Systematic Review of Cognitive Function in Euthymic Bipolar Disorder and Pre-Surgical Temporal Lobe Epilepsy.

BACKGROUND: Bipolar disorder (BD) and temporal lobe epilepsy (TLE) overlap in domains including epidemiology, treatment response, shared neurotransmitter involvement and temporal lobe pathology. Comparison of cognitive function in both disorders may indicate temporal lobe mediated processes relevant to BD. This systematic review examines neuropsychological test profiles in euthymic bipolar disorder type I (BD-I) and pre-surgical TLE and compares experimental designs used. METHODS: A search of PubMed, PsychINFO, and Scopus using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was conducted. Inclusion criteria were comparison group or pre- to post-surgical patients; reported neuropsychological tests; participants aged 18-60 years. Fifty six studies met criteria: 27 BD-I; 29 TLE. RESULTS: Deficits in BD-I compared to healthy controls (HC) were in executive function, attention span and verbal memory. Deficits in TLE compared to HC were in executive function and memory. In the pre- to post-surgical comparisons, verbal memory in left temporal lobe (LTL) and, less consistently, visuospatial memory in right temporal lobe (RTL) epilepsy declined following surgery. BD-I studies used comprehensive test batteries in well-defined euthymic patients compared to matched HC groups. TLE studies used convenience samples pre- to post-surgery, comparing LTL and RTL subgroups, few included comparisons to HC (5 studies). TLE studies typically examined a narrow range of known temporal lobe-mediated neuropsychological functions, particularly verbal and visuospatial memory. CONCLUSION: Both disorders exhibit deficits in executive function and verbal memory suggestive of both frontal and temporal lobe involvement. However, deficits in TLE are measured pre- to post-surgery and not controlled at baseline pre-surgery. Further research involving a head-to-head comparison of the two disorders on a broad range of neuropsychological tests is needed to clarify the nature and extent of cognitive deficits and potential overlaps.

The Current Status of the Ketogenic Diet in Psychiatry.

BACKGROUND: The ketogenic diet (KD) has been used in treatment-resistant epilepsy since the 1920s. It has been researched in a variety of neurological conditions in both animal models and human trials. The aim of this review is to clarify the potential role of KD in psychiatry. METHODS: Narrative review of electronic databases PubMED, PsychINFO, and Scopus. RESULTS: The search yielded 15 studies that related the use of KD in mental disorders including anxiety, depression, bipolar disorder, schizophrenia, autism spectrum disorder (ASD), and attention deficit hyperactivity disorder (ADHD). These studies comprised nine animal models, four case studies, and two open-label studies in humans. In anxiety, exogenous ketone supplementation reduced anxiety-related behaviors in a rat model. In depression, KD significantly reduced depression-like behaviors in rat and mice models in two controlled studies. In bipolar disorder, one case study reported a reduction in symptomatology, while a second case study reported no improvement. In schizophrenia, an open-label study in female patients (n = 10) reported reduced symptoms after 2 weeks of KD, a single case study reported no improvement. In a brief report, 3 weeks of KD in a mouse model normalized pathological behaviors. In ASD, an open-label study in children (n = 30) reported no significant improvement; one case study reported a pronounced and sustained response to KD. In ASD, in four controlled animal studies, KD significantly reduced ASD-related behaviors in mice and rats. In ADHD, in one controlled trial of KD in dogs with comorbid epilepsy, both conditions significantly improved. CONCLUSION: Despite its long history in neurology, the role of KD in mental disorders is unclear. Half of the published studies are based on animal models of mental disorders with limited generalizability to the analog conditions in humans. The review lists some major limitations including the lack of measuring ketone levels in four studies and the issue of compliance to the rigid diet in humans. Currently, there is insufficient evidence for the use of KD in mental disorders, and it is not a recommended treatment option. Future research should include long-term, prospective, randomized, placebo-controlled crossover dietary trials to examine the effect of KD in various mental disorders.

Comparison of precipitating factors for mania and partial seizures: Indicative of shared pathophysiology?

OBJECTIVES: Mania in bipolar disorder (BD) and partial (focal) seizures (PS) arising from the temporal lobes, have a number of similarities. Typically, a chronic course of the disorders is punctuated by acute illness episodes. Common features of episodes may include sensory, perceptual, cognitive and affective changes. Both respond to anticonvulsant treatment. Common mechanisms imputed include neurotransmitters and kindling processes. Further investigation may improve understanding of the occurrence of both mania and PS, casting light on the relevance of temporal lobe mediated processes and pathology. One avenue of investigation is to compare aetiological factors and determine the extent of overlap which may indicate shared brain localization or pathophysiology. Aetiology includes predisposing, precipitating or perpetuating factors. This paper examines the literature on precipitating factors of mania, first or subsequent episode, and of PS in diagnosed epilepsy, which is the second or subsequent seizure, to identify the extent and nature of their overlap. METHOD: Narrative review based on a literature search of PubMed and Google Scholar. RESULTS: Precipitating factors for both mania and PS were stress, sleep deprivation, antidepressant medication and, tentatively, emotion. For mania alone, goal-attainment events, spring and summer season, postpartum, and drugs include steroids and stimulants. For PS alone, winter season, menstruation and specific triggers in complex reflex epilepsies. Those not substantiated include lunar phase and menopause. A wide range of chemicals may provoke isolated seizures but by definition epilepsy requires at least two seizures. CONCLUSIONS: The overlap of precipitating factors in mania and PS imply that common brain processes may contribute to both, consistent with findings from neuroscience research.

Effect of dietary alpha-linolenic acid and its ratio to linoleic acid on platelet and plasma fatty acids and thrombogenesis.

The effect of dietary alpha-linolenic acid (18:3n-3) and its ratio to linoleic acid (18:2n-6) on platelet and plasma phospholipid (PL) fatty acid patterns and prostanoid production were studied in normolipidemic men. The study consisted of two 42-d phases. Each was divided into a 6-d pre-experimental period, during which a mixed fat diet was fed, and two-18 d experimental periods, during which a mixture of sunflower and olive oil [low 18:3n-3 content, high 18:2/18:3 ratio (LO-HI diet)], soybean oil (intermediate 18:3n-3 content, intermediate 18:2/18:3 ratio), canola oil (intermediate 18:3n-3 content, low 18:2/18:3 ratio) and a mixture of sunflower, olive and flax oil [high 18:3n-3 content, low 18:2/18:3 ratio (HI-LO diet)] provided 77% of the fat (26% of the energy) in the diet. The 18:3n-3 content and the 18:2/18:3 ratio of the experimental diets were: 0.8%, 27.4; 6.5%, 6.9; 6.6%, 3.0; and 13.4%, 2.7, respectively. There were appreciable differences in the fatty acid composition of platelet and plasma PLs. Nevertheless, 18:1n-9, 18:2n-6 and 18:3n-3 levels in PL reflected the fatty acid composition of the diets, although very little 18:3n-3 was incorporated into PL. Both the level of 18:3n-3 in the diet and the 18:2/18:3 ratio were important in influencing the levels of longer chain n-3 fatty acid, especially 20:5n-3, in platelet and plasma PL. Production of 6-keto-PGF1 alpha was significantly (P < 0.05) higher following the HI-LO diet than the LO-HI diet although dietary fat source had no effect on bleeding time or thromboxane B2 production.(ABSTRACT TRUNCATED AT 250 WORDS)

Pyridoxine, ascorbic acid and thiamine in Alzheimer and comparison subjects.

We compared the intake and functional levels of vitamins B6, C and B1 in 15 pairs of Alzheimer's disease and normal subjects. These were similar in both groups, except that B1 had lower functional values for the subjects with Alzheimer's disease. This suggests that it is unlikely that B6 or C could be used in the treatment of Alzheimer's disease. The role of B1 needs further exploration.

Dietary alpha-linolenic acid is as effective as oleic acid and linoleic acid in lowering blood cholesterol in normolipidemic men.

The effect of dietary oleic acid (OA), linoleic acid (LA), and linolenic acid (LNA) on plasma lipid metabolism was studied in eight normolipidemic men. A mixed-fat diet composed of conventional foods was fed during 6-d pre- and post-experimental periods. The same basic diet but with 75% of the fat (26% of total energy) provided by sunflower and olive; canola; soybean; and sunflower, olive, and flax oils was fed during four 18-d experimental periods. Mean plasma total cholesterol (-18%), low-density-lipoprotein-cholesterol, (-22%) and very-low-density-lipoprotein-cholesterol (-41%) concentrations were significantly (P less than 0.004) lower after the experimental diets than after the mixed-fat diet. Mean serum apolipoprotein B (-19%) and apolipoprotein A-I (-9%) concentrations were also significantly (P less than 0.0007) lower after the experimental diets. The experimental diets were equally effective in lowering total and lipoprotein cholesterol and apolipoprotein concentrations in plasma, indicating that dietary OA, LA, and LNA were equally hypocholesterolemic.

Accumulation of eicosapentaenoic acid in plasma phospholipids of subjects fed canola oil.

The metabolism of alpha-linolenic acid from canola oil was studied in eight normolipidemic men. The 42-day study was divided into three periods: a 6-day pre-experimental and two 18-day experimental. Approximately 75% of the dietary fat (28% of total energy) was provided by a mixture of fats during the pre-experimental period and either canola oil (CO) or sunflower oil (SO) during the experimental periods. The CO and SO diets were fed in a cross-over design. The ratios of linoleic to linolenic acid were 2.6:1 and 73.9:1 in the CO and SO diets, respectively. Dietary fat source had an effect on plasma phospholipid fatty acids: 18:1n-9, 18:3n-3 and 20:5n-3 were higher (p less than 0.05), and 18:2n-6 was lower in the phosphatidylcholine fraction; 18:1n-9 was higher and 20:4n-6 lower in the phosphatidyl-ethanolamine fraction; and 18:1n-9 and 20:5n-3 were higher and 20:4n-6 and 22:6n-3 were lower in the alkenylacyl ethanolamine phospholipid fraction on the CO diet as compared to the SO diet. Consumption of the canola oil diet resulted in higher n-3 fatty acid levels and lower n-6 fatty acid levels in plasma phospholipids than consumption of the sunflower oil diet.

Dietary canola oil: effect on the accumulation of eicosapentaenoic acid in the alkenylacyl fraction of human platelet ethanolamine phosphoglyceride.

Volunteers consumed a mixed-fat diet for 6 d (Pre-exp) and then either a canola-oil-based diet (CAN) containing linolenic acid (18:3n-3) or a sunflower-oil-based diet (SUN) rich in linoleic acid (18:2n-6) for 18 d, followed by the alternative diet in a crossover design. Platelet phospholipids were analyzed for changes in fatty acid composition. Eicosapentaenoic acid (EPA) (20:5n-3) was significantly higher in alkenylacyl ethanolamine phosphoglyceride (PPE) and in total phosphatidylcholine (PC) after CAN compared with SUN and Pre-exp. The 22:5n-3 was increased in PPE after CAN above concentrations found after both SUN and Pre-exp. Lower concentrations of 20:4n-6 and 22:4n-6 were observed with CAN in PC and lower concentrations of 22:4n-6 in PPE. These results indicate that the consumption of canola oil moderately increases EPA concentrations and alters the concentrations of other n-6 and n-3 fatty acids in human platelet phospholipids.

Comparison of the effect of canola oil and sunflower oil on plasma lipids and lipoproteins and on in vivo thromboxane A2 and prostacyclin production in healthy young men.

The effect of dietary fatty acid composition on plasma lipids and eicosanoid production was studied in normolipidemic men. Approximately 75% of the fat in the diet was provided by a mixture of fats (MF) during the 6-d pre and postperiods and either canola oil (CO) or sunflower oil (SO) during the two 18-d experimental periods. Saturated, monounsaturated, and polyunsaturated fatty acids provided 14%, 15%, and 7%; 5%, 20%, and 10%; and 7%, 7%, and 22%, respectively, of total dietary energy in the MF, CO, and SO diets, respectively. The CO and SO diets produced similar decreases in plasma total (20% and 15%, respectively) and low-density lipoprotein (25% and 21%, respectively) cholesterol. Plasma high-density lipoprotein cholesterol and triglyceride concentrations were not altered by either fat source. Bleeding time was longer and in vivo 1-keto-PGF1 alpha production was greater (p less than 0.05) when on the CO diet than when on the MF diet. The hypocholesterolemic and antithrombotic effects of the CO diet were equivalent to those of the SO diet.

A comparison of the effect of diets containing beef protein and plant proteins on blood lipids of healthy young men.

The effect of plant and animal protein on blood lipid levels was investigated in eight healthy normolipidemic men aged 18 to 27 yr. All subjects were fed both plant and animal protein diets in a cross-over design. Each diet was consumed for a 21-day period. Proteins from commonly used plant sources made up the plant protein diet. Beef protein was substituted for 55% of the plant proteins in the animal protein diet. Fasting venous blood samples were collected at the beginning of the study and at 7-day intervals throughout the 42-day study. Serum was analyzed for total cholesterol and triglycerides. Plasma low-density and high-density lipoprotein cholesterol were determined. There were not any statistically significant differences in mean serum total cholesterol or mean plasma low-density lipoprotein cholesterol when subjects consumed the diets. Mean plasma high-density lipoprotein cholesterol levels were significantly (p less than 0.05) elevated at the end of the 21-day period when the animal protein diet was consumed (48 +/- 3 mg/dl) compared to the period when the plant protein diet was fed (42 +/- 2 mg/dl). Mean serum triglyceride values were significantly (p less than 0.05) increased at day 7 of the plant protein diet period (136 +/- 19 mg/dl) compared to the same time period when the animal protein diet was consumed (84 +/- 12 mg/dl). The results of the study indicated that the ingestion of a diet in which 55% of the protein was supplied by beef protein was not associated with a hypercholesterolemic effect in healthy normolipidemic young men.