Bilge ÇETİN, Gülden KÖKSAL, Fatma ÇELİK, Meral TOPÇU

Epilepsi Hastası Çocuklarda Ketojenik Diyetin Epileptik Nöbet Sayısı Üzerine Etkisi

Amaç: Ketojenik diyet (KD), ilaca dirençli epilepsi nöbetlerinde alternatif bir tedavi yöntemi olarak öne sürülen, yüksek yağ, düşük karbonhidrat ve yeterli protein içeriğine sahip bir diyet tedavisidir. Diyetle alınan karbonhidratların sınırlanması ile oluşan ketonların beyinde çeşitli etki mekanizmaları ile epileptik nöbetleri azalttığı düşünülmektedir. Bu çalışma, dirençli epilepsi hastası çocuklarda ketojenik diyetin haftalık nöbet sayısı, vücut ağırlığı ve bazı biyokimyasal bulgular üzerindeki etkisini değerlendirmek amacıyla yürütülmüştür. Bireyler ve Yöntem: Çalışmaya dirençli epilepsi tanısı almış, haftalık nöbet sayısı7≤ olan ve en az 2 antiepileptik ilaç denenmesine rağmen nöbetleri kontrol altına alınamayan 2-18 yaş arası toplam 11 hasta dahil edilmiştir. Çalışma grubundaki 11 hastaya 3 ay süre ile yaş ve ideal ağırlıklarına uygun hazırlanan ketojenik diyet (enerjinin %80i yağ, %10u protein, %10u karbonhidrat) verilmiş, çalışmanın başında ve çalışma süresince hastalardan nöbet kayıtları alınmıştır. Ayrıca diyetin başında ve sonunda hastaların vücut ağırlıkları ve bazı biyokimyasal bulguları alınarak, tedavi sürecinde meydana gelen değişimler değerlendirilmiştir. Bulgular: Üç aylık diyet tedavisi sonunda araştırmaya katılan çocuklarda haftalık ortalama nöbet sayısının yaklaşık %55.0 oranında azaldığı belirlenmiştir (p

The Survey of Ketogenic Diets Effects Upon the Number of Seizures on Epileptic Children

Aim: Ketogenic diet (KD) is a high fat diet which is restricted in carbohydrate and adequate in protein and serves as an alternative treatment for refractory epilepsy. The ketones arise due to restriction of dietary carbohydrates and lead to a decrease in seizure frequency by various mechanisms of action on brain. This study was conducted to evaluate the effects of ketogenic diet on weekly seizure frequency, body weight and some biochemical parameters in children diagnosed with refractory epilepsy. Subjects and Methods: A total of 11 children between the ages of 2-18 year who were having more than 7 seizures per week and experienced a treatment failure with more than 2 antiepileptic drugs. Ketogenic diet adjusted to age and ideal body weight (80% of calories from fat, 10% from protein and 10% from carbohydrates) was applied for 3 months and weekly seizure records were collected at baseline and during study period. Some biochemical parameters and body weights were also recorded at baseline and after 3 months in order to assess the difference caused by the diet therapy. Results: At the end of 3 months, number of weekly seizures decreased significantly by 55.0% (p<0.05). Response to diet therapy (a decrease more than 50%) was 45.5% while two children became seizure free. It was found that children experienced a 7.0% weight loss during the KD treatment (p<0.05). Finally, after 3 months treatment, total cholesterol (12.5%), LDL-cholesterol (8.0%) and triglycerides (16.6%) were increased and AST (-10.7%), serum calcium (-6.9%), serum albumin (-10.5%) and hemoglobin (-2.1%) levels were decreased significantly. Conclusion: The results of this study supported the finding that ketogenic diet is effective in refractory epilepsy by reducing the number of seizures.

PDF

___

1. Neal L, McGrath G. Ketogenic Diets. In: Shaw V, Lawson M, editors. Clinical Paediatric Dietetics. 3rd ed. Oxford: Blackwell Publishing; 2007. p. 295-309.
2. Neal EG, Cross JH. Efficacy of dietary treatments for epilepsy. J Hum Nutr Diet 2010;23(2):113-119.
3. Kossoff EH, Freeman JM, Turner Z, Rubenstein JE. Ketogenic Diets: Treatment for Epilepsy and Other Disorders, fifth edition. demos HEALTH, New York, 2011.
4. Barañano KW, Hartman AL. The ketogenic diet: uses in epilepsy and other neurologic illnesses. Curr Treat Options Neurol 2008;10(6):410-419.
5. Bough KJ, Rho JM. Anticonvulsant mechanisms of the ketogenic diet. Epilepsia 2007;48(1):43-58.
6. Hartman AL, Gasior M, Vining EP, Rogawski MA. The neuropharmacology of the ketogenic diet. Pediatr Neurol 2007;36(5):281-292.
7. Kossoff EH, Pyzik PL, McGrogan JR, Vining EP, Freeman JM. Efficacy of the ketogenic diet for infantile spasms. Pediatrics 2002;109:780–783.
8. DiMario FJ Jr, Holland J. The ketogenic diet: a review of the experience at Connecticut Children’s Medical Center. Pediatr Neurol 2002;26:288–292.
9. Coppola G, Veggiotti P, Cusmai R, Bertoli S, Cardinali S, Dionisi-Vici C, et al. The ketogenic diet in children, adolescents and young adults with refractory epilepsy: an Italian multicentric experience. Epilepsy Res 2002;48:221.
10. Nordli DR Jr, Kuroda MM, Carroll J, Koenigsberger DY, Hirsch LJ, Bruner HJ, et al. Experience with the ketogenic diet in infants. Pediatrics 2001;108:129–133.
11. Maydell BV, Wyllie E, Akhtar N, Kotagal P, Powaski K, Cook K, et al. Efficacy of the ketogenic diet in focal versus generalized seizures. Pediatr Neurol 2001;25:208–212.
12. Lefevre F, Aronson N. Ketogenic diet for the treatment of refractory epilepsy in children: a systematic review of efficacy. Pediatrics 2000;105:46.
13. Vining EP. Clinical efficacy of the ketogenic diet. Epilepsy Res 1999;37:181–190.
14. Hassan AM, Keene DL, Whiting SE, Jacob PJ, Champagne JR, Humphreys P. Ketogenic diet in the treatment of refractory epilepsy in childhood. Pediatr Neurol 1999;21:548–352.
15. Vining EP, Freeman JM, Ballaban-Gil K, Camfield CS, Camfield PR, Holmes GL, et al. A multicenter study of the efficacy of the ketogenic diet. Arch Neurol 1998;55:1433–1437.
16. Freeman JM, Vining EP, Pillas DJ, Pyzik PL, Casey JC, Kelly LM. The efficacy of the ketogenic diet-1998: a prospective evaluation of intervention in 150 children. Pediatrics 1998;102:1358–1363.
17. Batchelor L, Nance J, Short B. An interdisciplinary team approach to implementing the ketogenic diet for the treatment of seizures. Pediatr Nurs 1997;23:465– 471.
18. Kossoff EH, Zupec-Kania BA, Amark PE, BallabanGil KR, Christina Bergqvist AG, Blackford R, et al. Optimal clinical management of children receiving the ketogenic diet: recommendations of the international ketogenic diet study group. Epilepsia 2009;50(2):304- 317.
19. Mady MA, Kossoff EH, McGregor AL, Wheless JW, Pyzik PL, Freeman JM. The ketogenic diet: adolescents can do it, too. Epilepsia 2003;44:847–851.
20. Kang CH, Kim JY, Kim DW, Kim DH. Efficacy and safety of the ketogenic diet for intractable childhood epilepsy: Korean Multicentric Experience. Epilepsia 2005;46(2):272-279.
21. Kosoff EH. More fat and fewer seizures: Dietary therapies for epilepsy. The Lancet Neurology 2004;3:415-420.
22. Couch SC, Schwarzman F, Carroll J, Koenigsberger D, Nordli DR, Deckelbaum RJ, et al. Growth and nutritional outcomes of children treated with the ketogenic diet. J Am Diet Assoc 1999;99(12):1573-1575.
23. Vining EP, Pyzik P, McGrogan J, Hladky H, Anand A, Kriegler S, et al. Growth of children on the ketogenic diet. Dev Med Child Neurol 2002;44(12):796-802.
24. Williams S, Basualdo-Hammond C, Curtis R, Schuller R. Growth retardation in children with epilepsy on the ketogenic diet: a retrospective chart review. J Am Diet Assoc 2002;102(3):405-457.
25. Liu YM, Williams S, Basualdo-Hammond C, Stephens D, Curtis R. A prospective study: growth and nutritional status of children treated with the ketogenic diet. J Am Diet Assoc 2003;103(6):707-712.
26. Peterson SJ, Tangney CC, Pimentel-Zablah EM, Hjelmgren B, Booth G, Berry-Kravis E. Changes in growth and seizure reduction in children on the ketogenic diet as a treatment for intractable epilepsy. J Am Diet Assoc 2005;105(5):718-725.
27. Neal EG, Chaffe HM, Edwards N, Lawson MS, Schwartz RH, Cross JH. Growth of children on classical and medium-chain triglyceride ketogenic diets. Pediatrics 2008;122(2):334-340.
28. Levy R, Cooper P. Ketogenic diet for epilepsy. Cochrane Database Syst Rev 2003;3:CD001903.
29. Keene DL. A systematic review of the use of the ketogenic diet in childhood epilepsy. Pediatr Neurol 2006;35(1):1-5.
30. Henderson CB, Filloux FM, Alder SC, Lyon JL, Caplin DA. Efficacy of the ketogenic diet as a treatment option for epilepsy: meta-analysis. J Child Neurol 2006;21(3):193-198.
31. Neal EG, Chaffe H, Schwartz RH, Lawson MS, Edwards N, Fitzsimmons G, et al. The ketogenic diet in the treatment of epilepsy in children: a randomised, controlled trial. Lancet Neurol 2008;7:500–506.
32. Neal EG, Chaffe H, Schwartz RH, Lawson MS, Edwards N, Fitzsimmons G, et al. A randomised trial of classical and medium-chain triglyceride ketogenic diets in the treatment of childhood epilepsy. Epilepsia 2009;50:1109–1117.
33. Levy RG, Cooper PN, Giri P. Ketogenic diet and other dietary treatments for epilepsy. Cochrane Database Syst Rev 2012 Mar 14;3: CD001903.
34. Kang HC, Chung DE, Kim DW, Kim HD. Early and late-onset complications of ketogenic diet for intractable epilepsy. Epilepsia 2004;45:1116-1123.
35. Lee PR, Kossoff EH. Dietary treatments for epilepsy: management guidelines for the general practitioner. Epilepsy Behav 2011;21(2):115-121.
36. Bergqvist AG. Long-term monitoring of the ketogenic diet: Do’s and Don’ts. Epilepsy Res 2012;100(3):261- 266.
37. Alaei M, Ghazavi M, Mahvelati F, Karimzadeh P, Shiva M, Tonekaboni SH. The effect of the ketogenic diet on the growth and biochemical parameters of the children with resistant epilepsy. Iranian Jour of Child Neurol 2010;3(4):41-44.