Fasting and ketogenic diet prevent seizures in epileptic children, magnesium-deficient rats and other animal models of seizure disorders. This effect has been attributed to increased levels of circulating ketone bodies. The purpose of this study was to determine the role of serum ketone bodies, measured as beta-hydroxybutyrate (BHB), in preventing audiogenically-induced seizures in weanling rats fed a magnesium-deficient diet for 17 days. The effect on seizure susceptibility was investigated by feeding a magnesium-deficient diet to weanling rats for 17 days. Fasting and ketogenic diet (dietary medium chain triglycerides, MCT) markedly decreased seizure incidence that was associated with increased serum BHB level. Also, rats fasted for 24h or fed 28 percent dietary MCT had decreased seizure incidence as compared with rats fed 3 percent dietary MCT or rats fasted for 6h. These effects were not caused by differences in caloric density or percentage of calories from fat in the diets. Gavaging 2 mmoles of BHB resulted in lower seizure incidence; as compared with rats gavaged with 0.5 mmoles BHB when measured 30 min after dosing. In contrast, gavaging 5.6 mmoles of glucose resulted in increased seizure incidence in 24-h-fasted rats. Gavaging 5.6 mmoles of glucose with 0.5 mmole of BHB simultaneously resulted in higher seizure incidence than gavaging with 2.0 mmole BHB and 1.4 mmole glucose simultaneuosly. In addition, gavaging 5.6 mmoles of glucose with 2 mmoles of BHB resulted in higher seizure incidence than gavaging 2 mmoles of BHB alone, which markedly reduced seizure incidence in fasted animals. Fasting, ketogenic diet (MCT) and gavaging BHB increase serum BHB and decrease serum glucose concentrations . Gavaging glucose reduced serum BHB and increased serum glucose concentration. There was an inverse relationship between serum BHB and glucose in all treatments of this study. Although some treatments affected serum minerals, these effects were not consistent among experiments. Therefore, fasting, ketogenic diet (MCT) and gavaging BHB or glucose does not affect serum minerals markedly or consistently; and modifications in serum minerals caused by these treatments do not account for this effect on seizure incidence and severity. Finally, increases in serum BHB and decreases in serum glucose were consistently associated with dose-dependent reductions in seizure susceptibility of rats fed a magnesium-deficient diet for 17 days.

The Cerulean Warbler (Dendroica cerulea) is state-listed as threatened or as a species of special concern throughout most of its range, suffering from extensive loss of breeding habitat. Although the Cerulean Warbler has been classified as a species of high conservation concern, little is known about its life history. Conservation and management efforts directed toward protecting forested landscapes on the breeding and non-breeding grounds, with the specific habitat requirements that this species prefers, are paramount. Yet, there is little specific quantitative data in existence regarding the pertinent vegetation structure in which the Cerulean Warbler can successfully breed. During the two field seasons of this project (2000 and 2001), sixty-two territories were located, monitored, and mapped during the nesting season. To determine the habitat selection of Cerulean Warblers, twenty-seven habitat variables were measured within the center of mapped territories and random sites (0.04 ha circle). The size of territories (n = 59) ranged from 0.036 ha to 1.427 ha. The number of large trees (> 38 cm DBH) was significantly higher in territories, as was the total density of all trees than in random sites. Vertical stratification between 0 - < 2 m was also significantly higher in territories than in random sites. Territories were located significantly closer to water bodies, roads, and agricultural fields. The relative abundance of Cerulean Warblers differed greatly among study sites (O/km2-3.86/k m2). In all study sites containing at least two birds throughout the breeding season, territories exhibited a significantly clumped distribution. As expected, canopy gaps were present in all territories, and perch trees were significantly larger than average trees available to males within territories. This species was located almost exclusively along ridgetops and mesic slopes. The greatest number of birds occurred in study sites that were located within state forests that are currently being managed for timber harvest versus national forest. / School of Physical Education

A dieta cetogênica (DC) é um tratamento não farmacológico prescrito especialmente para crianças e adolescentes com epilepsia refratária. A composição da dieta cetogênica é baseada no alto teor de gorduras, baixo teor de carboidratos e teor proteico moderado, sendo a produção de corpos cetônicos o mecanismo provável envolvido no controle das crises epilépticas. Apesar dos benefícios clínicos, a relação entre DC e o risco cardiometabólico não está bem estabelecida, especialmente sob os fatores de risco não clássicos. Objetivo: comparar os efeitos da dieta cetogênica clássica com a dieta cetogênica modificada nas subfrações de LDL e HDL, nos marcadores oxidativos, no perfil de apolipoproteinas e no perfil lipídico de crianças e adolescentes com epilepsia refratária, além do efeito clínico no controle da epilepsia. Métodos: Estudo de intervenção com recrutamento de crianças e adolescentes com epilepsia refratária de 1 a 19 anos de ambos os sexos do Instituto da Criança do Hospital das Clínicas da FMUSP. O grupo controle recebeu DC clássica e o grupo caso recebeu a DC modificada com redução em pelo menos 20% de ácidos graxos saturados (AGS) e redução da relação w6/w3 em pelo menos 50% em comparação a DC clássica. Para ambos os grupos foram analisados os seguintes parâmetros bioquímicos no período basal, após 3 meses e 6 meses de DC: perfil lipídico clássico, concentração de ácidos graxos não esterificados (AGNEs), substâncias reativas ao ácido tiobarbitúrico (TBARs), subfrações de lipoproteina de baixa densidade (LDL) e lipoproteína de alta densidade (HDL), e perfil de apolipoproteínas (APOA-I e APOB). Além da avaliação clínica, antropométrica e de consumo alimentar. Resultados: A redução de crises e dos fármacos antiepilépticos foi semelhante entre os grupos. O aumento na concentração de colesterol total (CT) e LDL foi inferior no grupo caso, a Não-HDL manteve-se significativamente menor no grupo caso em comparação ao grupo controle e a relação LDL/APOB foi superior no grupo controle após 6 meses de DC. O percentual de partículas pequenas de LDL apresentou aumento superior em 208% no grupo controle comparado ao grupo caso, e consequentemente o tamanho de LDL apresentou maior redução no grupo controle. A incidência de dislipidemia foi significativamente inferior no grupo caso considerando os pontos de corte para LDL (>=130 mg/dL) e não-HDL (>=145 mg/dL). Não houve diferença entre os grupos na concentração de ácidos graxos não esterificados (AGNES) e substâncias reativas ao ácido tiobarbitúrico (TBARs). Conclusão: A mudança do perfil de gorduras 10 contribuiu para melhora das concentrações de marcadores de risco cardiometabólico (CT, LDL e LDL pequenas) e consequentemente, perfil mais cardioprotetor nos pacientes do grupo caso. / The ketogenic diet (KD) is a non-pharmacological treatment especially prescribed to children and adolescentes with refractory epilepsy. The composition of the ketogenic diet is based on the high fat, low carbohydrate and moderate protein. The production of ketone bodies is the probable mechanism involved in the control of epileptic seizures. Despite the clinical benefits, the relationship between KD and cardiometabolic risk is not well established, especially under non-classical risk factors. Objective: to compare the effects of the classical KD with the modified KD on the LDL and HDL subfractions, in oxidative biomarkers, in apolipoprotein profile and lipid profile of children and adolescentes with refractory epilepsy, as well as the clinical effect on control of seizure. Methods: Dietary intervention study with recruitment of children and adolescentes with refractory epilepsy aged 1 to 19 years of both sexes from the Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina da USP. The control group received classical KD and the case group received modified KD with a reduction of at least 20% saturated fatty acids (SFA) and a reduction of the w6/w3 ratio by at least 50% compared to classic KD. For both groups, the following biochemical parameters were analyzed at baseline and after 3 and 6 months of the KD: classical lipid profile, concentration of non-esterified fatty acids (NEFAs), thiobarbituric acid reactive substances (TBARs), low density lipoprotein (LDL) and high density lipoprotein (HDL) subfractions, size LDL, and apolipoprotein profile (APOA-I and APOB). In addition to clinical, anthropometric and food consumption assessment. Results: The reduction of seizures and antiepileptic drugs was similar between the groups. The increase in total cholesterol (TC) and LDL levels was lower in the case group, non-HDL remained significantly lower in the case group compared to the control group and the LDL/APOB ratio was higher in the control group after 6 months of KD. The percentage of small LDL particles showed a 208% higher in the control group than case group. Consequently, the LDL size showed a greater reduction in the control group. The incidence of dyslipidemia was significantly lower in the case group considering cut-off points for LDL (>=130 mg/dL) and non-HDL (>=145 mg/dL). There was no difference between the groups in the NEFAs and TBARs levels. Conclusion: The change in the fatty acids profile contributed to improvement the concentrations of cardiometabolic risk markers (TC, 12 LDL and small LDL), and consequently, a more cardioprotective profile in the patients of case group.

No description available.

Low carbohydrate diets have been studied for many years as nutritional therapy for treating patients with type 2 diabetes mellitus (T2DM). Type 2 diabetes is an inflammatory disease that is defined by high blood glucose and HbA1c, lipid levels, BMI, central adiposity, and cholesterol levels, are some among the many indicators that can signal risk for diabetes or help to diagnose diabetes. These indicators are used in studies to evaluate the effectiveness of the nutritional therapy in producing positive health outcomes. Many medications are available for the treatment of T2DM; however, they have a host of side effects, and nutritional therapy has been shown to at least help reduce the dosage of these medications needed by the patients. There are other forms of nutritional therapy besides low carbohydrate diets, and some controversy remains about low carbohydrate diets that in the long term, replacing carbohydrates with fats and proteins could result in increased cholesterol and lipid levels, creating an increased risk for cardiovascular disease. Although some studies have found that low carbohydrate diets, especially very low carbohydrate ketogenic diets (VLCK), do result in increased cholesterol, it is generally an increase in HDL, which is considered good cholesterol and not harmful. Overall weight loss benefits from reduced central adiposity, BMI, and reduced HbA1c levels outweigh the increase in HDL as a side effect. A few different variations of low carbohydrate diets are compared in this review, such as very low carbohydrate ketogenic diets, moderate carbohydrate calorie restricted diets, and moderate carbohydrate low (MCD) Glycemic Index (GI) diets. Due to the ability to exchange carbohydrates with high GI for carbohydrates with low GI, the MCD with low GI sounds promising for good adherence and positive health outcomes in the long run. Although very low carbohydrate ketogenic diets produce many positive health outcomes, the nutritional therapy must be very well designed and followed up, and care must be taken that fiber and nutrients are maintained in the diet. Adherence is a key part of the success of nutritional therapy and a study design plays a major role in that. Providing behavioral development classes, nutritional information classes, and intermittent classes focused on physical activity and healthy habit formation leads to overall increased positive affect which is better for the patient and thus, for the study as well. The easier the nutritionist or dietician can make the therapy transition for the participant, the more likely they are also to stay and try to stick with it. For example, in the studies where the study coordinator provided some small food provisions at the beginning or throughout the study seemed to be successful because the patients were less likely to fall to making their own choices poorly and being inconsistent. Although there were many diets that resulted in many positive health outcomes, ultimately a well-designed, adherence focused, very low carbohydrate ketogenic diet seemed to be the most effective at decreasing HbA1c and producing other positive health outcomes as well. In the long term however, a VLCKD, may be unsustainable for the patient and the body, given the extreme reduction in important carbohydrates.

No description available.

No description available.

Individuals with epilepsy manage the clinical manifestations of the condition, primarily seizure-related activity, with daily use of pharmacologic agents, making it one of the most common neurological conditions treated with drug therapy for symptom management. Pharmacologic agents for epilepsy, also known as anti-epileptic drugs (AEDs), are commonly prescribed to treat seizures and neurologic conditions associated with epilepsy but can lead to a reduced quality of life and many unwanted side effects. Complementary and alternative treatments can also provide relief from seizures associated with epilepsy. The purpose of this literature review was to evaluate the effectiveness of complementary and alternative treatments compared to pharmacological treatment for individuals with epilepsy. A literature review examining different alternative treatments, such as physical activity, medical cannabis, neurostimulation, and various diets, and their benefits on seizure reduction, seizure frequency, and the quality of life was conducted from various online databases. Research articles published from 2003 to 2020 that focused on the benefits of complementary and alternative therapies in controlling the clinical manifestations of epilepsy were included for synthesis. Results from 10 studies that used a complementary or alternative therapy as a treatment for epilepsy, alone or in combination with pharmacological therapy, were compared for effectiveness on clinical manifestations. Seventy percent of the studies analyzed show at least a fifty percent reduction in seizure frequency. The studies suggest that complementary and alternative therapies can be effective as monotherapy or as adjuvant agents for reducing seizure frequency, reducing seizure duration, and improving quality of life. Although benefits were found in each study, many studies were performed on animals or had small sample sizes, indicating the need for further research.

No description available.

Introdução - A dieta cetogênica (DC) é um tratamento não farmacológico prescrito especialmente para crianças e adolescentes com epilepsia refratária. Objetivo - Avaliar o impacto da dieta cetogênica clássica nas características oxidativas, físicas e lipídicas das lipoproteínas de crianças e adolescentes com epilepsia refratária. Métodos - Ensaio clínico não controlado de séries temporais com recrutamento de crianças e adolescentes com epilepsia refratária de 1 a 19 anos de ambos os sexos do Instituto da Criança do Hospital das Clínicas da FMUSP. Parâmetros bioquímicos foram analisados: perfil lipídico, concentração de ácidos graxos não esterificados (AGNEs), LDL eletronegativa [LDL(-)], Anticorpo anti- LDL(-), substâncias reativas ao ácido tiobarbitúrico (TBARs), subfrações da lipoproteína de alta densidade (HDL) e lipoproteína de baixa densidade (LDL). Além das análises bioquímicas foram avaliadas medidas antropométricas para classificação do estado nutricional, medidas de composição corporal por bioimpedância elétrica e consumo alimentar por registro alimentar de 3 dias. Todas essas medidas foram coletadas antes da DC (T=0), 3 meses após a DC (T1) e 6 meses após a DC (T2). Resultados - A concentração de colesterol total (CT), triacilgliceróis (TG), LDL, HDL, apolipoproteínas (APO A-I e APOB) e não-HDL aumentaram significativamente nos momentos T1 e T2. As razões CT/HDL, LDL/HDL e APOB/APOA-I também apresentaram aumento significativo indicando aumento superior das lipoproteínas e apolipoproteínas mais aterogênicas. Apesar desses aumentos, nenhuma dessas relações ou concentração de lipoproteínas e apolipoproteínas apresentaram aumento progressivo comparando-se T1 versus T2. De modo contrário, observamos aumento progressivo ao longo do tempo na concentração de AGNEs, partículas pequenas de LDL e redução no tamanho médio da LDL de 27,3 nm no T0 versus 26,7 nm no T2. A concentração de TBARs aumentou enquanto a LDL(-) reduziu. A classificação do estado nutricional bem como o % de massa magra e % de massa gorda não mudaram ao longo do tempo. Conclusões - A DC apresentou impacto negativo no metabolismo lipídico contribuindo com o aumento de partículas pequenas de LDL e um fenótipo mais aterogênico. / Introduction - The ketogenic diet (KD) is a non-pharmacological treatment prescribed for children and adolescents with refractory epilepsy. Objective To assess the impact of the classic ketogenic diet in the oxidative, physical and lipid lipoprotein characteristics of children and adolescents with refractory epilepsy. Methods - Single arm, times series trial with recruitment of children and adolescents 1-19 years of both sexes of the Instituto da Criança do Hospital das Clínicas da FMUSP, after doctor indication for treatment with KD. Biochemical parameters were analyzed: lipid profile, level of non esterified fatty acids (NEFAS), LDL electronegative [LDL (-)], anti-LDL (-), thiobarbituric acid reactive substances (TBARS), subfractions of high density lipoprotein (HDL), subfractions of low density lipoprotein (LDL) and LDL size. In addition, anthropometric measurements for classification of nutritional status, body composition by bioimpedance electrical and dietary intake through food records evaluated in 3 days. All these measures were collected before the KD (T = 0), three months after the KD (T1) and 6 months after KD (T2). Results - The level of total cholesterol (TC), triglycerides (TG), LDL, HDL, apolipoproteins (Apo A-I and Apo B) and non-HDL increased significantly in T1 and T2. The rations TC/HDL, LDL/HDL and APOB/APO A-I also showed a significant increase indicating higher increase in lipoproteins and apolipoproteins atherogenic. Despite these increases, any such rations or levels of lipoproteins and apolipoproteins progressive increase comparing T1 versus T2. Conversely, we observed a progressive increase along time in the levels of NEFAS, small LDL and reduction of LDL size of 27.3 nm (T0) to 26.7 nm (T2). The levels of TBARS increased while LDL (-) reduced. The classification of nutritional status as well as the % of lean mass and % of fat mass didn´t change along time. Conclusions - The KD showed a negative impact on lipid metabolism contributing to increased small LDL particles and a more atherogenic phenotype.