This pilot study by Christiansen, Rødbro, and Sjö was published in 1974 in the British Medical Journal. The frequency of epileptic seizures was observed in a controlled therapeutic trial on 23 epileptic inpatients before and after treatment with vitamin D2 or placebo in addition to anticonvulsant drugs. The number of seizures was reduced during treatment with vitamin D2 but not with placebo. The effect was unrelated to changes in serum calcium or magnesium. The results may support the concept that epileptics should be treated prophylactically with vitamin D (Br Med J 1974; 2 (5913): 258-9).
Charlie is a son of the famous American film director Jim Abrahams. When Charlie was one year old, he had numerous daily seizures. No medication for epilepsy helped, and he had also had an unsuccessful brain surgery. But everything changed when he came to Johns Hopkins Hospital, where he was cured of his epilepsy by the ketogenic diet. The diet was undertaken despite resistance from the five pediatric neurologists he had seen.
When Charlie’s parents realized that Charlie was but one of hundreds of thousands of children whose families were either not being informed, or being misinformed about dietary therapy, they started in 1994 The Charlie Foundation in order to raise awareness about the ketogenic diet as a treatment for childhood epilepsy.
On April 2, 2008 Charlie Abrahams, whose epilepsy had been cured by the ketogenic diet, addressed an audience of over 300 scientists, neurologists, dietitians, and nurses at the first “International Symposium on Dietary Therapy for Epilepsy and Other Neurological Disorders.” He presented an award to Millicent Kelly, R.D. the Johns Hopkins dietitian who taught his family the diet.
“Leptin plays a role in modulating structure and synaptic communication in brain. Some studies on animal models reported that chronic leptin deficiency in mice raise susceptibility to seizure and leptin administeringin rodent seizure models suppresses seizures via direct effects on glutamate neurotransmission. So, leptin receptor activation is suggested as a novel targets for treatment of epilepsy in animal. However, another recently published study on animal model indicateddose-related proconvulsant activity of leptin. Leptin resistance and increased blood level of leptin is reported in epilepsy in human.
Given that, leptin level in autism is higher than controls. Also, long-term plasma leptin levels in Rett syndrome is reported. It is worth conducting studies investigating possible difference between the group of ASD with epilepsy and the group of ASD without epilepsy regarding leptin level and its receptor resistance. Probably, leptin may be a link between autism and epilepsy that provides an avenue for novel or better management of autistic children with epilepsy. For example, Ketogenic diets which are effective for epilepsy management increase leptin level in Young rodents.”
Ghanizaeh A. Leptin as a new approach for treatment for autism and epilepsy, a hypothesis with clinical implications. Brain Dev 2011; 33 (1): 92; author reply 92-3. Epub 2010 Sep 6.
– Zinc has been found to play a critical role in regulating communication between cells in the brain, possibly governing the formation of memories and controlling the occurrence of epileptic seizures.
A collaborative project between Duke University Medical Center researchers and chemists at the Massachusetts Institute of Technology has been able to watch zinc in action as it regulates communication between neurons in the hippocampus, where learning and memory processes occur – and where disrupted communication may contribute to epilepsy.
“We discovered that zinc is essential to control the efficiency of communication between two critical populations of nerve cells in the hippocampus,” said James McNamara, M.D., senior author and chair of the Department of Neurobiology at Duke. “This addresses a longstanding controversy in the field.”
The study appeared in Neuron Journal online on Sept. 21.
McNamara noted that zinc supplements are commonly sold over the counter to treat several different brain disorders, including depression. It isn’t clear whether these supplements modify zinc content in the brain, or modify the efficiency of communication between these nerve cells. He emphasized that people taking zinc supplements should be cautious, pending needed information on the desired zinc concentrations and how oral supplements affect them.
More than 50 years ago scientists discovered that high concentrations of zinc are contained in a specialized compartment of nerve cells, called vesicles, that package the transmitters which enable nerve cells to communicate. The highest concentrations of brain zinc were found among the neurons of the hippocampus, the center of learning and memory.
Zinc’s presence in these vesicles suggested that zinc played some role in communication between nerve cells, but whether it actually did so remained controversial.
To address this controversy, McNamara and his colleagues at Duke teamed up with Dr. Steve Lippard and colleagues in the Department of Chemistry at the Massachusetts Institute of Technology.
The Lippard team synthesized a novel chemical that bound zinc far more rapidly and selectively than previously available compounds. Use of this chemical let the Duke team rapidly bind the zinc released by nerve cells, taking it out of circulation and preventing enhanced communication.
The Duke team went on to confirm that eliminating zinc from the vesicles of mutant mice also prevented enhanced communication. They also found that increases in the transmitter glutamate seemed to increase zinc-mediated enhancement of communication.
Interestingly, the nerve cells in which the high concentrations of zinc reside are critical for a particular type of memory formation. Excessive enhancement of communication by the zinc-containing nerve cells occurs in epileptic animals and may worsen the severity of the epilepsy.
“Carefully controlling zinc’s regulation of communication between these nerve cells is critical to both formation of memories and perhaps to occurrence of epileptic seizures,” McNamara said.
McNamara also noted that the scientific collaboration between the Duke and MIT scientists was critical to the success of this work. The availability of the novel chemical provided a critical tool that allowed the neuroscientists to unravel the puzzle.
Pan E, Zhang X, Huang Z, Krezel A, Zhao M, Tinberg CE, Lippard SJ, McNamara JO. Vesicular Zinc Promotes Presynaptic and Inhibits Postsynaptic Long-Term Potentiation of Mossy Fiber-CA3 Synapse. Neuron 2011; 71 (6): 1116-1 126.
You might have heard the term “brain food” used to describe food that’s good for you. Doctors at Mayo Clinic say there really is a diet that benefits the brain. But this diet is not for everybody. It’s for kids who have epilepsy, and it’s based on extremely high fats and very few carbs. More on how the ketogenic diet is helping some kids with epilepsy become seizure free.
Video from Mayo Clinic, USA
The high-fat ketogenic diet can dramatically reduce or completely eliminate debilitating seizures in most children with infantile spasms, whose seizures persist despite medication, according to a Johns Hopkins Children’s Center study published in 2010 in the journal Epilepsia.
Infantile spasms, also called West syndrome, is a stubborn form of epilepsy that often does not get better with antiseizure drugs. Because poorly controlled infantile spasms may cause brain damage, the Hopkins team’s findings suggest the diet should be started at the earliest sign that medications aren’t working.
“Stopping or reducing the number of seizures can go a long way toward preserving neurological function, and the ketogenic diet should be our immediate next line of defense in children with persistent infantile spasms who don’t improve with medication,” says senior investigator Eric Kossoff, M.D., a pediatric neurologist and director of the ketogenic diet program at Hopkins Children’s.
The ketogenic diet, made up of high-fat foods and few carbohydrates, works by triggering biochemical changes that eliminate seizure-causing short circuits in the brain’s signaling system. It has been used successfully in several forms of epilepsy.
A small 2002 study by the same Hopkins team showed the diet worked well in a handful of children with infantile spasms. The new study is the largest analysis thus far showing just how effective the diet can be in children with this condition.
Of the 104 children treated by the Hopkins team, nearly 40 percent, or 38 children, became seizure-free for at least six months after being on the diet for anywhere from just a few days to 20 months. Of the 38, 30 have remained so without a relapse for at least two years.
After three months on the diet, one-third of the children had 90 percent fewer seizures, and after nine months on the diet, nearly half of the children in the study had 90 percent fewer seizures. Nearly two-thirds had half as many seizures after six months on the diet.
Nearly two-thirds of the children experienced improvement in their neurological and cognitive development, and nearly 30 percent were weaned off antiseizure medications after starting the diet.
Most of the children continued taking their medication even after starting the diet, the researchers say, because the two are not mutually exclusive and can often work in synergy.
Researchers also used the diet as first-line therapy in18 newly diagnosed infants never treated with drugs, 10 of whom became seizure free within two weeks of starting the diet. The finding suggests that, at least in some children, the diet may work well as first-line therapy, but the researchers say they need further and larger studies to help them identify patients for whom the diet is best used before medications. Hopkins Children’s neurologists are actively using the ketogenic diet as first-line treatment in children with infantile spasms with promising results.
Side effects, including constipation, heartburn, diarrhea and temporary spikes in cholesterol levels, occurred in one-third of the children, with six percent of them experiencing diminished growth.
Despite these side effects, a recent study by Kossoff and his team showed that the ketogenic diet is safe long term.
Conflict of interest disclosure: Dr. Kossoff has received grant support from Nutricia Inc., for unrelated research. The terms of these arrangements are being managed by the Johns Hopkins University in accordance with its conflict-of-interest policies.
Hong AM, Turner Z, Hamdy RF, Kossoff EH. Infantile spasms treated with the ketogenic diet: Prospective single-center experience in 104 consecutive infants. Epilepsia 2010; 51 (8): 1403–1407.
Related on the Web
This is a 1997 television film, directed by Jim Abrahams, about a boy whose severe epilepsy, unresponsive to medications with terrible side effects, is controlled by the ketogenic diet. Aspects of the story mirror Abrahams’ own experience with his son Charlie.
When Lori Reimuller learns that her young son Robbie has epilepsy, she first trusts the judgment of the hospital staff in how best to bring it under control. As Robbie’s health slides radically downhill, however, she becomes frustrated and desperate, and so does her own research into the existing literature on treatments. When she decides to try the ketogenic diet, devised long ago by a doctor from Johns Hopkins, she is met with narrow-minded resistance from Robbie’s doctor, who is prepared to take legal action to prevent Lori from removing him from the hospital. This movie is an indictment of those in the medical profession who discuss only the treatment options they favor. Several of the minor characters are portrayed by people who have been not just helped, but cured by the ketogenic diet. Read More