Turkiye Klinikleri Journal of Health Sciences

.: REVIEW
Epilepside Diyet Tedavisine Güncel Yaklaşımlar
Current Approaches to Diet Therapy in Epilepsy
Zeynep CAFEROĞLUa
aBeslenme ve Diyetetik Bölümü, Erciyes Üniversitesi Sağlık Bilimleri Fakültesi, Kayseri, TÜRKİYE
Turkiye Klinikleri J Health Sci. 2019;4(3):333-47
doi: 10.5336/healthsci.2018-64515
Article Language: TR
Full Text
ÖZET
 Epilepsi, her yaştan insanı etkileyen kronik bir beyin hastalığıdır. Dünya genelinde yaklaşık 50 milyon insanın epilepsisi vardır ve bu da epilepsiyi dünyadaki en yaygın nörolojik hastalıklardan biri yapmaktadır. Epilepsi tedavisinde hedef, nöbet sıklığını ve şiddetini azaltmak, mümkünse tam nöbet kontrolü sağlamak, tekrarlayan nöbetlerin oluşturacağı hasarları önlemek, hastanın günlük aktivitelerini yapabilmesini sağlamaktır. Çoğu nöbet bir veya daha fazla anti-epileptik ilaç kullanılarak kontrol altına alınabilmektedir, ancak bir süre sonra bu ilaçlar nöbetler için yararlı olmayabilir ve bu durum, ilaca dirençli epilepsi olarak adlandırılmaktadır. Dirençli epilepsisi olan bireyler için, özel diyet tedavileri düşünülebilir. Hipokrat zamanından günümüze epilepsi tedavisinde çeşitli diyetler kullanılmış olup, güncel literatürde kabul gören yaklaşım yüksek yağ ve düşük karbonhidrat içeriğine sahip olan ketojenik diyetlerdir. Ketojenik diyetlerin nöbet sıklığını azalttığı öne sürülmektedir. Farklı tipleri bulunan (klasik ketojenik diyet, MCT diyeti, modifiye MCT diyeti gibi) diyet tedavileri arasında, özellikle odifiye Atkins diyeti olmak üzere daha az kısıtlayıcı olan ketojenik diyetlere ilgi son zamanlarda artmıştır. Ayrıca, diyete omega-3 yağ asitlerinin eklenmesi, lizin kısıtlaması veya magnezyum desteği yapılması ve ketojenik parenteral nütrisyon gibi yeni diyet yaklaşımları ile ilgili araştırmalar da mevcuttur. Bu derlemede, epilepsi tedavisinde kullanılan ketojenik diyet tipleri, nöbet kontrolündeki etkinlikleri, etki mekanizmaları ve olası yan etkileri ile diğer diyet tedavisi yaklaşımlarının açıklanması amaçlanmıştır.

Anahtar Kelimeler: İlaca dirençli epilepsi; ketojenik diyet; glisemik indeks; omega-3 yağ asidleri
ABSTRACT
 Epilepsy is a chronic brain disease that affects people of all ages. Approximately 50 million people worldwide have epilepsy, making it one of the most common neurological diseases in the world. The goal of the epilepsy treatment is to reduce the frequency and severity of the seizure, to ensure full seizure control if possible, to prevent the damage caused by recurrent seizures, to enable the patient to perform daily activities. Most seizures can be controlled using one or more anti-epileptic drugs, however after a while these drugs may not be useful for seizures, and this is called drug-resistant epilepsy. For individuals with resistant epilepsy, special dietary treatments may be considered. Various diets have been used in the epilepsy treatment from the time of Hippocrates to the present, and the approach adopted in the current literature is ketogenic diets with high fat and low carbohydrate content, and it is suggested that these diets reduce the frequency of seizures. Among the dietary treatments with different types (such as a classic ketogenic diet, MCT diet, modified MCT diet), interest in less restrictive ketogenic diets, especially the modified Atkins diet, has recently increased. There are also researches on new dietary approaches such as dietary supplementation of omega-3 fatty acids, lysine restriction or magnesium supplementation and ketogenic parenteral nutrition. In this review, it is aimed to explain the ketogenic diet types used in the epilepsy treatment, their effectiveness in seizure control, their mechanisms of action and possible adverse effects, and other dietary treatment approaches.

Keywords: Drug resistant epilepsy; ketogenic diet; glycemic index; omega-3 fatty acids
REFERENCES:
  1. Karadakovan A. [Nervous system diseases]. Karadakovan A, Aslan FT, editorler. Dahili ve Cerrahi Hastaliklarda Bakim. 2. Baski. Adana: Nobel Kitapevi; 2011. p.1193-7.
  2. World Health Organization. Epilepsy. Fact sheets. 8 February 2018.
  3. Turkdogan D. [Epilepsy treatment]. Aysun S, Anlar B, Altunbasak S, Dede G, Serdaroglu A, editorler. Cocuk Noroloji. 1. Baski. Ankara: Alp Ofset Matbaacilik; 2006. p.373-86.
  4. Gul G, Cokar O. [Therapeutic approach in patient with epilepsy]. Yeni N, Gurses C, editorler. Epilepsi Calisma Grubu Tani ve Tedavi Rehberi 2015. Akara: Turk Noroloji Dernegi; 2015. p.27-33.
  5. Martin K, Jackson CF, Levy RG, Cooper PN. Ketogenic diet and other dietary treatments for epilepsy. Cochrane Database Syst Rev. 2016;2:CD001903. [Crossref] 
  6. Ozenoglu A, Sokulmez P. [Nutritional therapy in neurological diseases]. Alphan MET, editor. Hastaliklarda Beslenme Tedavisi. 1. Baski. Ankara: Hatipoglu Yayinevi; 2013. p.745-806.
  7. Kossoff EH, Wang HS. Dietary therapies for epilepsy. Biomed J. 2013;36(1):2-8. [Crossref]  [PubMed] 
  8. Kessler SK, Neal EG, Camfield CS, Kossoff EH. Dietary therapies for epilepsy: future research. Epilepsy Behav. 2011;22(1):17-22. [Crossref]  [PubMed]  [PMC] 
  9. Kverneland M, Molteberg E, Iversen PO, Veierod MB, Tauboll E, Selmer KK, et al. Effect of modified Atkins diet in adults with drug-resistant focal epilepsy: a randomized clinical trial. Epilepsia. 2018;59(8):1567-76. [Crossref]  [PubMed] 
  10. Neal EG, Cross JH. Efficacy of dietary treatments for epilepsy. J Hum Nutr Diet. 2010;23(2):113-9. [Crossref]  [PubMed] 
  11. Payne NE, Cross JH, Sander JW, Sisodiya SM. The ketogenic and related diets in adolescents and adults--a review. Epilepsia. 2011;52(11):1941-8. [Crossref]  [PubMed] 
  12. Levy RG, Cooper PN, Giri P. Ketogenic diet and other dietary treatments for epilepsy. Cochrane Database Syst Rev. 2012;14(3):CD001903. [Crossref] 
  13. Lefevre F, Aronson N. Ketogenic diet for the treatment of refractory epilepsy in children: a systematic review of efficacy. Pediatrics. 2000;105(4):E46. [Crossref]  [PubMed] 
  14. Keene DL. A systematic review of the use of the ketogenic diet in childhood epilepsy. Pediatr Neurol. 2006;35(1):1-5. [Crossref]  [PubMed] 
  15. 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):193-8.
  16. Kim JA, Yoon JR, Lee EJ, Lee JS, Kim JT, Kim HD, et al. Efficacy of the classic ketogenic and the modified Atkins diets in refractory childhood epilepsy. Epilepsia. 2016;57(1):51-8. [Crossref]  [PubMed] 
  17. Sariego-Jamardo A, Garcia-Cazorla A, Artuch R, Castejon E, Garcia-Arenas D, Molero-Luis M, et al. Efficacy of the ketogenic diet for the treatment of refractory childhood epilepsy: cerebrospinal fluid neurotransmitters and amino acid levels. Pediatr Neurol. 2015;53(5):422-6. [Crossref]  [PubMed] 
  18. Likhodii S, Nylen K, Burnham WM. Acetone as an anticonvulsant. Epilepsia. 2008;49 Suppl 8:83-6. [Crossref]  [PubMed] 
  19. Masino SA, Rho JM. Mechanisms of ketogenic diet action. In: Noebels JL, Avoli M, Rogawski MA, eds. Jasper's Basic Mechanisms of the Epilepsies. 4th ed. Bethesda (MD): National Center for Biotechnology Information (US); 2012. p.1483-515. [Crossref] 
  20. Fuehrlein BS, Rutenberg MS, Silver JN, Warren MW, Theriaque DW, Duncan GE, et al. Differantial metabolic effects of saturated versus polyunsaturated fats in ketogenic diets. J Clin Endocrinol Metab. 2004;89(4):1641-5. [Crossref]  [PubMed] 
  21. Fraser DD, Whiting S, Andrew RD, Macdonald EA, Musa-Veloso K, Cunnane SC. Elevated polyunsaturated fatty acids in blood serum obtained from children on the ketogenic diet. Neurology. 2003;60(6):1026-9. [Crossref]  [PubMed] 
  22. Schlanger S, Shinitzky M, Yam D. Diet enriched with omega-3 fatty acids alleviates convulsion symtoms in epilepsy patients. Epilepsia. 2002;43(1):103-4. [Crossref]  [PubMed] 
  23. Cheng CM, Hicks K, Wang J, Eagles DA, Bondy CA. Caloric restriction augments brain glutamic acid decarboxylase-65 and -67 expression. J Neurosci Res. 2004;77(2):270-6. [Crossref]  [PubMed] 
  24. Cardenas-Rodriguez N, Huerta-Gertrudis B, Rivera-Espinosa L, Montesinos-Correa H, Bandala C, Carmona-Aparicio L, et al. Role of oxidative stress in refractory epilepsy: evidence in patients and experimental models. Int J Mol Sci. 2013;14(1):1455-76. [Crossref]  [PubMed]  [PMC] 
  25. 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. [Crossref]  [PubMed]  [PMC] 
  26. Kelley SA, Hartman AL. Metabolic treatments for intractable epilepsy. Semin Pediatr Neurol. 2011;18(3):179-85. [Crossref] 
  27. Kossoff EH. More fat and fewer seizures: dietary therapies for epilepsy. Lancet Neurol. 2004;3(7):415-20. [Crossref] 
  28. Ballaban-Gil KR. Complications of the ketogenic diet. In: Stafstrom CE, Rho JM, eds. Epilepsy and The Ketogenic Diet. 1st ed. New Jersey: Humana Press; 2004. p.123-8. [Crossref] 
  29. Lee PR, Kossoff EH. Dietary treatments for epilepsy: management guidelines for the general practitioner. Epilepsy Behav. 2011;21(2):115-21. [Crossref] 
  30. Bergqvist AG. Long-term monitoring of the ketogenic diet: do's and don'ts. Epilepsy Res. 2012;100(3):261-6. [Crossref]  [PubMed] 
  31. Tejada S, Martorell M, Capo X, Tur JA, Pons A, Sureda A. Omega-3 fatty acids and epilepsy. In: Patel VB, ed. The Molecular Nutrition of Fats. 1st ed. London, United Kingdom; San Diego, CA: Academic Press; 2019. p.261-70. [Crossref] 
  32. Pourmasoumi M, Vosoughi N, Derakhshandeh-Rishehri SM, Assarroudi M, Heidari-Beni M. Association of omega-3 fatty acid and epileptic seizure in epileptic patients: a systematic review. Int J Prev Med. 2018;9:36. [Crossref]  [PubMed]  [PMC] 
  33. Jung DE, Kang HC, Lee JS, Lee EJ, Kim HD. Safety and role of ketogenic parenteral nutrition for intractable childhood epilepsy. Brain Dev. 2012;34(8):620-4. [Crossref]  [PubMed] 
  34. Dressler A, Haiden N, Trimmel-Schwahofer P, Benninger F, Samueli S, Groppel G, et al. Ketogenic parenteral nutrition in 17 pediatric patients with epilepsy. Epilepsia Open. 2018;3(1):30-9. [Crossref]  [PMC] 
  35. Roan M. Management of long-term ketogenic parenteral nutrition. ICAN. 2011;3(5):282-7. [Crossref] 
  36. van Karnebeek CD, Stockler-Ipsiroglu S, Jaggumantri S, Assmann B, Baxter P, Buhas D, et al. Lysine-restricted diet as adjunct therapy for pyridoxine-dependent epilepsy: the PDE Consortium Consensus Recommendations. JIMD Rep. 2014;15:1-11. [Crossref]  [PMC] 
  37. van Karnebeek CD, Hartmann H, Jaggumantri S, Bok LA, Cheng B, Connolly M, et al. Lysine restricted diet for pyridoxine-dependent epilepsy: first evidence and future trials. Mol Genet Metab. 2012;107(3):335-44. [Crossref]  [PubMed] 
  38. Coughlin CR 2nd, van Karnebeek CD, Al-Hertani W, Shuen AY, Jaggumantri S, Jack RM, et al. Triple therapy with pyridoxine, arginine supplementation and dietary lysine restriction in pyridoxine-dependent epilepsy: neurodevelopmental outcome. Mol Genet Metab. 2015;116(1-2):35-43. [Crossref] 
  39. Kirkland AE, Sarlo GL, Holton KF. The role of magnesium in neurological disorders. Nutrients. 2018;10(6):E730. [Crossref]  [PMC] 
  40. Yary T, Kauhanen J. Dietary intake of magnesium and the risk of epilepsy in middle-aged and older Finnish men: a 22-year follow-up study in a general population. Nutrition. 2018;58:36-9. [Crossref]  [PubMed] 
  41. Yuen AW, Sander JW. Can magnesium supplementation reduce seizures in people with epilepsy? A hypothesis. Epilepsy Res. 2012;100(1-2):152-6. [Crossref]  [PubMed] 
  42. Osborn KE, Shytle RD, Frontera AT, Soble JR, Schoenberg MR. Addressing potential role of magnesium dyshomeostasis to improve treatment efficacy for epilepsy: a reexamination of the literature. J Clin Pharmacol. 2016;56(3):260-5. [Crossref] 
  43. Saghazadeh A, Mahmoudi M, Meysamie A, Gharedaghi M, Zamponi GW, Rezaei N. Possible role of trace elements in epilepsy and febrile seizures: a meta-analysis. Nutr Rev. 2015;73(11):760-79. [Crossref]  [PubMed] 
  44. Abdelmalik PA, Politzer N, Carlen PL. Magnesium as an effective adjunct therapy for drug resistant seizures. Can J Neurol Sci. 2012;39(3):323-7. [Crossref] 

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