Omega-3 Fatty Acids May Prevent Sudden Unexpected Death in Epilepsy in Children.

Abstract

Sudden unexpected death in epilepsy (SUDEP) accounts for a large number of deaths in children with epilepsy, causing considerable concerns in patients and their families.1–3 Although specific causes of SUDEP in children remain unknown, children with uncontrolled epilepsy or frequent generalized tonic-clonic seizures are at a high risk for SUDEP.3 Furthermore, the most common mechanisms of SUDEP in children are related to cardiac and respiratory abnormalities during and between seizures.2,3 Even considering that the best way to prevent SUDEP in childhood is still elusive, some procedures have been proposed, including education, pharmacologic therapy, surgical treatment, and dietary modifications, to minimize the occurrence of tragic SUDEP events.1–5 With these considerations in mind, we enjoyed reading the excellent review article by Wicker and Cole,6 published in your esteemed journal. Elegantly, the authors discussed the current knowledge and understanding of SUDEP in children and adolescents. Although we agree with the authors' positioning to further understand the etiology and risk factors of SUDEP,6 we want to highlight that other actions than medical and surgical therapies may be useful to minimize SUDEP occurrence.4,5,7 In this way, omega-3 fatty acid (omega-3 FA) supplementation and regular fish consumption have increasingly attracted the attention of neuroscientists.4,5,7,8Historically, one of the first reports of fish consumption as a medical therapy is described in the Old Testament book of Tobias, “Then the angel said to him: Take out the entrails of the fish, and lay up his heart, and his gall, and his liver for thee; for these are necessary for useful medicines.”7,9,10 Actually, it has been clearly shown that omega-3 FAs promote beneficial effects to the health system and several human diseases7,11,12 Concerning epilepsy per se, there are robust translational studies highlighting the importance of the recommended levels of fish consumption or omega-3 FA supplementation in order to minimize the frequency of seizures in adult and children with epilepsy and, especially, to reduce the occurrence of SUDEP.4,8,13 In brief, neuroprotective, antioxidant, and anti-inflammatory properties of omega-3 FAs are recognized as contributing to reduce the epilepsy risk and severity.4,8,13–15 Additionally, emerging research indicates that omega-3 FAs may improve children's health and brain development.16–18 Importantly, because there is no established adequate dose of omega-3 FAs in children, scientists from multiple countries have made statements concerning the recommended intake of omega-3 FAs for young children.11,16–18 For example, the United States Environmental Protection Agency recommends a weekly intake of less than 60 g of fish, always taking into account the effects of water pollutants and other chemicals on fish.16,18 In parallel, the World Health Organization recommends that infants start receiving 450 mg/day per 10 kg of body weight of omega-3 FAs, whereas the International Society for the Study of Fatty Acids and Lipids opts for 350 to 750 mg/day per 10 kg of body weight.16,18Overall, which lessons did we learn? Firstly, epilepsy in children is a multicausal and systemic condition. Secondly, the risk of a child dying from SUDEP is now widely recognized. Third, omega-3 FAs are crucial for children's health. Finally, the excellent article discussed here6 should stimulate translational research to explore the potential benefits of omega-3 FAs for children with epilepsy.