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--- epilepsy [2023/11/09 14:33] – kevin
+++ epilepsy [2024/10/02 09:27] (current) – [Dietary Therapies] andrewtaustin
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 In the absence of expert medical advice and appropriate oversight, individuals with a documented history of epilepsy must be precluded from receiving any form of Integral Eye Movement Therapy (IEMT). This contraindication arises from the necessity to mitigate potential risks and ensure the safety and well-being of the client, as such therapies may provoke seizures in susceptible individuals.
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 ==== Classification Based on Seizure Type ====
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   * **Generalised Seizures**: Engaging networks distributed across both hemispheres simultaneously. Types include:
-    * **Absence Seizures**: Manifest as brief lapses in awareness.
+    * **Absence Seizures**[(Absence Seizures [[https://epilepsysociety.org.uk/about-epilepsy/epileptic-seizures/absence-seizures]])]: Manifest as brief lapses in awareness.
-    * **Myoclonic Seizures**: Characterised by sudden, brief muscle jerks.
+    * **Myoclonic Seizures**[(Myoclonic Seizures [[https://epilepsysociety.org.uk/about-epilepsy/epileptic-seizures/myoclonic-seizures]])]: Characterised by sudden, brief muscle jerks.
-    * **Tonic-Clonic Seizures**: Known for convulsive movements.
+    * **Tonic-Clonic Seizures**[(Tonic-Clonic Seizures [[https://epilepsysociety.org.uk/about-epilepsy/epileptic-seizures/tonic-clonic-seizures]])]: Known for convulsive movements.
-    * **Atonic Seizures**: Leading to sudden loss of muscle tone.
+    * **Atonic Seizures**[(Atonic Seizures [[https://epilepsysociety.org.uk/about-epilepsy/epileptic-seizures/atonic-seizures]])]: Leading to sudden loss of muscle tone.
 ===== Focal Seizures =====
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 ==== Evolution to Bilateral Tonic-Clonic Seizures ====
-Some focal seizures can generalise, leading to bilateral tonic-clonic seizures. The initial focal onset may manifest as a warning or 'aura' before consciousness is lost and generalised convulsive movements begin. The tonic phase is characterised by a sudden loss of consciousness with muscle stiffening, while the clonic phase involves rhythmic jerking movements. Sudden cessation of respiration during the tonic phase may lead to cyanosis, and injuries can occur from falls or during convulsions.
+Some focal seizures can generalise, leading to bilateral tonic-clonic seizures. The initial focal onset may manifest as a warning or 'aura' before consciousness is lost and generalised convulsive movements begin. The tonic phase is characterised by a sudden loss of consciousness with muscle stiffening, while the clonic phase involves rhythmic jerking movements. Sudden cessation of respiration during the tonic phase may lead to cyanosis[(Cyanosis [[https://www.nhs.uk/conditions/blue-skin-or-lips-cyanosis/]])], and injuries can occur from falls or during convulsions.
 ===== Generalised Seizures =====
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 ==== Epilepsy Syndromes ====
-In addition to seizure type and aetiology, **epilepsy syndromes** are recognised by a cluster of features that occur together, which can include:
+In addition to seizure type and aetiology, **epilepsy syndromes[(Epilepsy Syndromes [[https://epilepsysociety.org.uk/about-epilepsy/information-parents/childhood-epilepsy-syndromes]])]** are recognised by a cluster of features that occur together, which can include:
   * **Specific Seizure Types**
   * **EEG Findings**
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 For those unsuitable for surgery, neurostimulation presents an alternative:
-  * **Vagus Nerve Stimulation (VNS)**
+  * **Vagus Nerve Stimulation[(Vagus Nerve Stimulation [[https://epilepsysociety.org.uk/about-epilepsy/treatment/vagus-nerve-stimulation]])] (VNS)**
   * **Deep Brain Stimulation (DBS)**
   * **Responsive Neurostimulation (RNS)**
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   * **Modified Atkins Diet**
   * **Low Glycaemic Index Treatment**
+**Ketogenic Diet**
+The Ketogenic Diet is a high-fat, low-carbohydrate, and adequate-protein diet that shifts the body’s primary fuel source from glucose to fats. This process, known as ketosis, involves the liver converting fats into ketones, which become the brain’s main energy source. Ketones are believed to have neuroprotective effects, stabilizing neurons and enhancing brain energy metabolism, which can reduce the excitability of the neurons responsible for seizures.
+The exact mechanism of why this works for epilepsy is not fully understood, but it's believed that ketones alter neurotransmitter activity, increase mitochondrial energy production, and modulate the production of glutamate (a neurotransmitter linked to excitatory neural activity). The reduction in excitatory neurotransmission and enhancement of inhibitory pathways, such as the GABAergic system, may help prevent seizures.
+This diet has been particularly effective for children with drug-resistant epilepsy and certain epileptic syndromes, such as Dravet syndrome and Lennox-Gastaut syndrome.
+**Modified Atkins Diet**
+The Modified Atkins Diet (MAD) is a less restrictive, yet similarly effective, version of the ketogenic diet. It allows more protein and carbohydrates compared to the classical ketogenic diet but still encourages ketosis by limiting carbohydrates and promoting fat as the primary fuel source.
+Like the ketogenic diet, the MAD works by inducing ketosis, which reduces the brain’s reliance on glucose for energy and utilizes ketones instead. Ketones have been shown to stabilize neuronal membranes, reduce neural excitability, and enhance inhibitory neurotransmission, similar to the ketogenic diet's effects. This diet is more flexible, making it easier for patients to adhere to, while still providing significant seizure control, especially in adolescents and adults.
+**Low Glycaemic Index Treatment (LGIT)**
+The Low Glycaemic Index Treatment (LGIT) diet focuses on controlling blood sugar levels by consuming carbohydrates that have a low glycaemic index (GI) — meaning they are digested and absorbed more slowly, resulting in a more gradual increase in blood glucose.
+The mechanism behind its effectiveness in epilepsy is thought to be linked to more stable blood glucose and insulin levels. Stable glucose reduces neuronal hyperexcitability, while avoiding spikes in blood sugar and insulin may prevent metabolic disturbances that could trigger seizures. Like the ketogenic and modified Atkins diets, LGIT may also induce mild ketosis, but the primary focus is on stabilizing blood glucose levels, which can have a stabilizing effect on the brain.
+In conclusion, these diets modify brain metabolism in ways that are believed to decrease neuronal excitability, stabilize energy production, and alter neurotransmitter function, all of which are thought to contribute to their anti-seizure effects. While the exact mechanisms continue to be studied, their efficacy, particularly in children with drug-resistant epilepsy, has been well documented.
 ==== Psychosocial Interventions ====