Hypocarnitinemia and its effect on seizure control in adult patients with intractable epilepsy on the modified Atkins diet
IntroductionPrevious studies have demonstrated the safety and efficacy of the modified Atkins diet (MAD) in attenuating seizures in patients with intractable epilepsy. MAD works by achieving ketosis, which is heavily dependent on the metabolic compound, carnitine, to facilitate the transport of long...
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Frontiers Media S.A.
2024-01-01
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| Series: | Frontiers in Nutrition |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fnut.2023.1304209/full |
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| author | Daniel Y. Chu Daniel Y. Chu Michele N. Ravelli Kelly M. Faltersack Arron L. Woods Dace Almane Zhanhai Li Emmanuel Sampene Elizabeth A. Felton |
| author_facet | Daniel Y. Chu Daniel Y. Chu Michele N. Ravelli Kelly M. Faltersack Arron L. Woods Dace Almane Zhanhai Li Emmanuel Sampene Elizabeth A. Felton |
| author_sort | Daniel Y. Chu |
| collection | DOAJ |
| description | IntroductionPrevious studies have demonstrated the safety and efficacy of the modified Atkins diet (MAD) in attenuating seizures in patients with intractable epilepsy. MAD works by achieving ketosis, which is heavily dependent on the metabolic compound, carnitine, to facilitate the transport of long-chain fatty acids across the mitochondria for beta-oxidation. The effect of carnitine on ketogenic diet therapy is not well-defined in the current literature. Thus, the purpose of our study is to investigate the effects of hypocarnitinemia on the efficacy of MAD.MethodsA retrospective chart review was conducted, and 58 adults with epilepsy undergoing MAD were evaluated. Generalized linear mixed effects models were used to compare the low carnitine status with normal carnitine group in patient measures of body mass index, seizure frequency and severity, number of anti-seizure medications, beta-hydroxybutyrate, triglyceride, and carnitine levels across baseline, 3–9-month follow-up (timepoint 1), 1-2-year follow-up (timepoint 2), and 2+ year follow-up (timepoint 3).ResultsOur study revealed that 38.3% of adult patients with epilepsy following MAD experienced low free carnitine at some point through the course of diet therapy. Patients with hypocarnitinemia at timepoint 2 showed a significant percent seizure increase while seizures continued to decrease in the normal carnitine group. Fasting triglyceride levels at timepoint 1 were significantly increased in the low carnitine group compared to normal carnitine group. Change in BHB, BMI, seizure severity, and number of ASMs showcased no significant differences between the low and normal carnitine groups.DiscussionIt may be important for clinicians to monitor for hypocarnitinemia in adults on MAD and provide carnitine supplementation when low. Further investigations into carnitine and MAD may inform clinical decisions on carnitine supplementation to maximize the efficacy of MAD therapy. |
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| institution | Directory Open Access Journal |
| issn | 2296-861X |
| language | English |
| last_indexed | 2024-03-08T16:50:58Z |
| publishDate | 2024-01-01 |
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| spelling | doaj.art-53f5e3277f714276b69d5641eddbcca92024-01-05T04:42:34ZengFrontiers Media S.A.Frontiers in Nutrition2296-861X2024-01-011010.3389/fnut.2023.13042091304209Hypocarnitinemia and its effect on seizure control in adult patients with intractable epilepsy on the modified Atkins dietDaniel Y. Chu0Daniel Y. Chu1Michele N. Ravelli2Kelly M. Faltersack3Arron L. Woods4Dace Almane5Zhanhai Li6Emmanuel Sampene7Elizabeth A. Felton8Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI, United StatesDepartment of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, United StatesDepartment of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI, United StatesDepartment of Clinical Nutrition, University of Wisconsin Hospitals and Clinics, Madison, WI, United StatesDepartment of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI, United StatesDepartment of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI, United StatesDepartment of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison, WI, United StatesDepartment of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison, WI, United StatesDepartment of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI, United StatesIntroductionPrevious studies have demonstrated the safety and efficacy of the modified Atkins diet (MAD) in attenuating seizures in patients with intractable epilepsy. MAD works by achieving ketosis, which is heavily dependent on the metabolic compound, carnitine, to facilitate the transport of long-chain fatty acids across the mitochondria for beta-oxidation. The effect of carnitine on ketogenic diet therapy is not well-defined in the current literature. Thus, the purpose of our study is to investigate the effects of hypocarnitinemia on the efficacy of MAD.MethodsA retrospective chart review was conducted, and 58 adults with epilepsy undergoing MAD were evaluated. Generalized linear mixed effects models were used to compare the low carnitine status with normal carnitine group in patient measures of body mass index, seizure frequency and severity, number of anti-seizure medications, beta-hydroxybutyrate, triglyceride, and carnitine levels across baseline, 3–9-month follow-up (timepoint 1), 1-2-year follow-up (timepoint 2), and 2+ year follow-up (timepoint 3).ResultsOur study revealed that 38.3% of adult patients with epilepsy following MAD experienced low free carnitine at some point through the course of diet therapy. Patients with hypocarnitinemia at timepoint 2 showed a significant percent seizure increase while seizures continued to decrease in the normal carnitine group. Fasting triglyceride levels at timepoint 1 were significantly increased in the low carnitine group compared to normal carnitine group. Change in BHB, BMI, seizure severity, and number of ASMs showcased no significant differences between the low and normal carnitine groups.DiscussionIt may be important for clinicians to monitor for hypocarnitinemia in adults on MAD and provide carnitine supplementation when low. Further investigations into carnitine and MAD may inform clinical decisions on carnitine supplementation to maximize the efficacy of MAD therapy.https://www.frontiersin.org/articles/10.3389/fnut.2023.1304209/fullmodified Atkins dietketogenic therapyseizureepilepsycarnitineketogenic dietary therapy |
| spellingShingle | Daniel Y. Chu Daniel Y. Chu Michele N. Ravelli Kelly M. Faltersack Arron L. Woods Dace Almane Zhanhai Li Emmanuel Sampene Elizabeth A. Felton Hypocarnitinemia and its effect on seizure control in adult patients with intractable epilepsy on the modified Atkins diet Frontiers in Nutrition modified Atkins diet ketogenic therapy seizure epilepsy carnitine ketogenic dietary therapy |
| title | Hypocarnitinemia and its effect on seizure control in adult patients with intractable epilepsy on the modified Atkins diet |
| title_full | Hypocarnitinemia and its effect on seizure control in adult patients with intractable epilepsy on the modified Atkins diet |
| title_fullStr | Hypocarnitinemia and its effect on seizure control in adult patients with intractable epilepsy on the modified Atkins diet |
| title_full_unstemmed | Hypocarnitinemia and its effect on seizure control in adult patients with intractable epilepsy on the modified Atkins diet |
| title_short | Hypocarnitinemia and its effect on seizure control in adult patients with intractable epilepsy on the modified Atkins diet |
| title_sort | hypocarnitinemia and its effect on seizure control in adult patients with intractable epilepsy on the modified atkins diet |
| topic | modified Atkins diet ketogenic therapy seizure epilepsy carnitine ketogenic dietary therapy |
| url | https://www.frontiersin.org/articles/10.3389/fnut.2023.1304209/full |
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