fuel for energy production in target tissues. The synthesis and utilization of KB are tightly regulated both at transcriptional and hormonal levels. The nuclear receptor peroxisome proliferator activated receptor α (PPARα), currently recognized as one of the master regulators of ketogenesis, integrates nutritional signals to the activation of transcriptional networks regulating fatty acid β-oxidation and ketogenesis. New factors, such as circadian rhythms and paracrine signals, are emerging as important aspects of this metabolic regulation. However, KB are currently considered not only as energy substrates but also as signaling molecules. β-hydroxybutyrate has been identified as class I histone deacetylase inhibitor, thus establishing a connection between products of hepatic lipid metabolism and epigenetics. Ketogenic diets (KD) are currently used to treat different forms of infantile epilepsy, also caused by genetic defects such as Glut1 and Pyruvate Dehydrogenase Deficiency Syndromes. However, several researchers are now focusing on the possibility to use KD in other diseases, such as cancer, neurological and metabolic disorders. Nonetheless, clear-cut evidence of the efficacy of KD in other disorders remains to be provided in order to suggest the adoption of such diets to metabolic-related pathologies.

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“…All these studies have evaluated the supplementation with omega-3 fatty acids, namely, purified forms of DHA and EPA. A recent Cochrane review concluded that in view of the limited number of studies and small sample sizes, there is not enough evidence to support the use of PUFAs supplementation in people with drug-resistant epilepsy [16]. There is limited data on the use of combined use of PUFAs with KD.…”

Section: Discussionmentioning

confidence: 99%

A Switch to Polyunsaturated Fatty Acid Based Ketogenic Diet Improves Seizure Control in Patients with Drug-resistant Epilepsy on the Mixed Fat Ketogenic Diet: A Retrospective Open Label Trial

Nathan

Bailur²,

Datay³

et al. 2019

Cureus

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IntroductionThe ketogenic diet (KD) is used for drug-resistant epilepsy. However, some patients find only a modest benefit, which may plateau over time. Evidence from several animal and human studies suggests that polyunsaturated fatty acids (PUFAs) may be a beneficial form of treatment for these patients. This retrospective study was conducted to evaluate whether a switch from classic mixed fats KD (MFKD) to a natural polyunsaturated fatty acid KD (PUFA-KD) would improve seizure control.MethodsThe study evaluated the medical paper record forms of patients who had at least one seizure per week despite the use of MFKD. These patients were started on PUFA-KD and grouped according to the oils preferred. We analyzed the effect on seizure control, tolerability, blood lipids, and adverse effects and whether the type of seizures, age of seizure onset, age at which KD was started, and the ratio of omega 6: omega 3 (n6:n3) fatty acids had any effect on seizure control.ResultsData from fifty patients (aged 10 months to 35 years) were analyzed. At the end of six and 12 months on the PUFA-KD, 12% (6) and 16% (8) were seizure-free and 82% (41) and 88% (44) had a >50% reduction in seizures, respectively. The mean seizure control at 12 months was highest in patients with mixed seizures followed by those with generalized seizures and lowest for those with focal seizures. Seizure control at 12 months was inversely correlated to the age of onset of epilepsy and age at initiation of KD. This improvement was independent of the type of PUFAs and the ratio of n6:n3 used. The PUFA-KD was generally well tolerated. Blood lipid levels significantly improved.ConclusionChanging to PUFA-KD improved seizure control in patients who did not respond satisfactorily to MFKD.

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Polyunsaturated fatty acid supplementation for drug-resistant epilepsy

Abstract: In view of the limited number of studies and small sample sizes, there is not enough evidence to support the use of PUFA supplementation in people with refractory epilepsy. More trials are needed to assess the benefits of PUFA supplementation in the treatment of drug-resistant epilepsy.

Cited by 12 publications

References 38 publications

A Review of Recruitment, Adherence and Drop-Out Rates in Omega-3 Polyunsaturated Fatty Acid Supplementation Trials in Children and Adolescents

A Review of Recruitment, Adherence and Drop-Out Rates in Omega-3 Polyunsaturated Fatty Acid Supplementation Trials in Children and Adolescents

Ketogenic Diet: A New Light Shining on Old but Gold Biochemistry

A Switch to Polyunsaturated Fatty Acid Based Ketogenic Diet Improves Seizure Control in Patients with Drug-resistant Epilepsy on the Mixed Fat Ketogenic Diet: A Retrospective Open Label Trial

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