In Reply We read with interest the letter by Scorza and colleagues regarding the potential use of ω-3 fatty acid supplementation to treat epilepsy. We need to systematically assess interventions to prevent sudden unexpected death in epilepsy (SUDEP), as has been done successfully in preventing sudden infant death syndrome, through the “back to sleep” and subsequent “safe to sleep” educational programs.
The authors cite 3 small human trials of ω-3 fatty acids to treat epilepsy. Two of these studies were negative and 1 found a small beneficial association with seizure frequency at a low dose but no association at a higher dose of ω-3 fatty acid supplementation. A finding that is concerning for the authors’ thesis is that the only SUDEP occurred in the high-dose ω-3 fatty acid treatment group. A recent Cochrane review analyzed these 3 studies as well as 5 additional studies of polyunsaturated fatty acid (PUFA) supplementation in epilepsy and concluded that “supplementation with PUFA did not produce significant differences in mean frequency of seizures, quality of life, or other side effects.”1
Devinsky O, Ryvlin P, Friedman D. Dietary Measures to Prevent Sudden Unexpected Death in Epilepsy—Reply. JAMA Neurol. 2018;75(9):1156. doi:10.1001/jamaneurol.2018.2254
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