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Gammoh O, Al-Smadi A, Mansour M, Ennab W, AL Hababbeh S, Al-Taani G, Alsous M, Aljabali AAA, Tambuwala MM. The relationship between psychiatric symptoms and the use of levetiracetam in people with epilepsy. Int J Psychiatry Med 2024; 59:360-372. [PMID: 37837222 PMCID: PMC11044508 DOI: 10.1177/00912174231206056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/15/2023]
Abstract
Background: Mental health in people with epilepsy (PWE) is often overlooked, especially in developing countries.Purpose: Consequently, the current work had two objectives: (1) to estimate the burden of depression, anxiety, insomnia, and stress, and (2) to examine the association of these psychiatric/psychological symptoms with levetiracetam and other relevant clinical factors in a cohort of Jordanian PWE.Research Design: This is a cross-sectional study. The demographic and clinical data were recorded. Depression was measured by the Patient Health Questionnaire-9 (PHQ-9, Arabic-validated version) and anxiety by the General Anxiety Disorder-7 (GAD-7, Arabic-validated version). The insomnia severity index (ISI-A, Arabic version) was used to assess sleep quality, and the Perceived Stress Scale (PSS-A, Arabic version) was used to measure perceived stress.Study Sample: Data were analyzed from 280 patients, of which 178 (63.6%) received levetiracetam as monotherapy or as adjuvant.Results: Depression was reported in 150 (53.6%), anxiety in 110 (39.3%), insomnia in 131 (46.8%), and clinically significant stress in 211 (75.4%). At univariate analysis, levetiracetam was not associated with psychiatric symptoms. Multivariate logistic regression revealed that severe depressive symptoms were associated with family history (OR = 2.47, 95% CI = 1.42-4.33, P = .001) and seizure type (OR = 1.69, 95% CI = 1.01-2.80, P = .04), severe anxiety symptoms were associated with family history (OR = 1.90, 95% CI = 1.12-3.23, P = .01), severe insomnia was associated with seizure type (OR = 2.16, 95% CI = 1.33-3.5, P = .002) and severe stress was associated with marital status (OR = 2.37, 95% CI = 1.31-4.29, P = .004).Conclusions: The high psychological burden of PWE is a challenging issue that requires attention and prompt action to control its risk factors. Levetiracetam was not associated with psychiatric symptoms in this study.
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Affiliation(s)
- Omar Gammoh
- Faculty of Pharmacy, Department of Clinical Pharmacy and Pharmacy Practice, Yarmouk University, Irbid, Jordan
| | - Ahmed Al-Smadi
- Faculty of Nursing, Al al-Bayt University, Mafraq, Jordan
| | | | - Wail Ennab
- Department of Neurology, Al-Bashir Hospital, Amman, Jordan
| | | | - Ghaith Al-Taani
- Faculty of Pharmacy, Department of Clinical Pharmacy and Pharmacy Practice, Yarmouk University, Irbid, Jordan
| | - Mervat Alsous
- Faculty of Pharmacy, Department of Clinical Pharmacy and Pharmacy Practice, Yarmouk University, Irbid, Jordan
| | - Alaa AA Aljabali
- Faculty of Pharmacy, Department of Pharmaceutics and Pharmaceutical Technology, Yarmouk University, Irbid, Jordan
| | - Murtaza M Tambuwala
- Lincoln Medical School, Brayford Pool Campus, University of Lincoln, Lincoln, Lincolnshire, UK
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Samia P, Naanyu V, Helen Cross J, Idro R, Boon P, Wilmshurst J, Luchters S. Ketogenic dietary therapy utilization in Kenya: A qualitative exploration of dietitian's perceptions. Epilepsy Behav Rep 2024; 26:100661. [PMID: 38560597 PMCID: PMC10978472 DOI: 10.1016/j.ebr.2024.100661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 03/04/2024] [Accepted: 03/18/2024] [Indexed: 04/04/2024] Open
Abstract
This study utilized a qualitative design to explore dietitians' perceptions regarding Ketogenic Diet Therapy (KDT) for patients with drug-resistant epilepsy in Kenya. Dietitians from Kenya were selected and consented. Audio-recorded interviews were conducted, followed by thematic analysis of verbatim transcripts to identify recurring patterns. The study enrolled 18 dietitians, fourteen of whom correctly described their understanding of KDT for managing drug-resistant epilepsy. There was a lack of confidence in their capacity to initiate the KDT with all expressing the need for further training and facilitation. Only one dietitian reported having initiated and maintained KDT. There was an overall positive view regarding KDT and willingness to implement KDT for patients with drug-resistant epilepsy. Dietitians expressed concerns regarding the availability of national policies, inadequate staffing to support families who require KDT, and the cost of implementing this intervention. Dietitians expressed interest in virtual training to enhance their understanding of KDT. Dietitians in Kenya are mostly aware of KDT utilization for the management of drug-resistant epilepsy. However, they cited poor capability and various barriers to implementation. There is a need for policies to facilitate KDT as a treatment option for the benefit of patients with drug-resistant epilepsy.
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Affiliation(s)
- Pauline Samia
- Department of Paediatrics and Child Health, Medical College, Aga Khan University, 3rd Parklands Avenue, University Centre, Nairobi, Kenya
- Brain and Mind Institute, Aga Khan University, 3rd Parklands Avenue, University Centre, Nairobi, Kenya
- Department of Public Health and Primary Care, Ghent University, Sint-Pietersnieuwstraat 25, Gent, Ost-Flandern, Belgium
| | - Violet Naanyu
- School of Arts & Social Sciences, Moi University, Main Campus, Eldoret, Kenya
- AMPATH Research, AMPATH Centre, Nandi Road, Eldoret, Kenya
| | - J Helen Cross
- UCL BRC NIHR Great Ormond Street, Institute of Child Health, London, United Kingdom
| | - Richard Idro
- Makerere University, Department of Paediatrics and Child Health, University Road, Kampala, Uganda
| | - Paul Boon
- Department of Neurology, Ghent University, Sint-Pietersnieuwstraat 25, Gent, Ost-Flandern, Belgium
| | - Jo Wilmshurst
- Department of Paediatric Neurology, Red Cross War Memorial Children's Hospital, Klipfontein Road, Cape Town, South Africa
- Institute of Neurosciences, University of Cape Town, Woolsack Drive, Cape Town, South Africa
| | - Stanley Luchters
- Department of Public Health and Primary Care, Ghent University, Sint-Pietersnieuwstraat 25, Gent, Ost-Flandern, Belgium
- The Centre for Sexual Health and HIV/AIDS Research (CeSHHAR), 4 Bath Road, Harare, Zimbabwe
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, United Kingdom
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Shaaban S, Al-Beltagi M, El Rashidy O, Nassar M, El Gendy Y. Ketogenic diet in childhood epilepsy: clinical algorithm in a tertiary care center. Front Pediatr 2023; 11:1221781. [PMID: 37484774 PMCID: PMC10361660 DOI: 10.3389/fped.2023.1221781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 06/16/2023] [Indexed: 07/25/2023] Open
Abstract
Background Dietary therapies play a crucial role in managing patients, especially those who have specific types of epilepsy, display adverse effects, or are not responding to pharmacological treatments. The ketogenic diet (KD) is a high-fat, restricted carbohydrate, and adequate protein regimen. The KD has proven to be an effective nonpharmacological treatment for drug-resistant epilepsy (DRE) by generating ketones that act as an alternative fuel source for the brain, thereby reducing the occurrence of seizures. The advantages of KD have been attributed to its universal availability, numerous administration techniques, and affordability. Objective This article presents the KD algorithm developed by a multidisciplinary team of experts at the Children's Hospital, Ain Shams University, Egypt. The algorithm serves as a guide for implementing the KD in the treatment of DRE in children. The algorithm has been previously validated through a study. Methods The algorithm consists of seven essential stages: (1) referral of patients to the Complex Epilepsy Committee, (2) pre-diet assessment of patients, (3) referral of patients to the Clinical Nutrition (CN) team, (4) diet selection and initiation, (5) seizure follow-up and diet fine-tuning, (6) diet reassessment after 3 months, and (7) evaluation of the KD journey after 24 months. Results The KD algorithm was systematically developed and proved highly influential in facilitating the implementation of the KD. The algorithm yielded significant health benefits in pediatric patients. Conclusion The KD algorithm provides a systematic approach to implementing the ketogenic diet and has demonstrated positive health outcomes in pediatric patients.
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Affiliation(s)
- Sanaa Shaaban
- Children's Hospital, Faculty of Medicine, Ain Shams University, Abbassia, Egypt
| | - Mohammed Al-Beltagi
- Paediatric Department, Faculty of Medicine, Tanta University, Tanta, Egypt
- Paediatric Department, University Medical Center, King Abdulla Medical Center, Arabian Gulf University, Dr. Sulaiman Al Habib Medical Group, Manama, Bahrain
| | - Omnia El Rashidy
- Children's Hospital, Faculty of Medicine, Ain Shams University, Abbassia, Egypt
| | - May Nassar
- Children's Hospital, Faculty of Medicine, Ain Shams University, Abbassia, Egypt
| | - Yasmin El Gendy
- Children's Hospital, Faculty of Medicine, Ain Shams University, Abbassia, Egypt
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Carroll JH, Martin-McGill KJ, Cross JH, Hickson M, Williams E, Aldridge V, Collinson A. Core outcome set development for childhood epilepsy treated with ketogenic diet therapy: Results of a scoping review and parent interviews. Seizure 2022; 99:54-67. [PMID: 35598573 DOI: 10.1016/j.seizure.2022.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/23/2022] [Accepted: 05/10/2022] [Indexed: 11/15/2022] Open
Abstract
PURPOSE Clinical trials on childhood epilepsy treated with ketogenic diet (KD) use a wide range of outcomes, however, patients and decision-makers often do not perceive the outcomes used as the most important. We sought parental opinion on outcomes of importance and compared these to outcomes reported in published research. METHODS Ethical approval (London-Surrey-REC19/LO/1680). A scoping review identified outcomes reported in previous studies of childhood epilepsy and KD. Parents were recruited from nine KD centres (UK), charities and social media (international), then interviewed (Jan-April 2020) to explore priority outcomes. Content analysis identified all outcomes in transcripts. Parent identified outcomes were compared with those in the scoping review. Outcomes were collated and grouped into domains according to the COMET Taxonomy. RESULTS Of 2663 articles;147 met inclusion criteria. 921 verbatim outcomes were sorted into 90 discrete outcomes, reduced to 70 in consultation with the study advisory group, then classified into 21 domains. Parents (n = 21) identified 39 outcomes as important from the scoping review and seven new outcomes. They prioritised both physiological and functional outcomes in contrast to past studies, which prioritised physiological outcomes. CONCLUSION Little consistency exists in the outcomes used in childhood epilepsy and KD research. Those traditionally used do not adequately reflect parents' important outcomes for their child. Clinical trials should consider the broader priorities of parents when choosing outcomes, in particular, functional outcomes. Identified outcomes will inform an international two-round Delphi-study with parent, professional and researcher participants to develop a core outcome set for this clinical area (COMET registration #1116).
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Affiliation(s)
| | | | - J Helen Cross
- Developmental Neurosciences, UCL, NIHR BRC Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Mary Hickson
- Faculty of Health, University of Plymouth, Devon, United Kingdom
| | - Emma Williams
- Matthew's Friends, Lingfield, Surrey, United Kingdom
| | - Val Aldridge
- Matthew's Friends, Lingfield, Surrey, United Kingdom
| | - Avril Collinson
- Faculty of Health, University of Plymouth, Devon, United Kingdom
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Alameen Ali H, Muthaffar O, AlKarim N, Kayyali H, Elmardenly A, Tamim A, Alansari H. The efficacy of non-fasting ketogenic diet protocol in the management of intractable epilepsy in pediatric patients: a single center study from Saudi Arabia. J Int Med Res 2022; 50:3000605221081714. [PMID: 35259998 PMCID: PMC8918967 DOI: 10.1177/03000605221081714] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objective To review the characteristics and outcomes of pediatric patients on a ketogenic diet (KD), an established treatment option for individuals with intractable epilepsy, in a tertiary epilepsy center. Methods This retrospective study included pediatric patients diagnosed with intractable epilepsy who had experienced no benefits from at least two appropriately chosen antiseizure medications. All patients were hospitalized, started a KD without fasting, and were observed for complications and tolerance. The etiology of epilepsy, side effects, and KD efficacy on seizure outcomes were also examined. Results Of 16 children included in the study, nine (56%) experienced significant seizure improvement, with three becoming seizure-free during the KD. Ten patients were fed orally, and six were fed through gastrostomy feeding tubes. Most were on a 3:1 ratio, and nine reached ketosis within the first three days of KD initiation. Initial recurrent hypoglycemia was documented in four patients, and four experienced vomiting and acidosis. Most families complied with the diet, and all of the children gained weight during the study period. Conclusion Ketogenic diets are an established and effective treatment for childhood epilepsy, with reversible mild adverse effects. A non-fasting KD protocol is a safe and effective option for children with intractable epilepsy.
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Affiliation(s)
- Hayat Alameen Ali
- Department of Clinical Nutrition Services, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Osama Muthaffar
- Department of Pediatrics, 37848King Abdulaziz University, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia.,Department of Pediatrics, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Nahla AlKarim
- Department of Clinical Nutrition Services, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Husam Kayyali
- Department of Pediatrics, 187187Sidra Medicine, Neurology Division, Sidra Medicine, Doha, Qatar
| | - Ahmed Elmardenly
- Department of Pediatrics, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Abdullah Tamim
- Department of Pediatrics, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Hala Alansari
- Department of Clinical Nutrition Services, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
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Cabrera AM, Fain H, Fain B, Muniategui J, Buiras VM, Galicchio S, Cacchia PA, Retamero M, Ocampo RP, Porto MB. [Treatment of refractory epilepsy. A comparison between classic ketogenic diet and modified Atkins diet in terms of efficacy, adherence, and undesirable effects]. NUTR HOSP 2021; 38:1144-8. [PMID: 34435501 DOI: 10.20960/nh.03172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Introduction Background: the ketogenic diet (CD) is an established, effective non-pharmacological treatment for refractory epilepsy in childhood. Aim: the objective of this study was to compare the efficacy, the presence of undesirable effects, and adherence between the classic ketogenic diet (DCC) and the modified Atkins diet (DAM). Materials and methods: a retrospective and comparative investigation was carried out to evaluate the medical records of all the patients who started treatment with a ketogenic diet by the same team between 2008 and 2018. In all, 57 patients were started on a DAM diet and 19 patients were given a DCC diet. Results: it was observed that both the Atkins and the classic diets were equally effective (approximately, 80 %; p = 0.252). Regarding adherence, there was a significantly higher percentage of adherence to the Atkins diet than to the classic diet (p = 0.018). Fewer adverse effects were observed with DAM than with DCC (p = 0.012). In all, 21 % of patients under DAM had unfavorable effects (12/57), while 52.63 % of patients on DCC had complications (10/19). Conclusion: a comparable effectiveness in terms of crisis control was found between DAM and DCC. However, DAM exhibits a much better adherence than DCC, and its undesirable effects are milder, less common. That is why, according to other works, it is likely that DAM should be first-choice for patients with refractory epilepsy in a large percentage of cases.
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Samia P, Naanyu V, Cross JH, Idro R, Boon P, Wilmshurst J, Luchters S. Qualitative exploration of feasibility and acceptability of the modified Atkins diet therapy for children with drug resistant epilepsy in Kenya. Epilepsy Behav 2021; 125:108362. [PMID: 34740092 DOI: 10.1016/j.yebeh.2021.108362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 09/20/2021] [Accepted: 09/25/2021] [Indexed: 01/01/2023]
Abstract
PURPOSE Approximately one-third of children with epilepsy have clinical syndromes characterized by drug resistance. Modified Atkins dietary therapy (MADT) can reduce seizures and improve health outcomes for these children. This intervention is yet to be consistently offered as standard of care in sub-Saharan Africa. OBJECTIVES This study aimed to assess feasibility and acceptability of MADT for children with drug-resistant epilepsy and identify enabling strategies for implementation and adherence to the MADT. METHODS This qualitative inquiry utilized in-depth interviews with purposively selected caregivers and adolescent patients having used MADT for drug-resistant epilepsy. A qualified team consisting of a social scientist and an interviewer carried out the interviews with consenting participants. Thematic analysis was done independent of the clinicians. RESULTS This study enrolled 17 participants including 14 caregivers of children aged 1-17 years, and three adolescents. Caregivers were predominantly trained professionals living in urban areas who had attended the epilepsy clinic for at least one year. Duration of continuous MADT use ranged from two weeks to two years. Among participants who indicated that they could afford to provide the MADT, it was less costly to provide for younger children and for those living in rural areas. At the time of the study, majority of the caregivers had ceased administration of the MADT, more than half of whom reported barriers including cost of food, child refusal of foods, and inconsistent dietician support. Social support was a key enabler to successful implementation and continuation of the diet. Majority of the participants considered MADT to be an effective and acceptable intervention for management of epilepsy. CONCLUSIONS Among participants in this focused Kenyan group, implementation of MADT was found to be feasible particularly for younger children living in rural areas. Majority of participants evaluated MADT to be an effective and acceptable intervention for management of epilepsy. Cultural factors did not influence feasibility or acceptability of MADT in this study.
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Affiliation(s)
- Pauline Samia
- Department of Paediatrics and Child Health, Medical College, Aga Khan University, Nairobi, Kenya; Brain and Mind Institute, Aga Khan University, Kenya; Department of Public Health and Primary Care, Ghent University, Belgium.
| | - Violet Naanyu
- School of Arts & Social Sciences, Moi University, Kenya; AMPATH Research, Eldoret, Kenya
| | - J Helen Cross
- UCL BRC NIHR Great Ormond Street, Institute of Child Health, London, United Kingdom
| | - Richard Idro
- Makerere University, Department of Paediatrics and Child Health, Kampala, Uganda
| | - Paul Boon
- Department of Neurology, Ghent University, Belgium
| | - Jo Wilmshurst
- Department of Paediatric Neurology, Red Cross War Memorial Children's Hospital, Cape Town, South Africa; Institute of Neurosciences, University of Cape Town, South Africa
| | - Stanley Luchters
- Department of Public Health and Primary Care, Ghent University, Belgium; Department of Population Health, Medical College, Aga Khan University, Nairobi, Kenya; Department of Epidemiology and Preventive Medicine, Monash University, Australia
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Nassar MF, El-Gendy YGA, Hamza MT, Mohamed MN, Radwan N. Effect of ketogenic diet for drug-resistant epilepsy on immunological cells. Neurol Sci 2021; 43:1987-1992. [PMID: 34449000 DOI: 10.1007/s10072-021-05574-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 08/17/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND AIM OF THE WORK Ketogenic diet (KD) is one of the treatments in drug-resistant epilepsy (DRE). The current study aimed at assessing the effect of KD-induced ketosis on different immunological cells since ketosis is reported to affect neutrophil function. METHODOLOGY We recruited 21 pediatric patients diagnosed with DRE assigned to start KD. Anthropometric measurements, complete blood picture with differential count, phagocytic function, lymphocyte subsets, and IgG estimation were estimated initially and after 6 months of KD. RESULTS There were no differences between the initial total leucocytic, neutrophil, and lymphocytic counts as well as the lymphocyte subsets, and the values after 6 months of KD. IgG values showed significant increase yet the values were still within the reference ranges. For the innate immune system, the phagocytic index was assessed and it showed a marked statistical reduction in patients after KD. CONCLUSION KD has no effect on neutrophil and lymphocytic counts as well as the number of adaptive and immune cells; nevertheless, it causes a reduction in phagocytic index in DRE. Accordingly, further detailed study for the full immunological profile and function is needed to ensure the safety of this therapeutic line and correlate it with the clinical history.
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Affiliation(s)
- May Fouad Nassar
- Pediatric Clinical Nutrition Unit, Children's Hospital, Ain Shams University, Cairo, Egypt.
| | | | | | | | - Nesrine Radwan
- Pediatric Allergy, Immunology and Rheumatology Unit, Children's Hospital, Ain Shams University, Cairo, Egypt
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Kishk NA, Yousof HZ, Ebraheim AM, Elkholy TAFA, Soliman SH, Mohammed RA, Shamloul RM. The effect of ketogenic diet escalation in adolescents and adults with drug-resistant epilepsy: a prospective study. Nutr Neurosci 2021; 25:2023-2032. [PMID: 34011238 DOI: 10.1080/1028415x.2021.1927604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Ketogenic diet (KD) is an accepted and effective treatment modality in patients with drug-resistant epilepsy (DRE). Different versions of ketogenic diets have been studied, however, the effect of ratio escalation in adolescence and adults has not been previously investigated. METHODS The current open-labeled interventional study was conducted on 80 patients with drug-resistant epilepsy DRE, 40 patients (intervention group) were exposed to dietary intervention besides their regular antiseizure medication (ASM) and compared to 40 control patients. The intervention group received Ketogenic diet in 2:1 ratio for 1 month then were divided into 2 subgroups, group A1 continued the 2:1 ratio for another 2 months while group A2 escalated to 3:1 dietary regimen. Socio-demographic, anthropometric measurements, epilepsy clinical parameters, and laboratory tests were recorded in addition to safety and tolerability documentation. The response rate was recorded after 1month and 3month. RESULTS Significant decrease in seizure frequency and severity were detected in Group A1 and A2 patients compared to controls after the 3 month period of intervention with significant improvement of quality of life scores in both subgroups. Both subgroups also showed comparable results regarding their response rate to KD. Better acceptance of diet taste were reported by subgroup A1 with a significantly higher lipid profile detected in subgroup A2. CONCLUSION KD has a beneficial effect as adjunctive treatment in adolescents and adults with DRE. Escalation from 2:1 to 3:1 ratio is associated with less compliance rather than better response in patients with DRE.
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Affiliation(s)
- Nirmeen Adel Kishk
- Faculty of Medicine, Neurology Department, Cairo University, Cairo, Egypt
| | - Hanaa Zaghloul Yousof
- Faculty of Medicine, Public Health and Community Department, Cairo University, Cairo, Egypt.,Scientific Research Department, Armed Forces College of Medicine AFCM, Egypt
| | | | | | - Shaimaa H Soliman
- Faculty of Medicine, Neurology Department, Cairo University, Cairo, Egypt
| | - Randa Adel Mohammed
- Faculty of Home Economics, Nutrition and food Science Department, AlAzhar University, Egypt
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Svedlund A, Hallböök T, Magnusson P, Dahlgren J, Swolin-Eide D. Prospective study of growth and bone mass in Swedish children treated with the modified Atkins diet. Eur J Paediatr Neurol 2019; 23:629-638. [PMID: 31085021 DOI: 10.1016/j.ejpn.2019.04.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 04/05/2019] [Accepted: 04/05/2019] [Indexed: 12/27/2022]
Abstract
PURPOSE The modified Atkins diet (MAD) is a less restrictive treatment option than the ketogenic diet (KD) for intractable epilepsy and some metabolic conditions. Prolonged KD treatment may decrease bone mineralization and affect linear growth; however, long-term studies of MAD treatment are lacking. This study was designed to assess growth, body composition, and bone mass in children on MAD treatment for 24 months. METHODS Thirty-eight patients, mean age (SD) 6.1 years (4.8 years), 21 girls, with intractable epilepsy (n = 22), glucose transporter type 1 deficiency syndrome (n = 7), or pyruvate dehydrogenase complex deficiency (n = 9) were included. Body weight, height, body mass index (BMI), bone mass, and laboratory tests (calcium, phosphorus, magnesium, alkaline phosphatase, cholesterol, 25-hydroxyvitamin D, insulin-like growth factor-I and insulin-like growth factor binding protein 3) were assessed at baseline and after 24 months of MAD treatment. RESULTS Approximately 50% of the patients responded with more than 50% seizure reduction. Weight and height standard deviation score (SDS) were stable over 24 months, whereas median (minimum - maximum) BMI SDS increased from 0.2 (-3.3 to 4.5) to 0.7 (-0.9 to 2.6), p < 0.005. No effects were observed for bone mass (total body, lumbar spine and hip) or fat mass. CONCLUSIONS The MAD was efficient in reducing seizures, and no negative effect was observed on longitudinal growth or bone mass after MAD treatment for 24 months.
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Affiliation(s)
- A Svedlund
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Region Västra Götaland, Sahlgrenska University Hospital, The Queen Silvia Children's Hospital, Department of Pediatrics, Gothenburg, Sweden.
| | - T Hallböök
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Region Västra Götaland, Sahlgrenska University Hospital, The Queen Silvia Children's Hospital, Department of Pediatrics, Gothenburg, Sweden
| | - P Magnusson
- Department of Clinical Chemistry, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - J Dahlgren
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Region Västra Götaland, Sahlgrenska University Hospital, The Queen Silvia Children's Hospital, Department of Pediatrics, Gothenburg, Sweden
| | - D Swolin-Eide
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Region Västra Götaland, Sahlgrenska University Hospital, The Queen Silvia Children's Hospital, Department of Pediatrics, Gothenburg, Sweden
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Kaddumukasa M, Mugenyi L, Lhatoo S, Sewankambo N, Blixen C, Sajatovic M, Katabira E. Seizure severity is associated with poor quality of life in people living with epilepsy (PLWE) in Uganda: A cross-sectional study. Epilepsy Behav 2019; 96:104-108. [PMID: 31125798 PMCID: PMC6597271 DOI: 10.1016/j.yebeh.2019.04.033] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 04/18/2019] [Accepted: 04/19/2019] [Indexed: 11/26/2022]
Abstract
RATIONALE There is a paucity of information about the association of seizure severity and quality of life (QoL) in people living with epilepsy (PLWE) in sub-Saharan Africa. We evaluated the relationship between seizure severity and health-related quality of life (HRQoL) of patients with epilepsy being followed up in an outpatient neurology clinic in urban central Uganda. METHODS Forty-eight PLWE who met the study inclusion criteria were enrolled. The study questionnaire was comprised of the Chalfont Seizure Severity Scale (CSSS) and the Quality of Life Inventory in Epilepsy (QOLIE-31). Spearman's rank correlation coefficient was used to determine the association between seizure severity and QoL score. RESULTS The median age of the study participants was 25 years, with median age (interquartile range (IQR)) of epilepsy onset of 12 (6-18) years. Over 57.4% of the study participants were unemployed. The mean (standard deviation (SD)) of QOLIE-31 and Seizure Severity Score was 62.5 (14.5) and 62.4 (1.6), respectively. There was no gender difference in the seizure severity scores (p = 0.451). An inverse relationship existed between seizure severity and the total QOLIE-31 score (Spearman's rank correlation coefficient, r = -0.48, p = 0.001), and seizure worry (r = -0.31, p = 0.030). CONCLUSIONS In this Ugandan sample, seizure severity is unacceptably high and directly impacts the life of PLWE. Interventions that reduce seizure severity are urgently needed in our settings to reduce seizures and improve the QoL in PLWE.
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Affiliation(s)
- Mark Kaddumukasa
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda.
| | - Levicatus Mugenyi
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University. P.O. Box 7072, Kampala, Uganda
| | - Samden Lhatoo
- Department of Neurology, The University of Texas, Health Science Center at Houston, 6431 Fannin Street - Suite MSB 7.044, Houston, TX 77030, USA.
| | - Nelson Sewankambo
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda.
| | - Carol Blixen
- Neurological and Behavioral Outcomes Center, University Hospitals Cleveland Medical Center & Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Cleveland, OH 44106, USA.
| | - Martha Sajatovic
- Neurological and Behavioral Outcomes Center, University Hospitals Cleveland Medical Center & Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Cleveland, OH 44106, USA.
| | - Elly Katabira
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda.
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