Dietary medium chain triglycerides for management of epilepsy: New data from human, dog, and rodent studies.
Dietary medium chain triglycerides for management of epilepsy: New data from human, dog, and rodent studies.
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作者：
Han FY;Conboy-Schmidt L;Rybachuk G;Volk HA;Zanghi B;Pan Y;Borges K
许多研究表明，癫痫大脑区域的葡萄糖代谢可能会受到损害。能量对维持正常的大脑功能至关重要，包括离子和神经递质的平衡。能量缺乏可能导致离子梯度的破坏，从而触发神经元去极化和癫痫的产生。因此，致痫脑区葡萄糖代谢过程的紊乱表明癫痫患者和动物有特殊的营养需求，因为他们可能从葡萄糖以外的辅助大脑燃料中受益。生酮饮食提供酮体乙酰乙酸酯和β-羟基丁酸盐，可作为大脑的辅助燃料。在大约50%患有某些类型癫痫的儿童和成人中，他们可以耐受并维持这些饮食方案，发作频率可以有效地减少。最近的数据表明，添加中链甘油三酯(MCTs)，它提供中链脂肪酸辛酸和癸酸，以及酮体作为辅助大脑能量，可以在啮齿动物癫痫模型以及患有癫痫的狗和人类中受益。在这里，我们回顾了这些证据，包括65%的人类耐受性，在狗身上的疗效研究，MCTS可能的抗惊厥作用机制，特别是癸酸以及代谢和抗氧化机制。总而言之，对于人类和患有癫痫的狗来说，MCT是一种很有前途的标准药物治疗的辅助药物，因为它们没有目前抗癫痫药物的中枢神经系统副作用。现在需要在儿童、成人和狗身上进行更大规模的临床试验，以找到MCT的理想成分和剂量，以及反应最好的癫痫类型。
Many studies show that glucose metabolism in epileptic brain areas can be impaired. Energy is crucial to maintain normal brain function, including ion and neurotransmitter balances. Energy deficits can lead to disruption of ion gradients, which can trigger neuronal depolarization and generation of seizures. Thus, perturbed metabolic processing of glucose in epileptogenic brain areas indicates a specific nutritional need for people and animals with epilepsy, as they are likely to benefit from auxiliary brain fuels other than glucose. Ketogenic diets provide the ketone bodies acetoacetate and β‐hydroxybutyrate, which can be used as auxiliary fuel by the brain. In approximately 50% children and adults with certain types of epilepsy, who can tolerate and maintain these dietary regimens, seizure frequency can be effectively reduced. More recent data demonstrate that addition of medium chain triglycerides (MCTs), which provide the medium chain fatty acids octanoic and decanoic acid, as well as ketone bodies as auxiliary brain energy, can be beneficial in rodent seizure models, and dogs and humans with epilepsy. Here, this evidence is reviewed, including tolerance in 65% of humans, efficacy studies in dogs, possible anticonvulsant mechanisms of actions of MCTs, and specifically decanoic acid as well as metabolic and antioxidant mechanisms. In conclusion, MCTs are a promising adjunct to standard pharmacological treatment for both humans and dogs with epilepsy, as they lack central nervous system side effects found with current antiepileptic drugs. There is now a need for larger clinical trials in children, adults, and dogs to find the ideal composition and doses of MCTs and the types of epilepsy that respond best.
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