Many of our existing anticonvulsant medications exert effects on inhibitory neurotransmission, and more specifically, by enhancing synaptic levels of γ-aminobutyric acid (GABA) or modulating post-synaptic GABAA receptors (Meldrum & Rogawski, 2007; White et al., 2007). Examples of such agents include tiagabine, vigabatrin, benzodiazepines, barbiturates, felbamate, and topiramate. Thus, given the wealth of information regarding GABAergic neurotransmission, one possibility is that the KD, perhaps through ketone bodies, might be responsible for elevating synaptic levels of GABA, which would then yield an inhibitory (and potentially anticonvulsant) effect.
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The relevance of leptin to seizure susceptibility was recently highlighted by Erbayat-Altay and colleagues (2008) who demonstrated a significantly decreased threshold in leptin-deficient ob/ob mice to pentylenetetrazol-induced seizures. Indeed, leptin itself inhibits seizures induced by 4-aminopyridine and pentyelenetrazole-induced, possibly through blockade of AMPA receptor-mediated synaptic transmission (Xu et al., 2008). If the limiting of AMPA receptor-mediated transmission is a critical factor, it should be recalled this can also be accomplished by topiramate. With respect to the KD, the leptin signaling system is believed to contribute to slow weight gain associated with chronic treatment in both rodents and humans (Thio et al., 2006). KD-fed juvenile rodents had higher serum leptin levels and lower insulin levels than control rats fed a standard diet.
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Thus, if fatty acids (and perhaps more specifically, polyunsaturated fatty acids or PUFAs), enhance mitochondrial uncoupling, and if this basic downstream mechanism is responsible for both anticonvulsant and neuroprotective effects (which has yet to be demonstrated), then could taking a chemical uncoupler such as 2,4-dinitrophenol (DNP) render the same effects? Of course, it is well known that DNP, a potent mitochondrial uncoupler that greatly increases the basal metabolic rate, and once used to treat obesity in the 1930’s, has a major untoward side-effect profile – namely, high fever and the risk of death. Clearly, if mitochondrial uncoupling were to represent the essential target, then less potent (and less toxic) compounds are required, and novel delivery systems need to be developed.
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