Abstract

BackgroundTherapies that significantly improve the neurological and functional recovery of individuals with spinal cord injury (SCI) are still urgently needed. The ketogenic diet (KD) has been shown to improve forelimb motor function in an SCI rat model, likely by reducing inflammation and cell death in the spinal cord. Furthermore, our recent pilot study in patients with SCI showed that, compared with a standard hospital diet (SD), 5 weeks of KD started during acute care improved upper extremity motor function and reduced serum levels of a neuroinflammatory blood protein. The primary goals of the current study are to: 1) show the safety and feasibility of administering a KD during acute care for SCI; 2) determine if consuming 5 weeks of a KD significantly improves motor and sensory functions, functional independence and glycemic control; and 3) quantify serum biomarkers that are linked to improvements in neurological recovery and functional independence via targeted proteomics.Methods/designIn a single-masked, longitudinal, randomized, parallel-controlled study, a total of 60 eligible, acutely traumatic spinal cord injured (cervical 5 to thoracic 12) participants ranging in age from 18 to 60 years with American Spinal Injury Association impairment scale (AIS) grades A–C (AIS-A, sensorimotor complete; AIS-B, sensory incomplete/motor complete; and AIS-C, nonfunctional motor incomplete) are being enrolled. Neurological and functional examinations, resting energy expenditure, blood, urine, and stool collections, and protein analyses related to neurological recovery will be performed within 72 h of injury (baseline measure) and repeated after 5 weeks of KD or SD (discharge measure). We anticipate a completion rate of 80% with a total of 48 participants.DiscussionIntervention with a more neuroprotective diet during acute care of SCI can be implemented anywhere in the world at low cost and without major regulatory hurdles. Better functional recovery will lead to a better quality of life and long-term health outcomes in individuals with SCI. While this study targets SCI, if successful it has the potential to improve neurological outcomes for individuals with various traumatic injuries.Trial registrationNCT03509571 Registered on April 28, 2018.

Highlights

  • Therapies that significantly improve the neurological and functional recovery of individuals with spinal cord injury (SCI) are still urgently needed

  • Better functional recovery will lead to a better quality of life and long-term health outcomes in individuals with SCI

  • The ketogenic diet (KD) is a high-fat, low-carbohydrate diet designed to mimic the metabolic and biochemical changes that occur during calorie restriction, ketosis

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Summary

Introduction

Therapies that significantly improve the neurological and functional recovery of individuals with spinal cord injury (SCI) are still urgently needed. SCI in humans leads to the well-recognized loss of motor and sensory function, and the less-studied multiple secondary complications (i.e., bladder and bowel dysfunction, metabolic disorders and cardiovascular disease) caused by extreme physical inactivity due to paralysis [1,2,3]. These secondary complications of SCI contribute to the greatly reduced lifespan of these patients, which is rarely emphasized. Individuals with improved neurological recovery are expected to better manage problems such as spasticity, weight gain and chronic pain, and to be less likely to experience feelings of anxiety, loneliness and depression

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