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Comment: Ghrelin and des-acyl ghrelin: Do they predict success of AED treatment?

Ghrelin and des-acyl ghrelin are gastric mucosa–secreted neuropeptide hormones whose primary function is energy homeostasis, with widespread actions on many tissues including the hypothalamus and hippocampus. Their role in sleep and pituitary function suggested an effect in epilepsy, and elevated ghrelin levels were found in adults with controlled epilepsy.1 But subsequent studies have had confusing results, with both higher and lower ghrelin levels in adults and children with epilepsy, including lower levels in the acute postictal period.2 Weight changes, pre/postpubertal status, sample timing, and valproate use may all be confounders. Generally animal studies support a neuroprotective and antiepilepsy effect of ghrelin.3

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