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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Lauren is the food photographer, recipe developer, and author behind the healthy living website Wicked Spatula. With a focus on mindful and sustainable living she aspires to show her audience that healthy eating doesn't have to be boring, complicated, or tasteless and that healthy living is all about getting in touch with yourself and your surroundings.
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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.
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Furthermore, if the KD increases GABA levels in the brain, then such an effect is approximated by vigabatrin, an irreversible inhibitor of the degradative enzyme GABA-transaminase, as well as by tiagabine, a GABA re-uptake blocker that interferes with presnaptic GABA transporters (White et al., 2007). Yet, the anticonvulsant profile of the KD is distinct from that of vigabatrin and tiagabine (Hartman et al., 2007). The general approach of deriving another pill that enhances brain GABA levels may not be relevant or viable, since many seizure types seem to be exacerbated by agents that contribute to enhanced tonic inhibition, and extrasynaptic GABA receptors that mediate tonic inhibition are more sensitive to elevated ambient GABA concentrations (Sazgar & Bourgeois, 2005). Indeed, increased GABAergic inhibition in the cortex appears to underlie the mechanism of synchronization and seizure generation in two mouse models of autosomal dominant nocturnal frontal lobe epilepsy (Klassen et al, 2006)
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Untuk memperdalam ilmunya, beliau selalu aktif mengikuti pelatihan mengenai gizi dan nutrisi hingga asupan nutrisi untuk penderita penyakit metabolik dan degeneratif. Pada tahun 2019, beliau mendapatkan sertifikasi dari Harvard Medical School dalam mengikuti pelatihan mengenai “Obesity Medicine.” Beberapa kali beliau juga aktif menjadi narasumber acara mengenai gizi di televisi, radio, surat kabar, sosial media, hingga seminar. Di tengah aktivitasnya, beliau kini menjadi tim medis di Persatuan Atletik Seluruh Indonesia. Dokter Raissa bisa ditemui di tempat praktik pribadinya di Sawo 15 Menteng, atau di RS Pondok Indah - Puri Indah dan di RS Metropolitan Medical Center.
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The earliest demonstration of direct in vivo effects of ketone bodies was made by Keith in the early 1930’s, when he determined that acetoacetate, when administered intraperitoneally in rabbits, prevented seizures induced by thujone (1933), a convulsant constituent found in many essential oils and an antagonist of GABAA receptors (Höld et al., 2000). This seminal observation was later confirmed in an audiogenic seizure-susceptible mouse model (Rho et al., 2002). More intriguingly, however, Likhodii and colleagues (2003) established the broad anticonvulsant properties of acetone in four different animal models, and when injected intraperitoneally, produced plasma and cerebrospinal fluid (CSF) concentrations consistent with those used to suppress seizures. These results confirmed and extended historical observations supporting an anticonvulsant action for acetone, through as yet undetermined mechanisms (Likhodii & Burnham, 2002). And in further support of this, other investigators found that acetone was detectable (up to a concentration of 0.7 mM) in the brains of fully controlled KD-treated patients with epilepsy using proton magnetic resonance spectroscopy (Seymour et al, 1999).