ketogenic diet for seizures

epilepsy means “seizure disorder”, sopeople with epilepsy have recurring and unpredictable seizures. a seizure is a period where cellsin the brain, or neurons, are synchronously active, or active at the same time, when they’renot supposed to be. now when i say that neurons are “active”,i mean that they’re firing or sending a message using electrical signals relayed fromneuron to neuron. and if you look at a neuron under a microscope,each electrical signal that passes through it is really just ions flowing in and outof it through protein channels. the way this ion flow is controlled is through neurotransmitters,a type of signaling molecule, and receptors. neurotransmitters bind to the receptors andbasically tell the cell to either open up

the ion channels and relay the electricalmessage, called excitatory neurotransmitters, or close the ion channels and stop the electricalmessage, called inhibitory neurotransmitters. during a seizure, clusters of neurons in thebrain become temporarily impaired and start sending out a ton of excitatory signals, overand over again, and these are sometimes said to be paroxysmal. these paroxysmal electricaldischarges are thought to happen due to either too much excitation, or too little inhibition(which are kinda two sides of the same coin, right?). the main excitatory neurotransmitterin the brain is glutamate, and nmda is the primary receptor that responds to glutamateby opening ion channels that let calcium in, a positive ion that tells the cell to sendsignals. some patients with epilepsy seem

to have fast or long-lasting activation ofthese receptors. on the flip side, the main inhibitory neurotransmitter in the brain isgaba, which binds to gaba receptors that tell the cell to inhibit the signal by openingchannels that let in chloride ions, which are negative ions that tell the cell to inhibitsignals. some patients with epilepsy seem to have genetic mutations in which their gabareceptors are dysfunctional, and so they aren’t able to help inhibit signals. in additionto potentially having a primary genetic cause, though, these receptors and ion channels mightbe affected by all sorts of things like brain tumors, brain injury, or infection. whether it’s a decrease in inhibition oran increase in activation, when groups of

neurons start firing simultaneously, overand over, it’s often noticed by others as obvious outward signs, like jerking, moving,and losing consciousness, but can also be subjective experiences that are only noticedby the person experiencing it, like fears or strange smells, it all depends on whichneurons in the brain are affected. people with epilepsy experience recurringepisodes of some form of seizures, and we can start grouping the seizures by the regionof the brain that’s affected. when the affected area is limited to one hemisphere - or onehalf of the brain - or sometimes even a smaller area like a single lobe, we call it a partialor focal seizure. these seizures can be subcategorized by whether someone remains conscious duringthe seizure, which is called a simple partial

seizure, or whether someone has impaired consciousnessduring the seizure, which is called a complex partial seizure. simple partial seizures typicallyaffect a small area of the brain, and can involve the person experiencing strange sensations,like hearing or tasting something, but can also involve jerking movements in specificmuscle groups if the neurons controlling those muscles are affected. if the jerking activitystarts in a specific muscle group, and spreads to surrounding muscle groups as more neuronsare affected, it’s referred to as a jacksonian march. typically, the person is conscious(awake and alert) and will usually know that something is happening and will remember theseizure afterwards. complex partial seizures, on the other hand, involve losing consciousnesscompletely or having impaired awareness and

responsiveness, so they might not rememberexactly what happened during a seizure. now, in contrast to the partial or focal seizure,a generalized seizure is where both hemispheres of the brain are affected. sometimes, a seizurewill start out as a partial seizure and then quickly develop into a generalized seizure,and in those situations it’d be called a secondary generalized seizure because a partialseizure came before it and was the primary event. just like partial seizures, there aresome subcategories of generalized seizures as well. one subtype is a tonic seizure, wherethe muscles all the sudden become stiff and flexed, which can cause the patient to fall,often backwards. on the flipside, they can be atonic as well, where their muscles suddenlyrelax and become floppy, which again can cause

the patient to fall, but this time forward.seizures can also be clonic, where they have violent muscle contractions, also known asconvulsions. tonic-clonic seizures are the most common generalized seizures, where patientsexperience a tonic phase where the muscles suddenly tense up, followed by the clonicphase, where muscles rapidly contract and relax. myoclonic seizures are yet anothertype, and are short muscle twitches, sometimes just a single twitch but sometimes many ina short amount of time. finally there are absence seizures, where patients lose consciousnessand quickly regain consciousness, generally with the only outward sign being that theperson looks like they spaced out, like if they were walking, they’ll suddenly standstill. the key for all of these is that they

all involve both hemispheres of the brain,and patients lose consciousness either briefly or for longer periods of time. if the seizures themselves last for a longerperiod of time (like over 5 minutes of ongoing seizures or having multiple seizures withoutreturning to normal in between), then it’s called status epilepticus. these are usuallyof the tonic-clonic subtype of seizures, but it can also be caused by the other types thatdon’t involve convulsions. this situation is considered a medical emergency and canbe life-threatening if not treated immediately. due to the severity of these seizures, patientsare often treated acutely with benzodiazepines, which help enhance the effect of the inhibitoryneurotransmitter gaba.

following a seizure, sometimes patients canexperience symptoms following a seizure, like confusion, called “post-ictal” confusion,which means “after seizure” confusion. also, patients might experience paralysisthat affects the arms or the legs, usually just limited to one side of the body. andthis is known as todd’s paralysis or todd’s paresis, and can last for quite a while - onaverage about 15 hours; and usually it subsides by itself completely after 2 days. the precisemechanism behind todd’s paralysis isn’t currently well understood, but it’s thoughtto be the result of temporary but severe suppression of activity of the area in the brain affectedby the seizure. typically, after a seizure is over, patientswill have brain imaging techniques like mri

or ct scans, as well as an eeg, or electroencephalogram,which detects electrical activity in the brain. with patients who’ve just started havingseizures, brain scans are used to find out if there’re any anatomical abnormalities,like brain tumors or abnormal blood vessels that could be causing the seizures, of whichwould be treated surgically. because epilepsy can vary from patient to patient in the type,severity, and frequency of seizures, diagnosis typically involves a variety of examinationsand tests in combination with a thorough evaluation of their clinical history. once epilepsy’s been diagnosed, it’s oftentreated with daily medication, the primary form of medication being anticonvulsants,of which there are a wide variety of options

available that have different targets in thebrain, so the choice is based on the specific needs of the patient, including factors likeage, lifestyle, other health problems, and the category or subcategory of the epilepsysyndrome. other treatment options include epilepsy surgery, where they’ll remove what’sthought to be causing the seizures, like a specific part of the brain or a tumor. nervestimulation might also be considered, where certain nerves like the vagus nerve are stimulated,which is thought to control seizures by influencing neurotransmitter release. also, patients mightadopt a ketogenic diet, which is a diet that forces the body to burn fat instead of carbohydrates,which produces ketone bodies which are used by the brain as an energy source instead ofglucose—although many hypotheses have been

suggested for why this seems to reduce seizuresfor some patients, the exact mechanism isn’t very well understood.