Epilepsi Hastalarında Uygulanan Ketojenik Diyet Çeşitleri ve Etkinlikleri

Yıl 2023, Cilt: 8 Sayı: 2, 353 - 362, 01.08.2023

Melek Köken , Yasemin Ertaş Öztürk

https://doi.org/10.25279/sak.1058122

Öz

Epilepsi, beyinde elektriksel aktivitedeki değişimler sonucunda nöronların anormal ve aşırı deşarjı nedeni ile oluşan, her yaşta görülebilen, dünyada yaklaşık 65-70 milyon bireyi etkileyen nörolojik hastalıklardan biridir. Epilepsi tedavisinin amacı; mümkünse nöbetlerin sıklığını ve şiddetini azaltmak, tekrarlayan nöbetlerin neden olduğu hasarı önlemek için kontrolü sağlamak ve hastaların günlük aktivitelerini gerçekleştirmelerini sağlamaktır. Nöbetlerin çoğu bir veya daha fazla antiepileptik ilaçla kontrol altına alınabilir, ancak bu ilaçlar bir süre sonra nöbetlerin azaltılmasında etkili olmayabilir. İlaca dirençli epilepsi tedavisinde ketojenik diyetler (KD) uzun zamandır kullanılmaktadır. Yapılan çalışmalar, bu diyetlerin bireye özgü tasarlanması, kısıtlayıcılığının az ve daha lezzetli olması sayesinde hastaların yaşam kalitesini artırdığını göstermektedir. Ketojenik diyetin farklı türleri bulunmakla birlikte genel olarak yüksek yağ (yaklaşık %90) ve düşük karbonhidrat içeriğine sahiptir. Bu derleme çalışma KD türlerinin epilepsi hastalarında nöbetlerin sıklığına ve şiddetine etkisini değerlendirmek amacı ile yapılmıştır.

Anahtar Kelimeler

Düşük glisemik indeks diyeti, ilaca dirençli epilepsi, klasik ketojenik diyet, modifiye atkins ketojenik diyeti, orta zincirli trigliserit ketojenik diyeti

Destekleyen Kurum

Bulunmamaktadır.

Types of Ketogenic Diets and Efficiency in Epilepsy Patients

Öz

Epilepsy is one of the neurological diseases that occur due to abnormal and excessive discharge of neurons as a result of changes in electrical activity in the brain, can be seen at any age, and affect approximately 65-70 million individuals in the world. The aim of epilepsy treatment; if possible, to reduce the frequency and severity of seizures, to prevent damage caused by recurrent seizures, and to enable patients to perform their daily activities. Most seizures can be controlled with one or more antiepileptic drugs, but these drugs may not help seizures with time. Ketogenic diets (KDs) have been used for a long time in the treatment of drug-resistant epilepsy (IDE). Studies show that these diets increase the quality of life of patients thanks to their individual design, less restrictiveness and more deliciousness. Generally, KD has a high fat content (almost 90%), and low carbohydrate content and is available in different types. In this review, it is aimed to examine the efficacy of KD types on seizure frequency and severity.

Anahtar Kelimeler

Low glycemic index diet, drug resistant epilepsy, classic ketogenic diet, modified atkins ketogenic diet, medium chain triglyceride ketogenic diet

Kaynakça

• Alqahtani, F., Imran, I., Pervaiz, H., Ashraf, W., Perveen, N., Rasool, M.F., Alasmari, AF., Alharbi, M., Samad, N., Alqarni, S.A., Al-Rejaie, S.S., & Alanazi, M. (2020). Nonpharmacological interventions for ıntractable epilepsy. Saudi Pharmaceutical Journal, 28 (8), 951-962.
• Araya-Quintanilla, F., Celis-Rosati, A., Rodriguez-Leiva, C., Silva-Navarro, C., Silva-Pinto, Y., & Toro-Jeira, B. (2016). Effectiveness of a ketogenic diet in children with refractory epilepsy: a systematic review. Revista de Neurologia, 62 (10), 439-448.
• Armeno, M., Verini, A., Caballero, E., Cresta, A., Valenzuela, G.R., & Caraballo, R. (2021). Long-term effectiveness and adverse effects of ketogenic diet therapy in infants with drug-resistant epilepsy treated at a single center in Argentina. Epilepsy Research, 178 (2021), 106793.
• Baby, N., Vinayan, K.P., Pavithran, N., & Roy, A.G. (2018). A Pragmatic Study on Efficacy, Tolerability and Longterm Acceptance of Ketogenic Diet Therapy in 74 South Indian Children With Pharmacoresistant Epilepsy. Seizure, 58, 41-46.
• Bayındır, A., & Yardımcı H. (2018). Bazı Kronik Hastalıklarda Orta Zincirli Yağ Asitlerinin Kullanımı. İzmir Kâtip Çelebi Üniversitesi Sağlık Bilimleri Fakültesi Dergisi, 3 (3), 25-29.
• Caferoğlu, Z. (2019). Epilepside Diyet Tedavisine Güncel Yaklaşımlar. Türkiye Klinikleri Sağlık Bilimleri Dergisi. 4 (3), 333-347.
• Cervenka, M.C., Patton, K., Eloyan, A., Henry, B., & Kossoff, E. (2016). The impact of the Modified Atkins Diet on Lipid Profiles in Adults With Epilepsy. Nutritional Neuroscience, 19 (3), 131-137.
• Çetin, B., Köksal, G., Çelik, F., & Topçu, M. (2013). Epilepsi hastası çocuklarda ketojenik diyetin epileptik nöbet sayısı üzerine etkisi. Beslenme ve Diyet Dergisi, 41 (1), 27-34.
• Dünya Sağlık Örgütü (DSÖ). (1 Nisan, 2022). Epilepsi. https://www.who.int/news-room/fact-sheets/detail/epilepsy.
• Green, S.F, Nguyen, P, Kaalund-Hansen, K, Rajakulendran, S, Murphy, E. (2020). Effectiveness, Retention, and Safety of Modified Ketogenic Diet in Adults With Epilepsy at a Tertiary-Care Centre in the UK. Journal of Neurology. 267 (4), 1171–1178.
• Goswami, J.N., & Sharma, S. (2019). Current Perspectives On The Role Of The Ketogenic Diet In Epilepsy Management. Neuropsychiatric Disease and Treatment, 15, 3273-3285.
• Ilgaz, F., Günbey, C., Ardıçlı, D., Yalnızoğlu, D., & Topçu, M. (2019). Dirençli epilepside düşük glisemik indeksli diyet tedavisi: Olgu Sunumu. Beslenme ve Diyet Dergisi, 7 (2), 108-113.
• Karimzadeh, P., Sedighi, M., Beheşti, M., Azargashb, E., Ghofrani, M., & Abdollahe-Gorgi, F. (2014). Low Glycemic Index Treatment in pediatric refractory epilepsy: The first Middle East report. Seizure, 23 (7), 570-572.
• Kim, J. A., Yoon, J. R., Lee, E. J., Lee, J. S., Kim, J. T., Kim, H. D., & Kang, H. C. (2016). Efficacy of the classic ketogenic and the modified Atkins diets in refractory childhood epilepsy. Epilepsia, 57 (1), 51-58.
• Kim, S.H., Kang, H.C., Lee, E.J., Lee, J.S., & Kim, H.D. (2017). Low glycemic index treatment in patients with drug-resistant epilepsy. Brain and Development, 39 (8), 687-692.
• Kozioł, M., Czuczwar, S.J., Januszewski, S., & Pluta, R. (2019). Ketogenic Diet and Epilepsy. Nutrients, 11 (10), 2510.
• Kumru, B., & Dai, A. (2019). Dirençli Epilepsi Tedavisinde Modifiye Atkins Diyeti Uygulaması: Olgu Sunumu. Beslenme ve Diyet Dergisi, 47 (3), 109-113.
• Lee, H., Chi, C., & Liao, J. (2018). Use of Cooking Oils in a 2:1 Ratio Classical Ketogenic Diet for Intractable Pediatric Epilepsy: Long-term Effectiveness and Tolerability. Epilepsy Research, 147, 75-79.
• Lin, K. L., Lin, J. J., & Wang, H. S. (2020). Application of ketogenic diets for pediatric neurocritical care. Biomedical journal, 43 (3), 218-225.
• Lyons, L., Schoeler, N. E., Langan, D., & Cross, J. H. (2020). Use of ketogenic diet therapy in infants with epilepsy: a systematic review and meta-analysis. Epilepsia, 61(6), 1261-1281.
• McDonald, T.J.W., Henry-Barron, B.J., Felton, E.A., Vizthum, D., Kossoff, E.H., & Cervenka, M.C. (2018). Improving Compliance in Adults With Epilepsy on a Modified Atkins Diet: A Randomized Trial. Seizure, 60, 132-138.
• Meira, I.A., Romao, T.T., Prado, H.J., Krüger, L.T., Pires, M.E., & Conceiçao, P.O. (2019). Ketogenic diet and epilepsy: What we know so far. Frontiers in neuroscience, 29 (13), 2-5.
• Miranda, M. J., Mortensen, M., Povlsen, J.H., Nielsen, H., & Beniczky, S. (2011). Danish Study of a Modified Atkins Diet for Medically İntractable Epilepsy in Children: Can We Achieve the Same Results as With the Classical Ketogenic Diet? Seizure, 20 (2), 151-155.
• Molteberg, E., Thorsby, P. M., Kverneland, M., Iversen, P. O., Selmer, K. K., Nakken, K. O., & Taubøll, E. (2020). Effects of modified Atkins diet on thyroid function in adult patients with pharmacoresistant epilepsy. Epilepsy & Behavior, 111, 107285.
• Muzykewicz, D. A., Costello, D. J., Halpern, E. F., & Thiele, E. A. (2009). Infantile spasms in tuberous sclerosis complex: prognostic utility of EEG. Epilepsia, 50 (2), 290-296.
• Neal, E.G, Chae, H., Schwartz, R.H, Lawson, M.S, Edwards, N, Fitzsimmons, G., Whitney, A., & Cross, J.H. (2009). A randomized trial of classical and medium-chain triglyceride ketogenic dietsin the treatment of childhood epilepsy. Epilepsia, 50 (5), 1109-1117.
• Uyar, G.Ö., & Şanlıer, N. (2018). Çocukluk Çağı Dirençli Epilepsilerinde Ketojenik Diyet Uygulamalarının Etkisi. Turk Noroloji Dergisi, 24 (3), 216.
• Raju, K., Gulati, S., Kabra, M., Agarwala, A., Sharma, S., Pandey, R.M., & Kalra, R. (2011). Efficacy of 4:1 Versus 2.5:1 Ketogenic Ratio Diets in Refractory Epilepsy in Young Children: A Randomized Open Labeled Study. Epilepsy Research, 96 (1-2), 96-100.
• Sampaio, L.P. (2016). Ketogenic diet for epilepsy treatment. Arquivos de Neuro-psiquiatria, 74 (10), 1678-1685.
• Schoeler, N.E., Simpson, Z., Whiteley, V.J., Nguyen, P., Meskell, R., Lightfoot, K., Martin-McGill, K.J., Olpin, S., & Ivison, F. on behalf of the Ketogenic Dietitians Research Network (KDRN). (2020). Biochemical assessment of patients following ketogenic diets for epilepsy: Current practice in the UK and Ireland. Epilepsia Open, 5 (1), 73-79.
• Seo, J., Lee, Y., Lee, J., Kang,, H., & Kim H. (2007). Efficacy and Tolerability of the Ketogenic Diet According to Lipid: Nonlipid Ratioscomparison of 3:1 with 4:1 Diet. Epilepsia, 48 (4), 801-805.
• Sondhi, V., Agarwala, A., Pandey, R., Chakrabarty, B., Jauhari, P., Lodha, R., Toteja, G.S., Sharma, S., Paul, V.K., Kossoff, E., & Gulati, S. (2020). Efficacy of Ketogenic Diet, Modified Atkins Diet, and Low Glycemic Index Therapy Diet Among Children With Drug-Resistant Epilepsy: A Randomized Clinical Trial. JAMA Pediatics, 174 (10), 944-951.
• Titre-Johnson, S., Schoeler, N., Eltze, C., Williams, R., Vezyroglou, K., McCullagh, H., Freemantle, N., Heales, S., Kneen, R., Marston, L., Martland, T., Nazareth, I., Neal, E., Lux, A., Parker, A., Agrawal, S., Fallon, P., & Cross, C.H. (2017). Ketogenic Diet in the Treatment of Epilepsy in Children Under the Age of 2 Years: Study Protocol for a Randomised Controlled Trial. Trials, 18 (1), 195.
• Ünalp, A. (2017). Çocukluk çağı epilepsilerinde ketojenik diyet uygulamaları. İzmir Dr. Behçet Uz Çocuk Hast. Dergisi, 7 (3), 169-177.
• Ünalp, A., Gürbüz, G., Edızer, S., Toklu Baysal, B., Akışın, Z., Köse, M., Çalık, T., & Yılmaz, Ü. (2018). Üçüncü basamak bir çocuk hastanesindeki ketojenik diyet ekibinin ketojenik diyet tedavisi deneyimleri. Journal of Dr. Behcet Uz Children's Hospital, 8 (3), 175-183.
• Wells, J., Swaminathan, A., Paseka, J., & Hanson, C. (2020). Efficacy and Safety of a Ketogenic Diet in Children and Adolescents with Refractory Epilepsy-A Review. Nutrients, 12 (6), 1809.
• Wheless, J. W. (2001). The ketogenic diet: an effective medical therapy with side effects. Journal of child neurology, 16 (9), 633-635.
• Zhu, D., Wang, M., Wang, J., Yuan, J,, Niu, G., Zhang, G., Sun, L., Xiong, H., Xie, M., & Zhao, Y. (2016). Ketogenic Diet Effects on Neuro Development of Children With Intractable Epilepsy: A prospective study. Epilepsy Behavior, 55, 87-91.