While the relationships between seizure activity, oxidative stress and neuronal injury have yet to be clarified, previous studies have indicated that defects in antioxidant systems may contribute to seizure genesis and epileptogenesis (Cock, 2002; Patel, 2004; Liang & Patel, 2006; Shin et al, 2008). Earlier, the effects of a KD on mitochondrial ROS generation were discussed. Are there other mechanisms through which oxidative stress can be attenuated in epileptic brain?
In rats fed a KD, Ziegler et al (2003) found an increase in antioxidant activity using a luminol oxidation assay in the hippocampus, and a four-fold increase in glutathione peroxidase activity. Consistent with these findings, Jarrett et al (2008) recently reported an up-regulation of GSH biosynthesis in adolescent rats fed a KD. Furthermore, these investigators observed improved mitochondrial antioxidant status, and proposed that these changes were responsible for preventing mitochondrial DNA from oxidant-induced damage. Collectively, these studies suggest that the KD may indeed exert neuroprotective activity.
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Given these findings, it is not surprising that investigators have studied the effects of dietary supplementation with PUFAs alone, to determine whether these substrates can render an anticonvulsant effect. Early case reports suggested that seizures might be better controlled with this approach (Schlanger et al., 2002). However, a recent randomized trial in adult patients with epilepsy failed to demonstrate superiority of a PUFA supplement (EPA) plus DHA, 2.2 mg/day in a 3:2 ratio) over placebo (Bromfield et al., 2008). Thus, the jury is still out as to whether PUFAs alone can mirror the clinical effects of the KD.