The impact of omega-3 on recurrent seizures in epileptic patients: A case study with evidence-based approaches

  • Nadiyah Wijayanthie Faculty of Medicine, Universitas Indonesia - Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia and Universitas Indonesia Hospital
  • Wiji Lestari Faculty of Medicine, Universitas Indonesia - Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia and Universitas Indonesia Hospital
Keywords: epilepsy, recurrent epilepsy, case study, omega-3 fatty acid

Abstract

Background: Epileptogenesis is also associated with increased production of excessive pro-inflammatory cytokines” which shows connection between pro-inflammatory cytokines as triggering factor with omega-3 which has anti-inflammatory effect. Omega-3, known for its neuroprotective and anticonvulsant properties, exhibits promising effects on epileptic seizure attacks. Objective: This study aimed to evaluate the effect of omega-3 supplementation on the incidence of seizures in epilepsy patients. Methods: This study used a literature search using advanced queries in the databases PubMed, Scopus, ProQuest, and Cochrane Library, and combined MeSH terms with Title/Abstract. The collected literature is discarded if there are duplicates, then literature is filtered that meets the eligibility criteria. We used the Oxford Center for Evidence-Based Medicine as a means of critical appraisal and determining the level of evidence of the selected literature. Results: Four chosen literatures were critically assessed. Two articles indicating no significant difference between omega-3 and placebo and two articles showed had a significantly higher number of seizure-free days than placebo. The first article, involving 78 adults, reported a 50% reduction in seizure risk with a frequency RR of 0.57, 95% CI 0.19 to 1.75 (IS = 0%) indicating no significant difference between omega-3 and placebo groups after 12 weeks of treatment. The second study, comprising mostly non-significant findings, demonstrated no significant correlation between omega-3 and epilepsy attacks in epilepsy patients. The third literature revealed seizure occurrences per month in the EPA group (9.7±1.2), DHA group (11.7±1.5), and placebo group (16.6±1.5). Incidence rate ratio (IRR) adjusted for seizure type in EPA and DHA groups compared to the placebo group were 0.61 (CI = 0.42–0.88, p = 0.008, a 42% reduction) and 0.67 (CI = 0.46–1.0, p = 0.04, a 39% reduction), respectively. Both treatment groups had a significantly higher number of seizure-free days compared to the placebo group (p < 0.05). The fourth study reported intervention group frequency (4.72 ± 1.6, p= 0.014) and placebo frequency (11.64 ± 1.63, p=0.014) with intervention group seizure duration (6.64 ± 1.39, p=0.009) compared to placebo group (14.36 ± 2.18, p=0.009). Conclusion: Omega-3 supplementation may be considered for management in patients with recurrent epileptic seizures, although its effect on reducing seizure frequency remains inconsistent.

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Author Biographies

Nadiyah Wijayanthie, Faculty of Medicine, Universitas Indonesia - Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia and Universitas Indonesia Hospital
Department of Nutrition
Wiji Lestari, Faculty of Medicine, Universitas Indonesia - Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia and Universitas Indonesia Hospital
Department of Nutrition

References

Anwar H, Khan QU, Nadeem N, et al. Epileptic Seizures. Discoveries. 2020;8(2):e110.

WHO. Epilepsy-A Public Health Imperative. Thailand: L’IV Com Sàrl. 2019. 1–18 p.

WHO. Epilepsy. World Health Organization. 2023. Available from: https://www.who.int/news-room/fact-sheets/detail/epilepsy

PERDOSSI. Pedoman Tatalaksana Epilepsi: Kelompok Studi Epilepsi Perhimpunan Dokter Spesialis Saraf indonesia. Surabaya Airlangga Univ Press. 2016;5.

Minwuyelet F, Mulugeta H, Tsegaye D, lake B, Getie A, Tsegaye B, et al. Quality of Life and Associated Factors among Patients with Epilepsy at Specialized Hospitals, Northwest Ethiopia; 2019. PLoS One. 2022;17:1–14.

Asrani SK, Devarbhavi H, Eaton J, Kamath PS. Burden of Liver Diseases in the World. J Hepatol. 2019;70(1):151–71.

Falco-Walter J. Epilepsy-Definition, Classification, Pathophysiology, and Epidemiology. Semin Neurol. 2020;40(6):617–23.

Tan THL, Perucca P, O’Brien TJ, Kwan P, Monif M. Inflammation, Ictogenesis, and Epileptogenesis: An Exploration Through Human Disease. Epilepsia. 2021;62(2):303–24.

Shimada T, Takemiya T, Sugiura H, Yamagata K. Role of Inflammatory Mediators In The Pathogenesis of Epilepsy. Mediators Inflamm. 2014;2014.

Ekaputri Hz TW, Larassati L, Verbty NA, Kusdyah E. Karakteristik Pasien Epilepsi Di Rumah Sakit Kota Jambi Periode Januari Sampai Desember 2018. J Med Malahayati. 2020;4(2):112–9.

Haag M. Essential Fatty Acids and the Brain. Can J Psychiatry. 2003;48(3):195–203.

Kang JX, Weylandt KH. Modulation of Inflammatory Cytokines by Omega-3 Fatty Acids. Subcell Biochem. 2008;49:133–43.

Omrani S, Taheri M, Omrani MD, Arsang‐Jang S, Ghafouri‐Fard S. The Effect of Omega‐3 Fatty Acids on Clinical and Paraclinical Features Of Intractable Epileptic Patients: A Triple Blind Randomized Clinical Trial. Clin Transl Med. 2019;8(1):4–9.

Pourmasoumi M, Vosoughi N, et al. Association of Omega-3 Fatty Acid and Epileptic Seizure in Epileptic Patients: A Systematic Review. Int J Prev Med. 2018;9(36):1–8.

Vasconcelos S, et al. Polyunsaturated Fatty Acid Supplementation for Drug-Resistant Epilepsy. Cochrane Database Syst Rev. 2016;(8):1–26.

Ibrahim FAS, Ghebremeskel K, Abdel-Rahman ME, Ahmed AAM, Mohmed IM, Osman G, et al. The Differential Effects of Eicosapentaenoic Acid (EPA) and Docosahexaenoic Acid (DHA) on Seizure Frequency in Patients with Drug-Resistant Epilepsy — A Randomized, Double-Blind, Placebo-Controlled Trial. Epilepsy Behav. 2018;87:32–8.

Dahlin M, Hjelte L, Nilsson S, Åmark P. Plasma Phospholipid Fatty Acids are Influenced by a Ketogenic Diet Enriched with n-3 Fatty Acids in Children With Epilepsy. Epilepsy Res. 2007;73(2):199–207.

Bazan NG, Musto AE, Knott EJ. Endogenous Signaling by Omega-3 Docosahexaenoic Acid-Derived Mediators Sustains Homeostatic Synaptic and Circuitry Integrity. Mol Neurobiol. 2011;44(2):216–22.

Kavyani Z, Musazadeh V, Fathi S, et al. Efficacy of the Omega-3 Fatty Acids Supplementation on Inflammatory Biomarkers: An Umbrella Meta-Analysis. Int Immunopharmacol. 2022;111.

Li K, Huang T, Zheng J, Wu K, Li D. Effect of Marine-Derived N-3 Polyunsaturated Fatty Acids On C-Reactive Protein, Interleukin 6 And Tumor Necrosis Factor α: A meta-analysis. PLoS One. 2014;9(2):1–28.

Börjesson SI, Elinder F. An Electrostatic Potassium Channel Opener Targeting the Final Voltage Sensor Transition. J Gen Physiol. 2011;137(6):563–77.

Chuang Y. Mitochondrial Dysfunction and Oxidative Stress in Seizure-Induced Neuronal Cell Death. Acta Neurol Taiwan. 2010;19(1):3–15.

Sri Kantha S. Dietary Effects of Fish Oils on Human Health: A Review of Recent Studies. Yale J Biol Med. 1987;60(1):37–44.

Gencer B, Djousse L, Al-Ramady OT, Cook NR, Manson JAE, Albert CM. Effect of Long-Term Marine -3 Fatty Acids Supplementation on the Risk of Atrial Fibrillation in Randomized Controlled Trials of Cardiovascular Outcomes: A Systematic Review and Meta-Analysis. Circulation. 2021;144(25):1981–90.

von Schacky C. Importance of EPA and DHA Blood Levels in Brain Structure and Function. Nutrients. 2021;13(4).

Mansara PP, Deshpande RA, Vaidya MM, Kaul-Ghanekar R. Differential ratios of omega fatty acids (AA/EPA+DHA) modulate growth, lipid peroxidation and expression of tumor regulatory MARBPs in breast cancer cell lines MCF7 and MDA-MB-231. PLoS One. 2015;10(9):1–22.

Dasilva G, Boller M, Medina I, Storch J. Relative Levels of Dietary EPA and DHA Impact Gastric Oxidation and Essential Fatty Acid Uptake. J Nutr Biochem. 2018;55:68–75.

Ghasemi Fard S, Wang F, Sinclair AJ, Elliott G, Turchini GM. How does High DHA Fish Oil Affect Health? A Systematic Review of Evidence. Crit Rev Food Sci Nutr. 2019;59(11):1684–727.

Submitted

2023-12-24
Accepted
2024-02-21
Published
2024-02-29