Current Approach to Ketogenic Medical Nutrition Treatment with Adult Applications in Refractory Epilepsy

Year 2021, Volume: 5 Issue: 2, 431 - 441, 29.05.2021

Nurdan Şener , Gamze Akbulut

https://doi.org/10.46237/amusbfd.767163

Cited By: 1

Abstract

Since epilepsy can occur at any age, has a long treatment period and requires follow up, it greatly affects the quality of life. It was first described as a ‘brain disorder’ by Hippocrates. In the treatment of epilepsy; drug therapy, surgical treatment, and ketogenic medical nutrition therapy can be used. Hunger is accepted as an epilepsy treatment since the Hippocrates period. High-fat, low-carbohydrate ketogenic medical nutrition treatment mimic the metabolic state of hunger and ensures that fat is used as the main source of energy in the body. The enzyme that is metabolises ketone bodies is more in infants and children in terms of quantity, and it decreases with the aging process. Before starting ketogenic medical nutrition therapy, detailed food consumption record from the individual, evaluation of growth in infants and children by considering various parameters, obesity, malnutrition and so on should be obtained as important to determine the situations and calculate the appropriate daily energy requirement accordingly. In this review, ketogenic nutrition treatment is discussed with the current approach and with the examples of ketogenic medical nutrition treatment calculation.

Keywords

Epilepsy, Ketogenic medical nutrition therapy, Ketone bodies

Dirençli Epilepside Erişkin Uygulamaları ile Birlikte Ketojenik Tıbbi Beslenme Tedavisine Güncel Yaklaşım

Abstract

Epilepsi her yaşta ortaya çıkabilen, tedavi süresi uzun olan ve izlem gerektiren bir hastalık olmakla beraber yaşam kalitesini büyük ölçüde etkilemektedir. İlk kez Hipokrat tarafından “beyin hastalığı” olarak ifade edilmiştir. Epilepsinin tedavisinde, ilaç tedavisi, cerrahi tedavi ve ketojenik tıbbi beslenme tedavisi kullanılabilmektedir. Açlık, Hipokrat döneminden itibaren epilepsinin tedavisi olarak kabul edilmiştir. Ketojenik tıbbi beslenme tedavisi, yüksek yağ ve düşük karbonhidrat içeriği ile açlığın metabolik durumunu taklit ederek yağların vücutta ilk enerji kaynağı olarak kullanılmasını sağlamaktadır. Keton cisimciklerini metabolize eden enzim, bebeklerde ve çocuklarda daha fazla bulunmaktadır ve artan yaş ile azalmaktadır. Bu nedenle bebeklerde ve küçük yaştaki çocuklarda daha etkin bir tıbbi beslenme tedavisidir. Ketojenik tıbbi beslenme tedavisine başlanmadan önce, bireyden ayrıntılı besin tüketim kaydının alınması, bebeklerde ve çocuklarda çeşitli parametreler göz önünde bulundurularak büyümenin değerlendirilmesi, obezite, malnütrisyon vb. durumların saptanması ve bu doğrultuda uygun günlük enerji gereksinimin hesaplanması önemlidir. Bu derlemede ketojenik tıbbi beslenme tedavisine güncel yaklaşımla birlikte ketojenik tıbbi beslenme tedavisi hesaplama örneklerine de yer verilmiştir.

Keywords

Epilepsi, keton cisimcikleri, ketojenik tıbbi beslenme tedavisi

References

• 1. Aktekin, B., Agan, K., Arman, F., Aslan, K., Aykutlu, E., Baklan, B., Bozdemir, H. (2012). Epilepsi rehberi: Turk noroloji dernegi epilepsi calisma grubu. Epilepsi: Journal of the Turkish Epilepsi Society, 18(1), 26-39.
• 2. Bebin M. (2002). Pediatric partial and generalized seizures. J. Child Neurol, 17, 65-69.
• 3. Yalaz K. (1994). Çocukluk çağı nöbetlerine genel bakış. Katkı Pediatri Dergisi, 15(6) 447-457.
• 4. Thijs, R. D., Surges, R., O'Brien, T. J., Sander, J. W. (2019). Epilepsy in adults. The Lancet, 393(10172), 689-701.5.
• 5. Öge, E. Baykan, B. (2011). Nöroloji. Nobel Tıp Kitabevleri, İstanbul.
• 6. Epilepsi Rehberi Türk Nöroloji Derneği Epilepsi Çalışma Grubu 2007
• 7. Akpınar, Ç. K., Cengiz, N. (2014). Status Epileptikus' un Güncel Tanı, Tedavi ve Etiyolojisi. Epilepsi: Journal of the Turkish Epilepsi Society, 20(1).
• 8. Yeni Naz, S., Gürses C., (2015). Epilepsi Çalışma Grubu Tanı ve Tedavi Rehberi 2015, Türk Nöroloji Derneği
• 9. Beghi, E., Giussani, G., Sander, J. W. (2015). The natural history and prognosis of epilepsy. Epileptic Disorders, 17(3), 243-253.
• 10. Sander, J. W. A. S. (1993). Some aspects of prognosis in the epilepsies: a review. Epilepsia, 34(6), 1007-1016.
• 11. Kwan, P., Sander, J. W. (2004). The natural history of epilepsy: an epidemiological view. Journal of Neurology, Neurosurgery & Psychiatry, 75(10), 1376-1381.
• 12. Akdağ, G., Algın, D., Erdinç, O. EPİLEPSİ/EPILEPSY. Osmangazi Tıp Dergisi, 38(1).
• 13. Çim, N., Tolunay, H. E., Karaman, E., Güneş Elçi, G., Aksin, Ş., Boza, B., Sayan, S., Yıldızhan, R., Alkış, İ., Şahin, H. G. (2018). Epilepsinin gebelik sonuçları üzerine etkisi. Van Tıp Dergisi, 25(2), 180-187.
• 14. BORA, İ. H., DEMİR, A. B. (2019). Yaşlılarda Epilepsi Tedavisi. Türkiye Klinikleri Nöroloji-Özel Konular, 12(2), 64-68.
• 15. Kwan, P., Arzimanoglou, A., Berg, A. T., Brodie, M. J., Allen Hauser, W., Mathern, G., L. Moshé, S., Perucca, E., Wiebe, S., French, J. (2010). Definition of drug resistant epilepsy: consensus proposal by the ad hoc Task Force of the ILAE Commission on Therapeutic Strategies. Epilepsia, 51(6), 1069-1077.
• 16. Wiebe, S., Jetté, N. (2012). Epilepsy surgery utilization: who, when, where, and why?. Current opinion in neurology, 25(2), 187-193.
• 17. Swink, T. D., Vining, E. P., Freeman, J. M. (1997). The ketogenic diet: 1997. Advances in pediatrics, 44, 297-329.
• 18. Vidali, S., Aminzadeh, S., Lambert, B., Rutherford, T., Sperl, W., Kofler, B., Feichtinger, R. G. (2015). Mitochondria: The ketogenic diet—A metabolism-based therapy. The international journal of biochemistry & cell biology, 63, 55-59.
• 19. Jain, S. (2017). Management of epilepsy with ketogenic diet. Indian J Psychosocial Sci, 7, 15-20.
• 20. Lima, P. A. D., Sampaio, L. P. D. B., & Damasceno, N. R. T. (2014). Neurobiochemical mechanisms of a ketogenic diet in refractory epilepsy. Clinics, 69(10), 699-705.
• 21. Kossoff, E. H., Zupec‐Kania, B. A., Amark, P. E., Ballaban‐Gil, K. R., Christina Bergqvist, A. G., Blackford, R., Donner, E. J., Buchhalter, J. R., Caraballo, R. H., Cross, J. H., Dahlin, M.G., Klepper, J., Jehle, R. S., Kim, H. D., Liu, C. Ulus, J., Nordli Jr, D. R. Pfeifer, H. H., Rho, J. M., Stafstrom, C.E., Thiele, E. A., Turner, Z., Wirrell, E. C., Wheless, J. W., Veggiotti, P., PG Vining, E. (2009). Optimal clinical management of children receiving the ketogenic diet: recommendations of the International Ketogenic Diet Study Group. Epilepsia, 50(2), 304-317.
• 22. Schoeler, N. E., Cross, J. H. (2016). Ketogenic dietary therapies in adults with epilepsy: a practical guide. Practical neurology, 16(3), 208-214.
• 23. Kossoff, E. (2011). The Fat is in the Fire: Ketogenic Diet for Refractory Status Epilepticus: Ketogenic Diet in FIRES. Epilepsy Currents, 11(3), 88-89.
• 24. Thakur, K. T., Probasco, J. C., Hocker, S. E., Roehl, K., Henry, B., Kossoff, E. H., Kaplan, P. W., Geocadin, R. G., Hartman, A. L., Venkatesan, A., Cervenka, M. C. (2014). Ketogenic diet for adults in super-refractory status epilepticus. Neurology, 82(8), 665-670.
• 25. Strzelczyk, A., Reif, P. S., Bauer, S., Belke, M., Oertel, W. H., Knake, S., Rosenow, F. (2013). Intravenous initiation and maintenance of ketogenic diet: proof of concept in super-refractory status epilepticus. Seizure-European Journal of Epilepsy, 22(7), 581-583.
• 26. Miranda, M. J., Turner, Z., Magrath, G. (2012). Alternative diets to the classical ketogenic diet—Can we be more liberal?. Epilepsy research, 100(3), 278-285.
• 27. Felton, E. A., Cervenka, M. C. (2015). Dietary therapy is the best option for refractory nonsurgical epilepsy. Epilepsia, 56(9), 1325-1329.
• 28. Zare, M., Okhovat, A. A., Esmaillzadeh, A., Mehvari, J., Najafi, M. R., Saadatnia, M. (2017). Modified Atkins diet in adult with refractory epilepsy: A controlled randomized clinical trial. Iranian journal of neurology, 16(2), 72.
• 29. D’Andrea Meira, I., Romão, T. T., Pires do Prado, H. J., Krüger, L. T., Pires, M. E. P., da Conceição, P. O. (2019). Ketogenic diet and epilepsy: what we know so far. Frontiers in neuroscience, 13, 5.
• 30. Miranda, M. J., Mortensen, M., Povlsen, J. H., Nielsen, H., and Beniczky, S. (2011). Danish study of a Modified Atkins diet for medically intractable epilepsy in children: can we achieve the same results as with the classical ketogenic diet? Seizure 20, 151–155.
• 31. Martin, K., Jackson, C. F., Levy, R. G., and Cooper, P. N. (2016). Ketogenic diet and other dietary treatments for epilepsy. Cochrane Database Syst. Rev. 2:CD001903.
• 32. Uyar, G. Ö., Şanlıer, N. (2018). Çocukluk Çağı Dirençli Epilepsilerinde Ketojenik Diyet Uygulamalarının Etkisi. Turk Noroloji Dergisi, 24(3), 216.
• 33. van der Louw, E., van den Hurk, D., Neal, E., Leiendecker, B., Fitzsimmon, G., Dority, L., Thompson, L., Marchió. M., Dudzińska M., Dressler, A., Klepper, J., Auvin, S., Cross J., H., Klepper, J. (2016). Ketogenic diet guidelines for infants with refractory epilepsy. european journal of paediatric neurology, 20(6), 798-809.
• 34. Sivaraju, A., Nussbaum, I., Cardoza, C. S., Mattson, R. H. (2015). Substantial and sustained seizure reduction with ketogenic diet in a patient with Ohtahara syndrome. Epilepsy & behavior case reports, 3, 43-45.
• 35. Eun, S. H., Kang, H. C., Kim, D. W., Kim, H. D. (2006). Ketogenic diet for treatment of infantile spasms. Brain and Development, 28(9), 566-571.
• 36. Pires, M. E., Ilea, A., Bourel, E., Bellavoine, V., Merdariu, D., Berquin, P., Auvin, S. (2013). Ketogenic diet for infantile spasms refractory to first-line treatments: an open prospective study. Epilepsy research, 105(1-2), 189-194.
• 37. Kayyali, H. R., Gustafson, M., Myers, T., Thompson, L., Williams, M., Abdelmoity, A. (2014). Ketogenic diet efficacy in the treatment of intractable epileptic spasms. Pediatric neurology, 50(3), 224-227.
• 38. Hong, A. M., Turner, Z., Hamdy, R. F., Kossoff, E. H. (2010). Infantile spasms treated with the ketogenic diet: prospective single‐center experience in 104 consecutive infants. Epilepsia, 51(8), 1403-1407.