Ketogenic Diet in the Treatment of Epilepsy.

Epilepsy is one of the most disabling neurological diseases. Despite proper pharmacotherapy and the availability of 2nd and 3rd generation antiepileptic drugs, deep brain stimulation, and surgery, up to 30-40% of epilepsy patients remain drug-resistant. Consequences of this phenomenon include not only decreased a quality of life, and cognitive, behavioral, and personal disorders, but also an increased risk of death, i.e., in the mechanism of sudden unexpected death in epilepsy patients (SUDEP). The main goals of epilepsy treatment include three basic issues: achieving the best possible seizure control, avoiding the undesired effects of treatment, and maintaining/improving the quality of patients' lives. Therefore, numerous attempts are made to offer alternative treatments for drug-resistant seizures, an example of which is the ketogenic diet. It is a long-known but rarely used dietary therapy for intractable seizures. One of the reasons for this is the unpalatability of the classic ketogenic diet, which reduces patient compliance and adherence rates. However, its antiseizure effects are often considered to be worth the effort. Until recently, the diet was considered the last-resort treatment. Currently, it is believed that a ketogenic diet should be used much earlier in patients with well-defined indications. In correctly qualified patients, seizure activity may be reduced by over 90% or even abolished for long periods after the diet is stopped. A ketogenic diet can be used in all age groups, although most of the available literature addresses pediatric epilepsy. In this article, we focus on the mechanisms of action, effectiveness, and adverse effects of different variants of the ketogenic diet, including its classic version, a medium-chain triglyceride diet, a modified Atkins diet, and a low glycemic index treatment.

Activity of Selected Group of Monoterpenes in Alzheimer's Disease Symptoms in Experimental Model Studies-A Non-Systematic Review.

Alzheimer's disease (AD) is the leading cause of dementia and cognitive function impairment. The multi-faced character of AD requires new drug solutions based on substances that incorporate a wide range of activities. Antioxidants, AChE/BChE inhibitors, BACE1, or anti-amyloid platelet aggregation substances are most desirable because they improve cognition with minimal side effects. Plant secondary metabolites, used in traditional medicine and pharmacy, are promising. Among these are the monoterpenes-low-molecular compounds with anti-inflammatory, antioxidant, enzyme inhibitory, analgesic, sedative, as well as other biological properties. The presented review focuses on the pathophysiology of AD and a selected group of anti-neurodegenerative monoterpenes and monoterpenoids for which possible mechanisms of action have been explained. The main body of the article focuses on monoterpenes that have shown improved memory and learning, anxiolytic and sleep-regulating effects as determined by in vitro and in silico tests-followed by validation in in vivo models.

The Prophylactic Use of Antiepileptic Drugs in Patients Scheduled for Neurosurgery.

Antiepileptic drugs (AEDs) possess diverse mechanisms of action - enhancement of GABA-mediated events, inhibition of glutamate-mediated excitation, blockade of voltage-dependent sodium or calcium channels being the most frequently shared. They are not only used for the symptomatic management of epilepsy but in the treatment of psychiatric or neurologic disorders (e.g. bipolar disorder, neuropathic pain, prophylaxis of migraine). Generally, this group of drugs is also widely used in neurosurgery patients for the prevention of seizure activity and their effectiveness in this regard has been evaluated in this review. There is no controversy as to whether continue AEDs in patients with epilepsy scheduled for neurosurgery. A question arises on whether AEDs may be recommended to non-epileptic neurosurgical patients for the prevention of post-surgery early or late seizures. There are some positive examples indicating that AEDs may reduce the occurrence of preferably early seizures, some results also being positive in the case of late seizure activity. However, there are also many negative data in this regard. The existence of serious adverse effects and a possibility of pharmacokinetic interactions with the concomitant therapy may further complicate the decision on whether to start the prophylactic use of AEDs. In general, the existing evidence does not support the prophylactic use of AEDs, especially in patients who underwent craniotomy/craniectomy for the inhibition of late seizure activity.