Norman Swan: Let's stay with our brain theme because there's fascinating research in London which is suggesting that a potentially safe and effective way to treat epilepsy is with what effectively is a food supplement.
Matthew Walker is Professor of Neurology at University College London and his story starts with a rather old treatment for epilepsy; the so-called ketogenic diet.
Matthew Walker: It does. The story starts with two older treatments, the ketogenic diet which has been around for a long, long time and gained increasing use since about the '50s and more recently in children with very refractory epilepsy. So the ketogenic diet is a diet in which children and now adults have restricted carbohydrates and very large amounts of fats in their diet. And there are complications associated with that, with increased cholesterol in the blood, with side-effects, people produce ketones which is that rather unpleasant acetone-y smell on people's breath when they are starving, but ketones themselves can cause headaches and nausea. So it's a diet that is difficult to adhere to and it's a diet that has side effects.
Norman Swan: But it was thought to work because of the ketones, that you had to produce ketones for it to be effective.
Matthew Walker: Exactly right, exactly so, that the ketones themselves were thought to be the mechanism by which this diet worked, and the high fats that were given were given to produce the ketones. So there has been a lot of interest in the way that this diet works, so that the diet could be given as a pill rather than as a diet, because of the difficulties in adhering to that diet. And we came across an interesting discovery from a slightly different angle which was that we were very interested in a drug called sodium valproate that has been around for 50-odd years.
Norman Swan: An antiepileptic drug.
Matthew Walker: An antiepileptic drugs, yes, also used in other things as well, in bipolar disorders, also used for migraine. It's an incredibly effective antiepileptic drug. Its use is limited somewhat by the effects that it can have on the foetus, on the unborn child, and there is in fact recent evidence last year indicating that if a child is exposed to it in utero that the child will drop about 10 IQ points by the time they are six. But interestingly enough, even though it has been around for a long period of time, it was uncertain how this drug worked. In collaboration with a biochemist from the Royal Holloway in the University of London we tried to look at the mechanism of sodium valproate, and we discovered that it in fact works on the metabolism of the cell. Valproic acid, sodium valproate, is in fact a fatty acid. These are the things that constitute the fats in the body, so
Norman Swan: They are the building blocks of fat.
Matthew Walker: Exactly, and they are things that we consume all the time. And so we started testing through large numbers of these fatty acids, and in fact one of the first ones that we found was very effective was a fatty acid that gives lamb and mutton its taste. So it's used actually in the food industry as an additive to give you the mutton taste. But what we found as well is that amongst the most effective of these were the same fatty acids that are given to people in the ketogenic diet.
Norman Swan: Almost by coincidence to induce the ketones they were giving these fatty acids.
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A new treatment for epilepsy