Dieta cetogênica no tratamento de epilepsias farmacorresistentes

Abstract

A epilepsia é uma condição clínica crônica correspondente a um grupo de doenças que tem em comum crises epilépticas; ela atinge de 0,5% a 1,0% da população dos países desenvolvidos, podendo esta prevalência ser maior nos países em desenvolvimento. Aproximadamente um terço dos pacientes evolui com crises epilépticas intratáveis com medicamentos; em alguns casos, é possível o tratamento cirúrgico. Nos pacientes em que cirurgia não é possível, a dieta cetogênica passa a ser uma opção terapêutica, principalmente em crianças.Espera-se que esta terapia seja eficaz para, pelo menos, um terço dos pacientes, resultando em redução ou controle das crises. No presente trabalho, apresentamos métodos para o preparo e uso a dieta cetogênica. O planejamento da dieta é individualizado, seguindo-se recomendações para o consumo energético e proporções de gorduras, proteínas e carboidratos específicos. Sempre que introduzida a dieta, o paciente deve ser

Therapeutic Indications of the Ketogenic Diet: A Integrative Review

“…Epilepsy affects a large number of individuals, being one of the most serious and frequent neurological disorders in the pediatric age [12]. Approximately one-third of epileptic patients progress to a more severe condition with intractable epilepsy from a drug point of view, crises that are not controlled by maximum tolerated doses of 2 or 3 antiepileptic drugs, requiring the use of more invasive alternative treatments, such as a surgical procedure [2,7]. Refractory epileptic seizures represent a threat to the child, due to the increased risk of accidents and mortality, secondary malnutrition, with consequent damage and delay in physical and cognitive development, resulting from the disease and therapy, whose effectiveness is not as achieved [7,13].…”

“…It is suggested that the excessive supply of fat together with the reduction in the supply of carbohydrates can maintain the metabolic mechanism of starvation, a situation in which lipids are used as an energy source, maintaining a state of ketosis. The sedative effect of ketone bodies, their concentration in plasma, the degree of acidosis, partial dehydration, marked changes in lipid concentration and the metabolic adaptation of the brain resulting from ketosis would be the main factors responsible for controlling the attacks [2]. It is further suggested that a fundamental shift from glycolysis to DC-induced intermediary metabolism is necessary and sufficient for clinical efficacy.…”

“…KD consists of high-fat content, low or no carbohydrate content, and low or normal protein content [1]. Despite being a special and therapeutic diet, it must meet the general principles of nutrition and provide the body with energy, proteins, minerals, and vitamins, even though supplements, aiming at the development and maintenance of the patient's physiological conditions [2].…”

Ketogenic food pyramid for patients with refractory epilepsy: From theory to clinical practice

“…The average age of the age groups used in the calculation proposed by Freeman 12 The protein recommendation in the KD ranged from 0.75 to 1.0g protein/kg body weight, regardless of the age group 13 . The amount of fat in relation to the TCV was based on the KD macronutrient ratio established (4:1), in which 90% of TCV is derived from fats, and the remaining 10% from the sum of proteins and carbohydrates.…”

Adesão ao tratamento e qualidade de vida de indivíduos com epilepsia em tratamento ambulatorial

“…Para as crianças, que evoluem com crises epilépticas intratáveis e sem indicação cirúrgica, a dieta cetogênica pode ser uma opção terapêutica (29) .…”