This is a highly interesting study that tested the effect of MCT oil (55% octanoate, 45% decanoate) vs triheptanoin (a triglyceride that is composed of three seven-carbon (C7:0) fatty acids) in adults with refractory epilepsy. MCT seemed to be more effective, although the difference was not significance. From the 9 people in the MCT group finishing the trial, 4 (45%) showed >50% seizure reduction and the overall seizure reduction in this group was 54%. In my opinion, these are highly impressive numbers considering that these were refractory patients.
It seems that the research community is finally expanding its myopic and simplistic understanding of epilepsy as excitation/inhibition imbalance or "channelopathy". An increasing number researchers finally acknowledge that epilepsy is characterized by impaired energy metabolism and that restoration of impaired energy production is a much better treatment target. Here are some excellent review papers:
Metabolism and epilepsy: Ketogenic diets as a homeostatic link. - PubMed - NCBI
A Metabolic Paradigm for Epilepsy
Impairments in Oxidative Glucose Metabolism in Epilepsy and Metabolic Treatments Thereof
Randomised trial of add‐on triheptanoin vs. medium chain triglycerides in adults with refractory epilepsy
Karin Borges
Neha Kaul
Jack Germaine
Patrick Kwan
Terence J. O'Brien
First published: 05 February 2019
https://doi.org/10.1002/epi4.12308
This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1002/epi4.12308
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Abstract
Objective
To investigate feasibility, safety and tolerability of add‐on treatment of the triglycerides of heptanoate (triheptanoin) vs. triglycerides of octanoate and decanoate (medium chain triglycerides, MCT) in adults with treatment refractory epilepsy.
Methods
After an eight week prospective baseline period, people with drug‐resistant epilepsy were randomised in double blind fashion to receive triheptanoin or MCT. Treatment was titrated over 3 weeks to a maximum of 100 ml/day to be distributed over 3 meals and mixed into food, followed by 12‐week maintenance before tapering. The primary aims were to assess 1) safety by comparing the number of intervention‐related adverse events with triheptanoin vs. MCT treatment and 2) adherence, measured as percentage of the prescribed treatment doses taken.
Results
34 people were randomised (17 to MCT and 16 to triheptanoin). There were no differences regarding 1) number of participants completing the study (11 vs. 9 participants), 2) time until withdrawal, 3) total number of adverse events or those potentially related to treatment, 4) median doses of oils taken (59 vs 55 ml/day, p=0.59) or 5) change in seizure frequency (54% vs. 102%, p=0.16). Please note that people with focal unaware seizures were underrepresented in the triheptanoin treatment arm (p=0.04). Most common adverse events were gastrointestinal disturbances (47 and 62.5% of participants). Five people taking on average 0.73 ml MCT per kg body weight (0.64 ml/kg median) and one person taking 0.59 ml/kg triheptanoin showed >50% reduction in seizure frequency, specifically focal unaware seizures.
Significance
Add‐on treatment with MCT or triheptanoin was feasible, safe and tolerated for 12 weeks in two thirds of people with treatment resistant epilepsy. Our results indicate a protective effect of MCT on focal unaware seizures. This warrants further study. ACTRN12612000226808
PDFIt seems that the research community is finally expanding its myopic and simplistic understanding of epilepsy as excitation/inhibition imbalance or "channelopathy". An increasing number researchers finally acknowledge that epilepsy is characterized by impaired energy metabolism and that restoration of impaired energy production is a much better treatment target. Here are some excellent review papers:
Metabolism and epilepsy: Ketogenic diets as a homeostatic link. - PubMed - NCBI
A Metabolic Paradigm for Epilepsy
Impairments in Oxidative Glucose Metabolism in Epilepsy and Metabolic Treatments Thereof
