Day 1 :
- Brain and Neurological Disorders
Location: 1
Session Introduction
Raffaele Pilla
Pharm D, PhD, St. John of God Hospital, Fatebenefratelli, Benevento, Italy
Title: Therapeutic ketosis and the broad field of applications for the ketogenic diet: Ketone ester applications & clinical updates
Biography:
Raffaele Pilla, Pharm.D., Ph.D., Doctor Europaeus, received his Master’s degree in Pharmacy at G. d’Annunzio University in Chieti-Pescara, Italy. He was an Erasmus Student at Faculté de Pharmacie de Reims in Reims, France. He received his Doctor Europaeus in 2010 from Pitié-Salpétrière Institute in Paris, France. Also in 2010, he received his Ph.D. in Biochemistry, Physiology, and Pathology of Muscle at G. d’Annunzio University in Chieti-Pescara, Italy. He has written and lectured widely worldwide. He has been involved in ongoing research at the University of South Florida with the use of ketone esters.
Abstract:
It has been recently shown that nutritional ketosis is effective against seizure disorders and various acute/chronic neurological disorders. Physiologically, glucose is the primary metabolic fuel for cells. However, many neurodegenerative disorders have been associated with impaired glucose transport/metabolism and with mitochondrial dysfunction, such as Alzheimer’s/Parkinson’s disease, general seizure disorders, and traumatic brain injury. Ketone bodies and tricarboxylic acid cycle intermediates represent alternative fuels for the brain and can bypass the rate- limiting steps associated with impaired neuronal glucose metabolism. Therefore, therapeutic ketosis can be considered as a metabolic therapy by providing alternative energy substrates. It has been estimated that the brain derives over 60% of its total energy from ketones when glucose availability is limited. In fact, after prolonged periods of fasting or ketogenic diet (KD), the body utilizes energy obtained from free fatty acids (FFAs) released from adipose tissue. Because the brain is unable to derive significant energy from FFAs, hepatic ketogenesis converts FFAs into ketone bodies-hydroxybutyrate (BHB) and acetoacetate (AcAc)-while a percentage of AcAc spontaneously decarboxylates to acetone. Large quantities of ketone bodies accumulate in the blood through this mechanism. This represents a state of normal physiological ketosis and can be therapeutic. Ketone bodies are transported across the blood-brain barrier by monocarboxylic acid transporters to fuel brain function. Starvation or nutritional ketosis is an essential survival mechanism that ensures metabolic flexibility during prolonged fasting or lack of carbohydrate ingestion. Therapeutic ketosis leads to metabolic adaptations that may improve brain metabolism, restore mitochondrial ATP production, decrease reactive oxygen species production, reduce inflammation, and increase neurotrophic factors’ function. It has been shown that KD mimics the effects of fasting and the lack of glucose/insulin signaling, promoting a metabolic shift towards fatty acid utilization. In this work, the author reports a number of successful case reports treated through metabolic ketosis.
Katie Hoeveler
Assistant Professor of Clinical Psychiatry at the University of Pennsylvania
Title: PANS: Stovetop Cookware or Chronic Mental Illness?
Biography:
Katie Hoeveler, MD, started her medical career as a pediatrician in a hospital-based practice in San Diego, CA. She was drawn to the children with mental health challenges and became fascinated with brain pathology. Thus, she completed her Adult Psychiatry Residency and Child Psychiatry Fellowship as part of the Post Pediatric Portal Program at the Children’s Hospital of Philadelphia and the University of Pennsylvania. She stayed on at CHOP as a Consult-Liaison Psychiatrist and then Medical Director of the brand new Medical Behavioral Unit.
Abstract:
Statement of the Problem: Pediatric Autoimmune Neuropsychiatric Syndrome, or PANS, is characterized by an abrupt onset of neuropsychiatric symptoms following a microbial infection.Whether PANS is a distinct form of more typical cases of OCD or tic disorder is controversial, and many experts doubt the existence of PANS.Two cases of PANS following Mycoplasma Pneumoniae infection- in the same family- inspired us to investigate the evidence in the literature for the existence of PANS and the evidence for a genetic component to susceptibility to PANS. Methodology and Theoretic Orientation:We performed a literature search in PubMed and in UptoDate.We used the key words “PANS NOT PANDAS,” to exclude PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infection) which is a related, but separate, diagnosis. Given the relatively small number of articles on PANS, we included all articles in the literature review.We analyzed the articles for evidence of the existence of PANS as a unique diagnosis, separate from other neuropsychiatric diagnoses.We also analyzed the articles for evidence of a genetic component to susceptibility to PANS. Findings: Of the 29 articles on PANS, five articles presented clear evidence for the existence of PANS, and two articles addressed the genetic susceptibility to PANS.The remaining articles consisted of mainly of case reports and the treatment of PANS.The first group of five articles documented a unique constellation of neuropsychiatric symptoms, following a bacterial infection, that is not otherwise better described by any other medical nor neuropsychiatric disorder. The second group of two articles showed that there is significant autoimmunity in first degree relatives of patients with PANS, suggesting a genetic component to susceptibility.