Dirençli Epilepsi Tedavisinde Modifiye Atkins Diyeti Uygulaması: Olgu Sunumu

Ketojenik diyet; yüksek miktarda yağ, düşük miktarda karbonhidrat ve orta derecede protein içeren ve enerji kaynağı olarak karbonhidratlar yerine yağların kullanılmasını sağlayan bir diyettir. Yağların yıkılması sonucu ortaya çıkan ketonların beyne yaptığı bir etki mekanizması sayesinde epilepsi nöbetlerin azaldığı düşünülmektedir. Dirençli epilepside modifiye Atkins diyeti (MAD) ilk olarak 2003 yılında John Hopkins Hastanesi’nde geliştirilmiştir. MAD’de karbonhidrat alımı 10-20 g/gün iken enerji, protein, yağ (enerjinin yaklaşık %75’i) kısıtlaması yoktur ve hastalarda nöbet kontrolünü sağladığını gösteren çalışmalar mevcuttur. MAD, klasik ketojenik diyete göre daha az kısıtlayıcı ve uygulaması daha kolay olduğundan büyük çocuklar ve yetişkinlerde sıklıkla kullanılmaktadır. Bu olgu sunumunda, dirençli epilepsisi olan hastaya uygulanan MAD’nin nöbetler üzerindeki etkinliği incelenmiştir. Diyet tedavisine başladıktan 2 ay sonra nöbetler kesilmiştir ve ciddi bir yan etki görülmemiştir. İlaca yanıt vermeyen dirençli epilepsi hastalarında MAD sağlık profesyonellerinin gözetimi altında uygulanarak etkin bir tedavi seçeneği olarak görülebilir.

Modified Atkins Diet for the Treatment of Resistant Epilepsy: Case Report

Ketogenic diet is a high fat, low carbohydrate diet with moderate amounts of protein which leads the body to use fat as the major source of energy instead of carbohydrates. It is suggested that epileptic seizures can be reduced by a mechanism of action of ketones, which are produced by the breakdown of fats, to the brain. Modified Atkins diet (MAD) was first developed in 2003 at John Hopkins Hospital as a treatment option for refractory epilepsy. Carbohydrate intake is limited to 10 to 20 g/day in MAD, and studies showed that seizure control is achieved although there are no restrictions on calories, protein and fat (approximately 75% of daily calories). It is frequently used in older children and adolescents as it is less restrictive and easy to use compared with classic ketogenic diet. In this case report, the efficacy of MAD on seizure control in a patient with resistant epilepsy was presented. Two months after initiation of the diet, patient became seizure-free and no serious side effects were observed. In patients with resistant epilepsy who do not respond to medications, MAD applied under the supervision of health professionals may be used as an effective treatment option.

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Luat AF, Coyle L, Kamat D. The ketogenic diet: A practical guide for pediatricians. Pediatr Ann. 2016;45(12):e44650.
deCampo DM, Kossoff EH. Ketogenic dietary therapies for epilepsy and beyond. Curr Opin Clin Nutr Metab Care. 2019;22(4):264-8.
Kossoff EH, Zupec-Kania BA, Auvin S, Ballaban-Gil KR, Christina Bergqvist AG, Blackford R, et al. Optimal clinical management of children receiving dietary therapies for epilepsy: Updated recommendations of the International Ketogenic Diet Study Group. Epilepsia Open. 2018;3(2):175-92.
Sharma S, Jain P. The Modified Atkins Diet in Refractory Epilepsy. Epilepsy Res Treat. 2014;2014:1-6.
Kossoff EH, Dorward JL. The Modified Atkins Diet. Epilepsia. 2008;49(Suppl 8):37-41.
Fitzsimmons G, Sewell M. Ketogenic Diets. In: Clinical Paediatric Dietetics. John Wiley & Sons, Ltd; 2014. p. 354-80.
Freeman JM, Vining EPG, Kossoff EH, Pyzik PL, Ye X, Goodman SN. A blinded, crossover study of the efficacy of the ketogenic diet. Epilepsia. 2009;50(2):322-5.
Sharma S, Goel S, Jain P, Agarwala A, Aneja S. Evaluation of a simplified modified Atkins diet for use by parents with low levels of literacy in children with refractory epilepsy: A randomized controlled trial. Epilepsy Res. 2016;127:152-9.
George R, Salinsky M, Kuzniecky R, Rosenfeld W, Bergen D, Tarver WB, et al. Vagus nerve stimulation for treatment of partial seizures: 3. Long-term followup on first 67 patients exiting a controlled study. First International Vagus Nerve Stimulation Study Group. Epilepsia. 35(3):637-43.
Kossoff EH. More fat and fewer seizures: dietary therapies for epilepsy. Lancet Neurol. 2004;3(7):415-20.
Kossoff EH, McGrogan JR, Bluml RM, Pillas DJ, Rubenstein JE, Vining EP. A modified Atkins diet is effective for the treatment of intractable pediatric epilepsy. Epilepsia. 2006;47(2):421-4.
Chen W, Kossoff EH. Long-Term follow-up of children treated with the modified Atkins diet. J Child Neurol. 2012;27(6):754-8.