Achieving and maintaining compliance with the ketogenic diet

The ketogenic diet, a treatment for intractable epilepsy, is rarely initiated because it requires strict compliance with a diet that is perceived to be unpalatable. In a case study of a 15-year-old girl with uncontrolled epilepsy, we used a stimulus-choice procedure to assess relative preferences of 33 foods from the diet and to develop two treatments based on Premack's principle. The results of a multielement analysis showed that both treatments increased dietary compliance. Compliance was maintained with generalization of treatment across settings, and was associated with a 40% reduction in seizures.     

A multicenter study of the efficacy of the ketogenic diet

OBJECTIVE: To determine the efficacy of the ketogenic diet in multiple centers. DESIGN: A prospective study of the change in frequency of seizures in 51 children with intractable seizures who were treated with the ketogenic diet. SETTING: Patients were enrolled from the clinical practices of 7 sites. The diet was initiated in-hospital and the patients were followed up for at least 6 months. PATIENTS: Fifty-one children, aged 1 to 8 years, with more than 10 seizures per week, whose electroencephalogram showed generalized epileptiform abnormalities or multifocal spikes, and who had failed results when taking at least 2 appropriate anti-epileptic drugs. INTERVENTION: The children were hospitalized, fasted, and a 4:1 ketogenic diet was initiated and maintained. MAIN OUTCOME MEASURES: Frequency of seizures was documented from parental calendars and efficacy was compared with prediet baseline after 3, 6, and 12 months. The children were categorized as free of seizures, greater than 90% reduction, 50% to 90% reduction, or lower than 50% reduction in frequency of seizures. RESULTS: Eighty-eight percent of all children initiating the diet remained on it at 3 months, 69% remained on it at 6 months, and 47% remained on it at 1 year. Three months after initiating the diet, frequency of seizures was decreased to greater than 50% in 54%. At 6 months, 28 (55%) of the 51 initiating the diet had at least a 50% decrease from baseline, and at 1 year, 40% of those starting the diet had a greater than 50% decrease in seizures. Five patients (10%) were free of seizures at 1 year. Age, sex, principal seizure type, and electroencephalogram were not statistically related to outcome. CONCLUSION: The ketogenic diet is effective in substantially decreasing difficult-to-control seizures and can successfully be administered in a wide variety of settings.     

An interdisciplinary team approach to implementing the ketogenic diet for the treatment of seizures

Vascular endothelial cell growth factor (VEGF) plays a pivotal role in the regulation of angiogenesis by binding to its cognate receptor molecule type II (VEGFr-II, KDR). VEGFr-II is an endothelial cell-specific transmembrane tyrosine kinase important for vascular endothelial cell development and differentiation during embryogenesis, angiogenic processes under physiological conditions, and various diseases. An increasing number of reports indicate that VEGF/VEGFr-II also play a fundamental role for tumor angiogenesis. We present the generation and in vitro characterization of the monoclonal antibodies 2-7-9 and 2-10-1. Both antibodies are highly specific for VEGFr-II as demonstrated by Western blotting and immunoprecipitation. MAbs 2-10-1 and 2-7-9 bind to a disulphide bridge-stabilized epitope within domains 6 and 7 of the human VEGFr-II with an affinity of 8 and 80 nM, respectively. Furthermore, the antibodies are suitable for immunohistochemistry and ELISA techniques. Because both antibodies recognize their epitope on living cells, they also have the potential for drug targeting and diagnostic purposes.     

Sleep disorders in neurology: hyposomnia

Sleep disturbances are an important health problem; about 20-33% of the population suffer from hyposomnias (lack of sleep). Hyposomnias often accompany neurological disorders (head traumas, chronic cephalea, pain, cerebrovascular and neuromuscular disorders, M. Parkinson, and dementia). Slow wave sleep decreases, arousals increase, and sleep is fragmented; these types of hyposomnias are treated by treatment of the basic neurological disease. Some sleep disturbances (e.g. sleep apneas) are a risk factor for cerebrovascular disorders.     

Cognitive effects of ketogenic weight-reducing diets

OBJECTIVE: To determine whether ketogenic weight reducing diets have adverse effects on cognitive performance. SUBJECTS: 21 overweight women (mean BMI = 41 kg/m2). DESIGN: Randomized double-blinded study. METHOD: Subjects were randomized to ketogenic or nonketogenic liquid formula very low energy diets, that were comparable in energy and in protein content. Subjects remained on the diet for 28 days and were reevaluated periodically with brief measures of cognitive performance assessing attention and mental flexibility. RESULTS: Weight losses were comparable on the two diets (Mean = 8.1 kg). Performance on attention tasks did not differ as a function of the diet. However, performance on the trail making task, a neuropsychological test that requires higher order mental processing and flexibility, was adversely affected by the ketogenic diet. The worsening in performance was observed primarily between baseline and week one of the ketogenic diet. CONCLUSIONS: Further research is needed to confirm this finding and to determine whether ketogenic diets negatively affect other complex mental tasks, such as problem solving.     

Alternative medicine: where''s the evidence?

Third ventriculocisternostomy was performed in 23 patients for management of hydrocephalus. The procedure was offered as the first treatment in 18 cases and in lieu of a shunt revision in 4 cases. Median follow-up was 17 months (range 7-44 months). In 16 patients the operation was successful in treating their symptoms (73%). Cine MRI was helpful in evaluating patients with persistent ventriculomegaly. Resolution of symptoms in association with decreased ventricular size correlated best with outcome following this procedure. Third ventriculocisternostomy is technically safe and minimally invasive and should be offered as the first procedure in the management of noncommunicating hydrocephalus.     

The neurology of diabetes

Diabetic neuropathy, ranging from reversible mononeuropathies to irreversible and progressive autonomic neuropathy, is the most frequent neurological complication of diabetes. Diabetes also affects the central nervous system and manifestations vary from stroke to paroxysmal disorders related to fluctuations in blood glucose levels.     

Problems of perinatal neurology

An analysis of more than 1000 cases of early organic brain lesions has demonstrated that in 54% of them the etiology of neurological disturbances was an antenatal pathology, in 38%-intranatal and in 8%-postnatal. The prevention of perinatal disorders of the nervous system is considered as a complex problem including measures of health prevention for the future mothers, control over the development of pregnancy, perfection of obstetric aid, effective measures for the prevention of tissue hypoxia and its sequalae, elaboration of methods of rehabilitative therapy, work with personnel.