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To sushi or not to sushi: Can people with epilepsy have sushi from time to time?

2009; Elsevier BV; Volume: 16; Issue: 3 Linguagem: Inglês

10.1016/j.yebeh.2009.08.019

1525-5069

Roberta Monterazzo Cysneiros, Ricardo Mário Arida, Vera C. Terra, Eliza Y.F. Sonoda, Ésper A. Cavalheiro, Fúlvio A. Scorza,

Neuroscience and Neuropharmacology Research

Epilepsy is one of the most prevalent neurological conditions and knows no age, racial, social class, geographic, or national boundaries [[1]De Boer H.M. Mula M. Sander J.W. The global burden and stigma of epilepsy.Epilepsy Behav. 2008; 12: 540-546Abstract Full Text Full Text PDF PubMed Scopus (529) Google Scholar]. Unfortunately, sudden unexpected death in epilepsy (SUDEP) is the commonest cause of death directly related to epilepsy, occurring frequently in people with chronic epilepsy [[2]Tomson T. Nashef L. Ryvlin P. Sudden unexpected death in epilepsy: current knowledge and future directions.Lancet Neurol. 2008; 7: 1021-1031Abstract Full Text Full Text PDF PubMed Scopus (463) Google Scholar]. The main risk factors for SUDEP are associated with poorly controlled seizures, suggesting that most cases of SUDEP are seizure-related events [[2]Tomson T. Nashef L. Ryvlin P. Sudden unexpected death in epilepsy: current knowledge and future directions.Lancet Neurol. 2008; 7: 1021-1031Abstract Full Text Full Text PDF PubMed Scopus (463) Google Scholar]. Although potential pathomechanisms for SUDEP remain unknown, cardiac abnormalities during and between seizures might contribute to SUDEP [2Tomson T. Nashef L. Ryvlin P. Sudden unexpected death in epilepsy: current knowledge and future directions.Lancet Neurol. 2008; 7: 1021-1031Abstract Full Text Full Text PDF PubMed Scopus (463) Google Scholar, 3Stollberger C. Finsterer J. Cardiorespiratory findings in sudden unexplained/unexpected death in epilepsy (SUDEP).Epilepsy Res. 2004; 59: 51-60Abstract Full Text Full Text PDF PubMed Scopus (182) Google Scholar]. Progress continues to be made in relation to medical management of epilepsy, but the antiepileptic drugs are still limited in clinical efficacy. Following this reasoning, there is currently a paucity of credible evidence to support the use of complementary and alternative medical therapies in patients with epilepsy [[4]Schachter S.C. Complementary and alternative medical therapies.Curr Opin Neurol. 2008; 21: 184-189Crossref PubMed Scopus (36) Google Scholar]. Omega-3 fatty acid has an interesting role in this scenario. With respect to epilepsy, the first randomized, placebo-controlled, parallel group study of omega-3 supplementation in patients with chronic epilepsy showed only a transient effect on seizure frequency that was not confirmed by other research groups, but additional trials are required [5DeGiorgio C.M. Miller P. N-3 fatty acids (eicosapentanoic and docosahexanoic acids) in epilepsy and for the prevention of sudden unexpected death in epilepsy.Epilepsy Behav. 2008; 13: 712-713Abstract Full Text Full Text PDF PubMed Scopus (22) Google Scholar, 6Yuen A.W. Sander J.W. Fluegel D. et al.Omega-3 fatty acid supplementation in patients with chronic epilepsy: a randomized trial.Epilepsy Behav. 2005; 7: 253-258Abstract Full Text Full Text PDF PubMed Scopus (134) Google Scholar]. These results did not totally confirm that omega-3 fatty acids reduce the frequency of epileptic seizures in patients with intractable epilepsy; however, they supported the safety of omega-3 supplementation in people with epilepsy [[5]DeGiorgio C.M. Miller P. N-3 fatty acids (eicosapentanoic and docosahexanoic acids) in epilepsy and for the prevention of sudden unexpected death in epilepsy.Epilepsy Behav. 2008; 13: 712-713Abstract Full Text Full Text PDF PubMed Scopus (22) Google Scholar]. It is very important to emphasize that nutritional therapy (e.g., omega-3 supplementation) is not a substitute for anticonvulsant medications. From an experimental point of view, our research was the first to demonstrate that chronic treatment with omega-3 promotes neuroprotection and increases the number of parvalbumin-positive neurons in the hippocampus of rats with epilepsy, suggesting that omega-3 promotes positive plastic changes in the brain [[7]Ferrari D. Cysneiros R.M. Scorza C.A. et al.Neuroprotective activity of omega-3 fatty acids against epilepsy-induced hippocampal damage: quantification with immunohistochemical for calcium-binding proteins.Epilepsy Behav. 2008; 13: 36-42Abstract Full Text Full Text PDF PubMed Scopus (55) Google Scholar]. Quite interestingly, there is now great interest in omega-3 fatty acids for the prevention of SUDEP [5DeGiorgio C.M. Miller P. N-3 fatty acids (eicosapentanoic and docosahexanoic acids) in epilepsy and for the prevention of sudden unexpected death in epilepsy.Epilepsy Behav. 2008; 13: 712-713Abstract Full Text Full Text PDF PubMed Scopus (22) Google Scholar, 8Scorza F.A. Cysneiros R.M. Arida R.M. Terra-Bustamante V.C. de Albuquerque M. Cavalheiro E.A. The other side of the coin: beneficiary effect of omega-3 fatty acids in sudden unexpected death in epilepsy.Epilepsy Behav. 2008; 13: 279-283Abstract Full Text Full Text PDF PubMed Scopus (43) Google Scholar]. As omega-3 fatty acids per se have been shown to reduce cardiac arrhythmias and sudden cardiac deaths, it was proposed that omega-3 fatty acid supplementation in patients with refractory seizures may reduce seizures, seizure-associated cardiac arrhythmias, and hence SUDEP [5DeGiorgio C.M. Miller P. N-3 fatty acids (eicosapentanoic and docosahexanoic acids) in epilepsy and for the prevention of sudden unexpected death in epilepsy.Epilepsy Behav. 2008; 13: 712-713Abstract Full Text Full Text PDF PubMed Scopus (22) Google Scholar, 8Scorza F.A. Cysneiros R.M. Arida R.M. Terra-Bustamante V.C. de Albuquerque M. Cavalheiro E.A. The other side of the coin: beneficiary effect of omega-3 fatty acids in sudden unexpected death in epilepsy.Epilepsy Behav. 2008; 13: 279-283Abstract Full Text Full Text PDF PubMed Scopus (43) Google Scholar, 9Yuen A.W. Sander J.W. Is omega-3 fatty acid deficiency a factor contributing to refractory seizures and SUDEP? A hypothesis.Seizure. 2004; 13: 104-107Abstract Full Text Full Text PDF PubMed Scopus (40) Google Scholar]. Based on all these facts and considering the potential heart/brain benefits of omega-3, an interesting question could be evaluated: Should epileptologists be concerned with the omega-3 origin? Yes, they should be. For that, some arguments might be put forward. As we know, the human body cannot synthesize omega-3 fatty acids; hence, these nutrients must be obtained from food. In the brain, intake of long-chain omega-3 fatty acids, commonly found in fish and fish oil, not only contributes to central nervous system development but also may reduce the risk for certain adult nervous system diseases, including epilepsy [7Ferrari D. Cysneiros R.M. Scorza C.A. et al.Neuroprotective activity of omega-3 fatty acids against epilepsy-induced hippocampal damage: quantification with immunohistochemical for calcium-binding proteins.Epilepsy Behav. 2008; 13: 36-42Abstract Full Text Full Text PDF PubMed Scopus (55) Google Scholar, 8Scorza F.A. Cysneiros R.M. Arida R.M. Terra-Bustamante V.C. de Albuquerque M. Cavalheiro E.A. The other side of the coin: beneficiary effect of omega-3 fatty acids in sudden unexpected death in epilepsy.Epilepsy Behav. 2008; 13: 279-283Abstract Full Text Full Text PDF PubMed Scopus (43) Google Scholar, 10Bourre J.M. Omega-3 fatty acids in psychiatry.Med Sci. 2005; 21: 216-221Google Scholar, 11Mazza M. Pomponi M. Janiri L. Bria P. Mazza S. Omega-3 fatty acids and antioxidants in neurological and psychiatric diseases: an overview.Prog Neuropsychopharmacol Biol Psychiatry. 2007; 31: 12-26Crossref PubMed Scopus (227) Google Scholar]. Thus, the only foods that provide large amounts of omega-3 are seafood, such as salmon, sardines, trout, anchovies, and tuna [[12]Smith K.M. Sahyoun N.R. Fish consumption: recommendations versus advisories, can they be reconciled?.Nutr Rev. 2005; 63: 39-46Crossref PubMed Google Scholar]. In this context, eating fish is certainly appears to be an important component of a healthy diet. By contrast, it is very important to remember that some types of fish contain contaminants that we would rather not be eating and the major risk of fish consumption is its content of methylmercury [[12]Smith K.M. Sahyoun N.R. Fish consumption: recommendations versus advisories, can they be reconciled?.Nutr Rev. 2005; 63: 39-46Crossref PubMed Google Scholar]. As the concentration of methylmercury is increased in predatory fish, the best seafood choices are those with nonpredatory characteristics. Anchovies, Atlantic herring, Atlantic mackerel wild salmon, sardines, and trout have low levels of methylmercury, whereas tuna, shark, tilefish, and swordfish have high levels of methylmercury. [12Smith K.M. Sahyoun N.R. Fish consumption: recommendations versus advisories, can they be reconciled?.Nutr Rev. 2005; 63: 39-46Crossref PubMed Google Scholar, 13Jeejeebhoy K.N. Benefits and risks of a fish diet: should we be eating more or less?.Nat Clin Pract Gastroenterol Hepatol. 2008; 5: 178-179Crossref PubMed Scopus (25) Google Scholar, 14Fish: friend or foe? In addition to heart-healthy omega-3 fats, seafood can carry mercury and other toxins. For most people, the benefits of eating fish far outweigh the risks. Harv Heart Lett 2007;17:4–6.Google Scholar]. Indeed, we should remember the old adage "You are what you eat", which applies to our food just as much as it does to us. In fact, plants are influenced by the soil in which they grow, and animals by the feed they are given. Actually, in the wake of increased health consciousness, Japanese cuisine, especially sushi, is more popular now than ever. With the introduction of sushi machines, which combine the mass production of sushi with the delicate skills used by sushi chefs, making and selling sushi have become more accessible to countries all over the world [15The history of Sushi. Available from: http://www.sushi-master.com/usa/whatis/history.html.Google Scholar, 16Sushi. Available from: http://en.wikipedia.org/wiki/Sushi.Google Scholar]. Furthermore, people enjoy the fact that sushi is low in fat, concentrated with nutrients, and easy and quick to make. For instance, a typical serving of sushi, about 8–10 pieces, is around 350–400 calories. Because of the fish, sushi is high in protein and an excellent source of omega-3 fatty acids [15The history of Sushi. Available from: http://www.sushi-master.com/usa/whatis/history.html.Google Scholar, 16Sushi. Available from: http://en.wikipedia.org/wiki/Sushi.Google Scholar]. On the other hand, according to current knowledge, fish such as tuna can contain high levels of mercury and can be hazardous when consumed in large quantities [12Smith K.M. Sahyoun N.R. Fish consumption: recommendations versus advisories, can they be reconciled?.Nutr Rev. 2005; 63: 39-46Crossref PubMed Google Scholar, 13Jeejeebhoy K.N. Benefits and risks of a fish diet: should we be eating more or less?.Nat Clin Pract Gastroenterol Hepatol. 2008; 5: 178-179Crossref PubMed Scopus (25) Google Scholar, 14Fish: friend or foe? In addition to heart-healthy omega-3 fats, seafood can carry mercury and other toxins. For most people, the benefits of eating fish far outweigh the risks. Harv Heart Lett 2007;17:4–6.Google Scholar]. Finally, modern science recognizes the positive health effects of fish-containing diets. With respect to epilepsy, a number of different dietary modifications and nutritional supplements may help prevent seizures or improve other aspects of health in patients with epilepsy. In particular, our research group is quite convinced that omega-3 fatty acids are very important for the normal functioning of the brain and, more than this, are useful in the prevention and treatment of epilepsy. On the whole, we are totally in agreement with Weaver and colleagues [[17]Weaver K.L. Ivester P. Chilton J.A. Wilson M.D. Pandey P. Chilton F.H. The content of favorable and unfavorable polyunsaturated fatty acids found in commonly eaten fish.J Am Diet Assoc. 2008; 108: 1178-1185Abstract Full Text Full Text PDF PubMed Scopus (93) Google Scholar] suggesting that we must continue to be vigilant and explain to the public the health-related differences between species of fish to negate the widely held belief that eating any fish is beneficial. The authors have no conflicts of interest. This work was supported by CInAPCe-FAPESP , FAPESP , CNPq, CAPES .