Pairing a low-carbohydrate diet with typical epilepsy medications can reduce seizures in people with drug-resistant epilepsy by 50 per cent.

Using low-carb diets to treat epilepsy began but fell out of favour once anti-seizure medications were developed. However, nearly a third of the approximately worldwide with epilepsy don鈥檛 respond to these drugs.

at All India Institute of Medical Sciences, New Delhi and her colleagues recruited 160 people between 10 and 55 years old who had more than two seizures a month despite using at least three anti-seizure medications at maximum doses. The researchers advised half of them to follow a modified Atkins diet, which consists of eating only 20 grams of carbohydrates a day, drastically cutting down on the recommended for adult daily consumption under US dietary guidelines. All participants continued standard epilepsy drugs. Caregivers tracked seizures and meals using a daily log, and participants completed a quality-of-life questionnaire before and after the study.

After six months, more than 26 per cent of those on the low-carb diet saw monthly seizures reduced by more than 50 per cent compared to the month before the trial. The same was true for only 2.5 per cent of the control group. The low-carb group also reported significantly greater improvements in quality of life, on average, compared to the control group.

Low-carbohydrate diets reduce seizures by inducing ketosis, which is when the body burns fat as its primary fuel, says Tripathi. There are many potential mechanisms for why this improves epilepsy including changes in the gut microbiome, inflammation and electrical signalling between neurons, she says.

at Johns Hopkins University in Maryland says it is encouraging to see that the modified Atkins diet can be an effective treatment. Prior studies to treat epilepsy with diet often use the ketogenic diet, which requires calculating the ratio of carbs to fats in all foods. 鈥淭hat can be a lot more time consuming,鈥� says Cervenka, meaning fewer people stick to it. 鈥淭he modified Atkins diet is less rigorous with regard to preparation and monitoring,鈥� she says.

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For musician , being diagnosed with a rare form of epilepsy was devastating. “It was like my whole dream was really coming apart in my hands,” they say.

In their case, this musicogenic epilepsy, an epilepsy that can be triggered by musical stimulus, was induced by complex hand movements when playing the recorder. It left Bec feeling “as if my hands were carrying on without me”. It is estimated that 1 in 10 million people experience musicogenic epilepsy, and within that small group, each person can have a different trigger that can cause seizures. According to the , some people have it triggered by playing, listening, or even dreaming of music. “For me, it’s just to do with the way I’m moving my hands. Any complex finger movements can do it.”

Determined to continue playing, Bec completely changed musical styles, designed a digitally enhanced recorder called the Roborecorder, and began writing music that expressed their disability. “Having that limitation gives you your abilities to do something different and do something unusual and do something that is really amazing and no one else can do.”

Liza Bec’s story is part of , an exhibition at the Science and Industry Museum, Manchester, UK

Ultrasound waves have been used to control genetically altered brain cells in mice, a step towards using this technique to treat conditions such as Parkinson鈥檚 disease or epilepsy in humans.

One of the biggest advances in neuroscience of the past two decades is a method called optogenetics, in which cells are genetically tweaked so they can be turned on or off with light. Now the technique has been adapted to control brain cells via ultrasound, which opens up new possibilities for brain research and developing treatments for neurological disorders, says at the Salk Institute for Biological Studies in San Diego, California.

Optogenetic experiments involve making the brain cells of animals such as mice respond to light by adding a gene originally found in algae. They have led to a raft of discoveries about how different circuits within the brain affect behaviour, but the animals need to have fibre-optic cables put into their heads, which makes the work more complicated.

Chalasani and his colleagues have been working with a different gene called TRPA1, normally found in human brain and heart cells, which encodes a membrane protein that typically helps the cells respond to toxic chemicals.

When the brain cells of mice were given a copy of this gene, they started firing in response to ultrasound beamed directly at a small area of their heads. The frequency that elicited the response was 7 megahertz, which is known not to damage biological tissues. The team calls this approach 鈥渟onogenetics鈥�.

So far, the main medical application for optogenetic therapies has been putting such genes into people鈥檚 eyes to restore sight to those who are blind, as plenty of light reaches the eye.

But sonogenetic therapies could potentially control brain cells inside the head without having to implant any light sources. People could have specific groups of brain cells turned on and off with ultrasound waves, which would pass through the skull. 鈥淵ou could build a tool box for making different brain cells sensitive to different frequencies of ultrasound,鈥� says Chalasani.

The approach could one day be used as a treatment for epilepsy or Parkinson鈥檚 disease, for instance. But first there needs to be a way to deliver the TRPA1 gene into nerve cells inside the head, by getting past the blood-brain barrier.

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For people with severe epilepsy, no medication is effective 鈥� but a radical approach of implanting stem cells into the brain could stop seizures at their source.

The technique, which has so far shown promise in rats, would involve taking some of a patient鈥檚 own skin cells and turning them into embryonic-like stem cells in the lab. These can then be directed to become a kind of brain cell that damps down seizures.

Epilepsy arises when there is an聽imbalance between two different kinds of nerve cell in the聽brain; excitatory ones, which cause other cells to fire, and inhibitory ones, which block firing. Seizures result when excitation swamps inhibition.

For some people with epilepsy, the surge of excitation starts in one part of the brain, called the hippocampus, before spreading elsewhere. So Ashok Shetty at Texas A&M University and his colleagues tried boosting inhibition at that site to see what聽would happen.

First, Shetty鈥檚 team injected 38聽rats with a chemical that triggers a long seizure. The resulting brain damage causes the聽animals to have spontaneous seizures, starting from the hippocampus, over the next few聽months.

A week after the initial damage, the team implanted inhibitory brain cells in the hippocampi of about half the rats. Five months later, those given implanted cells had 70 per cent fewer seizures than those without implants.

To check it was really the inhibitory cells working, five of the animals were given inhibitory cells that were genetically modified to stop firing when the animal was dosed with a drug. When under the drug鈥檚 influence, these rats had seizures nearly as often as rats primed for seizure that hadn鈥檛 had any inhibitory cells implanted.

Dissections also showed that the implanted cells survived in the hippocampus.

Shetty says the treatment could be suitable for people whose seizures originate in a small part of their hippocampus, and whose only other option is surgery to remove that part. They could try a聽cell implant instead, and if something went wrong, they could have all the graft removed along with the epileptic brain tissue. And if the therapeutic cells were made from a patient鈥檚 own skin, they wouldn鈥檛 need medicines to stop rejection.

The study isn鈥檛 proof this approach will work, though, says Bruno Frenguelli at the University of Warwick, UK. The rats were given implants soon after their brain damage, and it isn鈥檛 clear if the technique would help people with seizures stemming from a head injury in the past, which is a common cause of epilepsy.

This article appeared in print under the headline 鈥淪tem cells could halt epilepsy鈥�