title: Identification of cerebral acetone by 1H-MRS in patients with epilepsy controlled by ketogenic diet.
abstract: Ketogenic diet (KD) is highly effective in controlling epileptic seizures in children. One of the mechanisms postulated, the accumulation of ketone bodies, acetoacetate (AcAc) and/or betahydroxybutyrate (beta-OHB) in the brain, would be detectable by non-invasive proton magnetic resonance spectroscopy (1H-MRS). 1H-MRS was performed in occipital cortical grey matter in 14 epileptics (E); ages 3.8-48.3 years), seven KD and seven without, and 16 healthy age-matched subjects. One E was examined before and after KD. A singlet resonance (sigma = 2.22 ppm), distinct from AcAc (sigma = 2.26 and 3.46 ppm), and identified as acetone was present in all spectra of children on KD (nine spectra in five children; concentration 0.7 +/- 0.2 mM). This resonance was absent from Control and E without diet. AcAc and beta-OHB, which were not detectable in KD brain, were found in urine or blood of all KD. Seizures were well controlled in all E in whom acetone was detected. Two of seven E, both adults, were seizure-free without detectable acetone. Cerebral acetone may contribute to seizure control in KD, but is unlikely to be the sole mechanism.
authors.affiliation: Huntington Medical Research Institutes, Pasadena, CA 91105, USA.
authors.forename: K J
authors.initials: KJ
authors.lastname: Seymour
authors.forename: S
authors.initials: S
authors.lastname: Bluml
authors.forename: J
authors.initials: J
authors.lastname: Sutherling
authors.forename: W
authors.initials: W
authors.lastname: Sutherling
authors.forename: B D
authors.initials: BD
authors.lastname: Ross
mesh_terms: D000096:Acetone / Q000378:metabolism*; D000293:Adolescent; D000328:Adult; D001921:Brain / Q000378:metabolism*; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D004041:Dietary Fats / Q000008:administration & dosage; D004827:Epilepsy / Q000178:diet therapy* / Q000378:metabolism*; D005260:Female; D006801:Humans; D007657:Ketone Bodies / Q000378:metabolism; D009682:Magnetic Resonance Spectroscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged
chemical_list: D004041:Dietary Fats; D007657:Ketone Bodies; D000096:Acetone