Many studies show that
glucose metabolism in epileptic brain areas can be impaired. Energy is crucial to maintain normal brain function, including ion and
neurotransmitter balances. Energy deficits can lead to disruption of ion gradients, which can trigger neuronal depolarization and generation of
seizures. Thus, perturbed metabolic processing of
glucose in epileptogenic brain areas indicates a specific nutritional need for people and animals with
epilepsy, as they are likely to benefit from auxiliary brain fuels other than
glucose.
Ketogenic diets provide the
ketone bodies acetoacetate and β-hydroxybutyrate, which can be used as auxiliary fuel by the brain. In approximately 50% children and adults with certain types of
epilepsy, who can tolerate and maintain these dietary regimens, seizure frequency can be effectively reduced. More recent data demonstrate that addition of medium chain
triglycerides (MCTs), which provide the medium chain
fatty acids octanoic and
decanoic acid, as well as
ketone bodies as auxiliary brain energy, can be beneficial in rodent seizure models, and dogs and humans with
epilepsy. Here, this evidence is reviewed, including tolerance in 65% of humans, efficacy studies in dogs, possible
anticonvulsant mechanisms of actions of MCTs, and specifically
decanoic acid as well as metabolic and
antioxidant mechanisms. In conclusion, MCTs are a promising adjunct to standard pharmacological treatment for both humans and dogs with
epilepsy, as they lack central nervous system side effects found with current
antiepileptic drugs. There is now a need for larger clinical trials in children, adults, and dogs to find the ideal composition and doses of MCTs and the types of
epilepsy that respond best.