Glutathione is an endogenous tripeptide antioxidant whose function is to prevent free radical-mediated cellular injury (Schulz et al., 2000). It is found in nearly every cell in the body, and almost exclusively in its reduced form (GSH) due to the constitutive activity of glutathione reductase which converts it from the oxidized state, glutathione disulfide (GSSG). Under conditions of oxidative stress, glutathione reductase is inducible, and hence is able to increase the reducing equivalents essential to neutralize unstable molecules such as reactive oxygen species (Schulz et al., 2000).
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Historically, many anticonvulsant medications have resulted from structural modifications of lead compounds that had themselves been discovered serendipitously. The mechanistic bases for their effectiveness have typically been elucidated post-hoc. At present, it is unclear which of many potential mechanisms reviewed in this supplement are relevant to the clinical effects of the KD. It would be far too difficult to integrate these numerous possibilities into a single unifying hypothesis (or a final common pathway), or to consider them simultaneously. Nevertheless, it might be instructive to consider each of these putative mechanisms one by one and ask a simple comparative question. If the mechanism or target in question is a critical determinant of the anticonvulsant efficacy of the KD, then would a similar intervention known to be based on that mechanism yield a comparable effect? Perhaps answering this question for each mechanistic speculation might help substantiate (or perhaps invalidate) that particular hypothesis.
One potential explanation for the anticonvulsant action of the KD argues that increased ATP synthesis should produce a positive bioenergetic balance, allowing stabilization of the resting membrane potential via enhanced activity of Na+-K+-ATPase (Bough & Rho, 2007). Several decades ago, De Vivo and colleagues (1978) reported that the KD increased the total quantity of bioenergetic substrates (such as adenosine triphosphate, or ATP) and elevated the energy charge in rat brain. These changes were purported to stabilize the cell membrane, especially in the face of excessive excitation. Consistent with these observations, a later human study utilizing magnetic resonance spectroscopic techniques indicated that patients with epilepsy fed a KD had elevated phosphocreatine to creatine levels in the brain (Pan et al., 1999). Recently, using cDNA microarray technology, increased expression of the mitochondrial ATP synthase β,D subunit in mouse brain was reported after KD treatment (Noh et al., 2004). And in the most comprehensive study of this kind to date, the KD was found to enhance mitochondrial biogenesis and significantly increase the number of transcripts encoding energy metabolism genes in rats (Bough et al., 2006). This increase in bioenergetic capacity enabled hippocampal slices from these animals to better withstand metabolic challenge from low glucose exposure. Taken together, the prevailing notion has been that increased energy production and reserve capacity enable greater resistance to neuronal hyperexcitability and hypersynchrony.
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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.
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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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Pilihlah lemak yang sehat termasuk lemak dari kelapa (santan, minyak kelapa), minyak zaitun, alpukat, chia, kacang rendah karbo (almond, kenari). Sebisa mungkin menghindari lemak dari hewan yang disuntik hormon, mengandung GMO, serta makanan proses dalam kemasan dengan tambahan kimia sintetik (perasa, pewarna, pengawet). Hindari juga minyak yang mengandung transfat seperti minyak canola, kedelai dan bunga matahari.
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Leptin is an important protein hormone that critically regulates energy intake and expenditure (Harvey, 2007; Hill et al., 2008). The mechanisms through which leptin exerts its effects on metabolism are largely unknown. Although leptin is predominantly found in adipocytes, it is also found highly expressed in areas of the hypothalamus. Interestingly, leptin modulates numerous membrane-bound ion channels, and exerts differential effects on neuronal excitability (Harvey, 2007).
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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?
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