Dieta cetogénica en epilepsia refractaria: Eficacia, evolución y complicaciones a largo plazo

Abstract

Ketogenic Diet in Refractory Epilepsy: efficacy, evolution and long-term complicationsBackground: Ketogenic diet (KD) represents an alternative in treatment of refractory epilepsy (RE). Objective: To evaluate the efficacy of the diet and the frequency of complications in patients belonging to the KD Program from Luis Calvo Mackenna Children's Hospital (HLCM). Methods: Evaluation of all children enrolled in the program between 1999 and 2004, with analysis every 6 months of the diet efficacy, digestive tolerance, nutritional status, cholesterol levels and nephrolithiasis. Results: 21 children were admitted, 14 boys, age between 6 months -17 years-old. 76%, 71% and 67% of patients followed KD at 6, 12 and 18 months, respectively, with KD efficacy of 67%. At 12 months, 24% of patients did not present seizures. At 18 months, 85% remained close to ideal body weight (15% obesity) and height/age Z score decreased (-0,7 ± 0,4; p < 0,05). Total cholesterol significantly increased at 6 months (64% hypercholesterolemia; decreased to 15% at 18 months). 2 patients developed nephrolithiasis. Conclusions:The study shows high efficacy of the KD for treatment of refractory epilepsy, with low rate of complications. It should be considered as a therapeutic alternative for these patients. (

biochemistry of ketogenesis and its role in weight management, neurological disease and oxidative stress

“…Early GLUT1-DS treatment should include the KD because it may improve neurophysiological functions like alertness, cognitive capacity, quality of life, and physical resilience. In more than 90% of cases, it may also (Raimann et al, 2007) stabilise bioenergy profiles and ameliorate nonepileptic paroxysmal manifestations (Ramm-Pettersen et al, 2014). Similar findings were also reported by Taylor et al (2018) and Nakamura et al, (2017).…”

Nutrición del Niño con Enfermedades Neurológicas Prevalentes: An Update

“…Esta dieta está indicada en pacientes con epilepsia refractaria o intratable en la que no hay respuesta al tratamiento con anticonvulsivantes. Su efi cacia está defi nida por una disminución de las convulsiones mayor a 50%, siendo entre 51 a 67% en seguimientos a 12 meses 39,40 . El mecanismo por el cual se produce este efecto es aun desconocido; se han planteado varias hipótesis: aumento de los niveles de ácido gamma-amino butírico (GABA) principal aminoácido inhibidor del SNC; acciones inhibitorias directas de los ácidos grasos; cambio del pH a nivel cerebral o alteraciones de los neurotransmisores 41 .…”

“…Sus principales complicaciones son intolerancia gastrointestinal, litiasis renal y dislipidemias 40,42 . La adherencia a la dieta es una difi cultad para el paciente y la familia existiendo nuevas alternativas que permiten mayor variabilidad de alimentos.…”

Dieta Cetogénica en el paciente con epilepsia refractaria

“…Varios estudios describen que la correcta utilización de DC en sujetos con ER disminuye al menos un 50% el número de crisis en la mitad de los pacientes tratados y una reducción de más del 90% de las convulsiones en un tercio de ellos 12,[16][17][18][19][20][21] .…”