Ketogenic diets and childhood epilepsy

Balcı M. C.

Pediatric epileptology, selçuk apak,burak tatlı, Editör, Nobel Tıp Kitapevi, İstanbul, ss.310-326, 2024

  • Yayın Türü: Kitapta Bölüm / Mesleki Kitap
  • Basım Tarihi: 2024
  • Yayınevi: Nobel Tıp Kitapevi
  • Basıldığı Şehir: İstanbul
  • Sayfa Sayıları: ss.310-326
  • Editörler: selçuk apak,burak tatlı, Editör
  • İstanbul Üniversitesi Adresli: Evet

Özet

First used in 1921 at a time when there were few options for the treatment of epilepsy, ketogenic diet therapies (KDT) have become long-standing treatments for individuals with drug-resistant epilepsy. Although used in children and adults for a considerable time, the prevalence of KDT decreased with the advent of antiepileptic drugs.For the treatment of epilepsy, different age groups, from infants to adults, can benefit from KDT. Since infants are known to have difficulties maintaining ketosis while meeting their growth needs for years, KDT was not recommended for children < two years of age. However, a recent case report shows that KDT is safe and effective for infants < six weeks of age.7 In fact, there is evidence that children < two years of age may be an ideal population for KDT. Guidelines were created in Europe covering the use of KDT in infants .Patients on KDT should be monitored regularly by both a dietitian and a neurologist. Children should be clinically evaluated to ensure correct administration of KDT one month after the start of treatment. Afterward, polyclinic evaluation should be made at 3, 6, 9, and 12 months, and the family should be contacted intermittently. Follow-up of children younger than one year should be done at even more frequent intervals. After the first year of diet therapy, outpatient evaluation can be done every six months by telephone or e-mail in the interim period.

BPatients on KDT should be monitored regularly by both a dietitian and a neurologist. Children should be clinically evaluated to ensure correct administration of KDT one month after the start of treatment. Afterward, polyclinic evaluation should be made at 3, 6, 9, and 12 months, and the family should be contacted intermittently. Follow-up of children younger than one year should be done at even more frequent intervals. After the first year of diet therapy, outpatient evaluation can be done every six months by telephone or e-mail in the interim period.
 Because urine ketones can be lower in the morning and higher in the evening, parents should check them at home several times a week, preferably at different times of the day. Some studies suggest that the serum beta-hydroxybutyrate level may more closely parallel seizure control. Measurement of serum ketone levels provides more accurate results but is more expensive and requires an interventional procedure. Monitoring of serum beta-hydroxybutyrate levels in infancy is recommended and may be performed when urinary ketone monitoring does not clinically correlate with seizure control or shows inexplicable fluctuations