>
>     Source:  Journal of the American Dietetic Association, July 1997 v97 n7
>              p793(2).
>
>
>      Title:  'We think your son has Lennox-Gastaut syndrome'- a case study
of
>              monosodium glutamate's effect on a child.
>     Author:  Anne Shovic, Robert D. Bart and Apryll M. Stalcup
>
>
>   Abstract:  A two-year-old boy presented with signs and symptoms of
>  uncontrollable seizures of multiple types mimicking that of Lennox-Gestaut
>  syndrome. It was later diagnosed as monosodium glutamate (MSG) related
>  seizures following a comparison with a similarly related case wherein
>  withdrawal from monosodium glutamate intake resulted to resumption of
normal
>  functions. A component of MSG known as aspartame acting as proconvulsant
was
>  believed to be the etiologic factor. Control of dietary MSG is the
effective
>  prevention of a more drastic intervention.
>
>
>   Subjects:  Glutamates - Health aspects
>              Monosodium glutamate - Health aspects
>              Chemicals - Adverse and side effects
>
>
>  Electronic Collection:  A19792007
>                     RN:  A19792007
>
>
>
>  Full Text COPYRIGHT 1997 American Dietetic Association
>
>  Glutamate is a naturally occurring nonessential amino acid that serves as
> one
>  of the body's excitatory neurotransmitters (1). It occurs in food as either
> a
>  free amino acid or bound as a constituent in proteins. Although foods high
> in
>  protein (eg, meat and dairy products) may have fairly high levels of bound
>  glutamate, free glutamate in foods is thought to be more closely associated
>  with adverse effects (1). Monosodium glutamate (MSG), which is used
>  extensively as a flavor enhancer, can be a major source of free glutamate
(2)
> .
>
>  A US Food and Drug Administration (FDA) panel has declared MSG safe,
stating
>  that MSG poses little health risk (3). However, Daniel Raitin, PhD, who
>  prepared the MSG report for the FDA stated, "Individual sensitivity to food
> is
>  just beginning to be explored and there is no reason to believe people
>  exquisitely sensitive to MSG are not out there" (4). In a report prepared
by
>  the Life Sciences Research Office, Federation of American Societies for
>  Experimental Biology (1), the ad hoc expert panel acknowledged that
>  preexisting conditions (eg, genetic predisposition, endogenous anomalies in
>  glutamate metabolism, impaired vitamin B-6 metabolism or deficiency) might
>  predispose persons to reactions from MSG. They concluded that it appeared
> that
>  oral ingestion of MSG had the potential to provoke a response in some
> persons
>  with severe unstable asthma. In addition, the panel validated some of the
> work
>  by Olney (5) that implicates MSG in the formation of lesions in certain
>  regions of the brain that are not protected by the blood-brain barrier. The
>  Institute of Food Technologists has also declared MSG to be safe for human
>  consumption (6). Any concern that is mentioned appears to apply only to a
>  small number of adult subjects who consumed large amounts of MSG. Very
> little
>  information is available on the effects of MSG in sensitivity-heightened
>  children. The following case study illustrates these effects and the unique
>  process that was taken by a mother and health professionals to deal with
the
>  situation.
>
>  CASE STUDY
>
>  In the fall of 1991, the mother of D.S., a 2.5-year-old boy, noticed that
> her
>  normally healthy son was experiencing "head dropping" incidents. She later
>  recalled that D.S.'s head would drop suddenly, as if he had sneezed but
>  without the exhalation of air. Although D.S. did not seem to be affected by
>  the episodes, his mother noted that he began stuttering and having
> unexplained
>  tantrums. By the end of February 1992, the head-dropping episodes were
>  occurring almost every night and with greater intensity. D.S. was brought
to
> a
>  pediatrician after head-dropping episodes two nights in a row in which he
> hit
>  his head on a cup hard enough to leave a mark on his forehead. He was
> examined
>  on March 3, 1992, but because he seemed so healthy, the pediatrician
delayed
>  obtaining an electro-encephalogram (EEG) or blood samples.
>
>  On the evening of March 5, 1992, D.S. experienced 10 to 12 seizures that
>  appeared to come in waves. His mother reported that D.S. had an initial
>  seizure that seemed to involve more than just his head and seemed to be
>  triggered by eating. That seizure was followed by 2 or 3 more seizures
> within
>  5 minutes. An emergency EEG was performed the next day and shortly after, a
>  computerized axial tomography scan and spinal tap were done.
>
>  According to the neurologist, D.S.'s EEG had the generalized spike and slow
>  wave pattern that is characteristic of Lennox-Gastaut syndrome. Lennox-
> Gastaut
>  syndrome is a rare form of epilepsy (about 1% of childhood epilepsies)
>  characterized by multiple seizure types that cannot be controlled with
>  currently available antiseizure medications (7,8). Most children with this
>  form of epilepsy develop progressive mental retardation and very few adult
>  patients are able to live independently.
>
>  Klonopin (Roche Laboratories, Nutley, NJ), an anticonvulsant medication,
was
>  prescribed to D.S. Possible side effects include drowsiness, ataxia,
>  behavioral disturbances, hyperactivity in children, dizziness, headaches,
>  blurred vision, confusion, congestion, anorexia, edema, and rash (9).
D.S.'s
>  major symptoms while on the medication were hyperactivity, clumsiness, and
>  anorexia. The hyperactivity and clumsiness subsided when the dosage was
>  reduced.
>
>  DISCUSSION
>
>  Approximately 6 months later a literature search turned up a 20-year-old
>  report in which a neurologist reported seizures in a very young child that
>  were not controlled until MSG was removed from the diet (10). When the
>  neurologist was contacted, she indicated that the child in her study, as
> well
>  as other MSG-sensitive children, grew up to be cognitively normal and
>  apparently became desensitized to MSG around the time they entered grade
>  school. Given that D.S. had no clinical manifestations (eg, developmental
>  delay) of Lennox-Gastaut syndrome other than the seizures and the
appearance
>  of the EEG, that D.S.'s seizures did not emerge until after he had been
> taken
>  off baby food, and that many of the family meals tended to be commercially
>  prepared foods, a possible link between MSG and the seizures was suspected.
>  The health care professionals treating D.S. recommended as an intervention
> the
>  elimination of MSG from the diet and continuation of antiseizure
medication.
>
>  RESULTS
>
>  The seizures stopped. D.S.'s mother was skeptical of the role of MSG in her
>  son's seizures and, after several seizure-free months, allowed her son to
> eat
>  a hot dog at a birthday party. Later in the same week, D.S. and a friend
ate
> a
>  large bag of snack chips (which listed MSG as an ingredient) when his
mother
>  was not watching. All that week, D.S.'s sleep patterns were disrupted and
> his
>  preschool teachers noted that he was clumsier than usual. He had behavior
>  problems (eg, was aggressive and difficult) and urinary incontinence,
>  sometimes several times a day. While attending another birthday party, D.S.
>  ate a slice of commercial pizza containing MSG. Three days later, after
> again
>  exhibiting the same sleep pattern disruption and other symptoms, he had
>  another head-dropping incident.
>
>  These two incidents strongly suggested that MSG was a factor in D.S.'s
>  seizures, possibly by lowering his seizure threshold. This same effect has
>  been shown with aspartame (11). In one study, aspartame exacerbated EEG
>  spike-wave discharge in children with generalized absence epilepsy, acting
> as
>  a proconvulsant. Although most of the neurologic concerns associated with
>  aspartame have centered on phenylalanine, one of the amino acids that
> comprise
>  the dipeptide, it should be noted that aspartate, the other amino acid in
> the
>  dipeptide, and glutamate bind to many of the same receptor sites in vivo,
> are
>  subject to many of the same transport mechanisms, and undergo
> interconversion
>  via aspartate aminotransferase. It is also interesting to note that the
>  incidence of febrile seizures in young children is almost five times higher
> in
>  Japan, where MSG is more commonly used as an additive, than it is in the
>  United States (12).
>
>  Currently, the FDA requires MSG to be listed on food labels as a food
>  additive. The agency will soon be proposing that foods containing notable
>  amounts of free glutamate be identified on the label. The amount considered
>  notable has yet to be determined (13).
>
>  Today, D.S. is a normal, healthy 7-year-old and has been completely off
>  antiseizure medication for more than a year. Caution is still being taken
to
>  eliminate MSG from his diet.
>
>  A dietitian can be an important member of a health care team when working
> with
>  children with seizures like those described in this case study. Minimizing
>  dietary MSG is an easy, noninvasive approach to try first before
> implementing
>  a more drastic medical intervention.
>
>  References
>
>  1. Raiten DJ, Talbot JM, Fisher KD. Analysis of Adverse Reactions to
>  Monosodium Glutamate (MSG). Bethesda, Md: American Institute of Nutrition;
>  1995.
>
>  2. IFIC [International Food Information Council] review on monosodium
>  glutamate: examining the myths.http:/ificinfo.health.org/review/ir.msg.htm.
>  May 13, 1997.
>
>  3. MSG judged safe for most people. FDA Consumer. 1995;29(9):2.
>
>  4. Debate over MSG's safety reignited. Tufts University Diet & Nutrition
>  Letter. 1995;13(9):6-7.
>
>  5. Olney JW. Excitotoxic food additives: functional teratological aspects.
>  Prog Brain Res. 1988;73:283-294.
>
>  6. Monosodium glutamate. Food Technol. 1995; 49(10):28. 7. Dulac O, Guyen
TN.
>
>  The Lennox-Gastaut syndrome. Epilepsia. 1993;34(suppl 7):S7-S17.
>
>  8. Murphy JV, Dehkharghani F. Diagnosis of childhood seizure disorder.
>  Epilepsia. 1994;35(suppl 2):S7-S17.
>
>  9. Arky R. Physicians' Desk Reference. 48th ed. Montrale, NJ: Medical
>  Economics Data Production Company; 1994.
>
>  10. Rief-Lehrer L. Possible significance of adverse reactions to glutamate
> in
>  humans. Fed Proc. 1976;35:2205-2212.
>
>  11. Canfield PR, Canfield CS, Dooley JM, Gordon K, Jollymore S, Weaver DF.
>  Aspartame exacerbates EEG spike-wave discharge in children with generalized
>  absence epilepsy. A double-blind controlled study. Neurology.
>  1992;42:1000-1003.
>
>  12. Hauser WA. The prevalence and incidence of convulsive disorders in
>  children. Epilepsia. 1994;35(suppl 2):S1-S6.
>
>  13. Monosodium glutamate, a statement of the Institute of Technologists.
> Nutr
>  Today. 1996;31(3): 107.
>
>  A. Shovic is the Plan V director and R. D. Bart is a professor of Internal
>  Medicine and Pediatrics and the division chief of Neurology at the
> University
>  of Hawaii, Honolulu. A. M. Stalcup is an associate professor in the
> Department
>  of Chemistry at the University of Cincinnati, Cincinnati, Ohio. At the time
> of
>  the study she was with the Department of Chemistry, University of Hawaii,
>  Honolulu.
>
>
>                                  -- End --
>
>  --------- End Forwarded Message ---------
>
>
>
>  --
>  Visit http://www.ivillage.com for your FREE iVillage.com email account.
>  iVillage.com: The Women's Network -- Real Solutions for Busy Women.



--

--------- Forwarded Message ---------

DATE: 16-JAN-1999 16:53:36
From: [EMAIL PROTECTED]
To: [EMAIL PROTECTED]

____________________________________________________________________________
Database: Health Reference Center
Sent from SearchBank.
Library: Boulder Public Library Services
____________________________________________________________________________


   Source:  Journal of the American Dietetic Association, July 1997 v97 n7
            p793(2).

    Title:  'We think your son has Lennox-Gastaut syndrome'- a case study of
            monosodium glutamate's effect on a child.
   Author:  Anne Shovic, Robert D. Bart and Apryll M. Stalcup

 Abstract:  A two-year-old boy presented with signs and symptoms of
uncontrollable seizures of multiple types mimicking that of Lennox-Gestaut
syndrome. It was later diagnosed as monosodium glutamate (MSG) related
seizures following a comparison with a similarly related case wherein
withdrawal from monosodium glutamate intake resulted to resumption of normal
functions. A component of MSG known as aspartame acting as proconvulsant was
believed to be the etiologic factor. Control of dietary MSG is the effective
prevention of a more drastic intervention.

 Subjects:  Glutamates - Health aspects
            Monosodium glutamate - Health aspects
            Chemicals - Adverse and side effects

Electronic Collection:  A19792007
                   RN:  A19792007


Full Text COPYRIGHT 1997 American Dietetic Association

Glutamate is a naturally occurring nonessential amino acid that serves as one
of the body's excitatory neurotransmitters (1). It occurs in food as either a
free amino acid or bound as a constituent in proteins. Although foods high in
protein (eg, meat and dairy products) may have fairly high levels of bound
glutamate, free glutamate in foods is thought to be more closely associated
with adverse effects (1). Monosodium glutamate (MSG), which is used
extensively as a flavor enhancer, can be a major source of free glutamate (2).

A US Food and Drug Administration (FDA) panel has declared MSG safe, stating
that MSG poses little health risk (3). However, Daniel Raitin, PhD, who
prepared the MSG report for the FDA stated, "Individual sensitivity to food is
just beginning to be explored and there is no reason to believe people
exquisitely sensitive to MSG are not out there" (4). In a report prepared by
the Life Sciences Research Office, Federation of American Societies for
Experimental Biology (1), the ad hoc expert panel acknowledged that
preexisting conditions (eg, genetic predisposition, endogenous anomalies in
glutamate metabolism, impaired vitamin B-6 metabolism or deficiency) might
predispose persons to reactions from MSG. They concluded that it appeared that
oral ingestion of MSG had the potential to provoke a response in some persons
with severe unstable asthma. In addition, the panel validated some of the work
by Olney (5) that implicates MSG in the formation of lesions in certain
regions of the brain that are not protected by the blood-brain barrier. The
Institute of Food Technologists has also declared MSG to be safe for human
consumption (6). Any concern that is mentioned appears to apply only to a
small number of adult subjects who consumed large amounts of MSG. Very little
information is available on the effects of MSG in sensitivity-heightened
children. The following case study illustrates these effects and the unique
process that was taken by a mother and health professionals to deal with the
situation.

CASE STUDY

In the fall of 1991, the mother of D.S., a 2.5-year-old boy, noticed that her
normally healthy son was experiencing "head dropping" incidents. She later
recalled that D.S.'s head would drop suddenly, as if he had sneezed but
without the exhalation of air. Although D.S. did not seem to be affected by
the episodes, his mother noted that he began stuttering and having unexplained
tantrums. By the end of February 1992, the head-dropping episodes were
occurring almost every night and with greater intensity. D.S. was brought to a
pediatrician after head-dropping episodes two nights in a row in which he hit
his head on a cup hard enough to leave a mark on his forehead. He was examined
on March 3, 1992, but because he seemed so healthy, the pediatrician delayed
obtaining an electro-encephalogram (EEG) or blood samples.

On the evening of March 5, 1992, D.S. experienced 10 to 12 seizures that
appeared to come in waves. His mother reported that D.S. had an initial
seizure that seemed to involve more than just his head and seemed to be
triggered by eating. That seizure was followed by 2 or 3 more seizures within
5 minutes. An emergency EEG was performed the next day and shortly after, a
computerized axial tomography scan and spinal tap were done.

According to the neurologist, D.S.'s EEG had the generalized spike and slow
wave pattern that is characteristic of Lennox-Gastaut syndrome. Lennox-Gastaut
syndrome is a rare form of epilepsy (about 1% of childhood epilepsies)
characterized by multiple seizure types that cannot be controlled with
currently available antiseizure medications (7,8). Most children with this
form of epilepsy develop progressive mental retardation and very few adult
patients are able to live independently.

Klonopin (Roche Laboratories, Nutley, NJ), an anticonvulsant medication, was
prescribed to D.S. Possible side effects include drowsiness, ataxia,
behavioral disturbances, hyperactivity in children, dizziness, headaches,
blurred vision, confusion, congestion, anorexia, edema, and rash (9). D.S.'s
major symptoms while on the medication were hyperactivity, clumsiness, and
anorexia. The hyperactivity and clumsiness subsided when the dosage was
reduced.

DISCUSSION

Approximately 6 months later a literature search turned up a 20-year-old
report in which a neurologist reported seizures in a very young child that
were not controlled until MSG was removed from the diet (10). When the
neurologist was contacted, she indicated that the child in her study, as well
as other MSG-sensitive children, grew up to be cognitively normal and
apparently became desensitized to MSG around the time they entered grade
school. Given that D.S. had no clinical manifestations (eg, developmental
delay) of Lennox-Gastaut syndrome other than the seizures and the appearance
of the EEG, that D.S.'s seizures did not emerge until after he had been taken
off baby food, and that many of the family meals tended to be commercially
prepared foods, a possible link between MSG and the seizures was suspected.
The health care professionals treating D.S. recommended as an intervention the
elimination of MSG from the diet and continuation of antiseizure medication.

RESULTS

The seizures stopped. D.S.'s mother was skeptical of the role of MSG in her
son's seizures and, after several seizure-free months, allowed her son to eat
a hot dog at a birthday party. Later in the same week, D.S. and a friend ate a
large bag of snack chips (which listed MSG as an ingredient) when his mother
was not watching. All that week, D.S.'s sleep patterns were disrupted and his
preschool teachers noted that he was clumsier than usual. He had behavior
problems (eg, was aggressive and difficult) and urinary incontinence,
sometimes several times a day. While attending another birthday party, D.S.
ate a slice of commercial pizza containing MSG. Three days later, after again
exhibiting the same sleep pattern disruption and other symptoms, he had
another head-dropping incident.

These two incidents strongly suggested that MSG was a factor in D.S.'s
seizures, possibly by lowering his seizure threshold. This same effect has
been shown with aspartame (11). In one study, aspartame exacerbated EEG
spike-wave discharge in children with generalized absence epilepsy, acting as
a proconvulsant. Although most of the neurologic concerns associated with
aspartame have centered on phenylalanine, one of the amino acids that comprise
the dipeptide, it should be noted that aspartate, the other amino acid in the
dipeptide, and glutamate bind to many of the same receptor sites in vivo, are
subject to many of the same transport mechanisms, and undergo interconversion
via aspartate aminotransferase. It is also interesting to note that the
incidence of febrile seizures in young children is almost five times higher in
Japan, where MSG is more commonly used as an additive, than it is in the
United States (12).

Currently, the FDA requires MSG to be listed on food labels as a food
additive. The agency will soon be proposing that foods containing notable
amounts of free glutamate be identified on the label. The amount considered
notable has yet to be determined (13).

Today, D.S. is a normal, healthy 7-year-old and has been completely off
antiseizure medication for more than a year. Caution is still being taken to
eliminate MSG from his diet.

A dietitian can be an important member of a health care team when working with
children with seizures like those described in this case study. Minimizing
dietary MSG is an easy, noninvasive approach to try first before implementing
a more drastic medical intervention.

References

1. Raiten DJ, Talbot JM, Fisher KD. Analysis of Adverse Reactions to
Monosodium Glutamate (MSG). Bethesda, Md: American Institute of Nutrition;
1995.

2. IFIC [International Food Information Council] review on monosodium
glutamate: examining the myths.http:/ificinfo.health.org/review/ir.msg.htm.
May 13, 1997.

3. MSG judged safe for most people. FDA Consumer. 1995;29(9):2.

4. Debate over MSG's safety reignited. Tufts University Diet & Nutrition
Letter. 1995;13(9):6-7.

5. Olney JW. Excitotoxic food additives: functional teratological aspects.
Prog Brain Res. 1988;73:283-294.

6. Monosodium glutamate. Food Technol. 1995; 49(10):28. 7. Dulac O, Guyen TN.
The Lennox-Gastaut syndrome. Epilepsia. 1993;34(suppl 7):S7-S17.

8. Murphy JV, Dehkharghani F. Diagnosis of childhood seizure disorder.
Epilepsia. 1994;35(suppl 2):S7-S17.

9. Arky R. Physicians' Desk Reference. 48th ed. Montrale, NJ: Medical
Economics Data Production Company; 1994.

10. Rief-Lehrer L. Possible significance of adverse reactions to glutamate in
humans. Fed Proc. 1976;35:2205-2212.

11. Canfield PR, Canfield CS, Dooley JM, Gordon K, Jollymore S, Weaver DF.
Aspartame exacerbates EEG spike-wave discharge in children with generalized
absence epilepsy. A double-blind controlled study. Neurology.
1992;42:1000-1003.

12. Hauser WA. The prevalence and incidence of convulsive disorders in
children. Epilepsia. 1994;35(suppl 2):S1-S6.

13. Monosodium glutamate, a statement of the Institute of Technologists. Nutr
Today. 1996;31(3): 107.

A. Shovic is the Plan V director and R. D. Bart is a professor of Internal
Medicine and Pediatrics and the division chief of Neurology at the University
of Hawaii, Honolulu. A. M. Stalcup is an associate professor in the Department
of Chemistry at the University of Cincinnati, Cincinnati, Ohio. At the time of
the study she was with the Department of Chemistry, University of Hawaii,
Honolulu.

                                -- End --

--------- End Forwarded Message ---------



--
Visit http://www.ivillage.com for your FREE iVillage.com email account.
iVillage.com: The Women's Network -- Real Solutions for Busy Women.


Reply via email to