Assuntos
Humanos , Dieta Cetogênica/história , Dieta Cetogênica/métodos , Dieta Cetogênica/tendências , Epilepsia Resistente a Medicamentos/dietoterapia , Dieta Rica em Proteínas e Pobre em Carboidratos , Erros Inatos do Metabolismo/dietoterapia , Doenças do Sistema Nervoso/dietoterapia , Resultado do TratamentoRESUMO
Hygienic and sanitary measures and social distancing policies implemented during the new coronavirus disease - COVID-19 - pandemic have altered the care and follow-up provided by healthcare professionals for patients with chronic diseases, including patients with epilepsy (PWEs). Telemedicine has become a solution for the healthcare of PWEs in many developed countries. In this short communication, we trace a particular perspective for the application of telemedicine for PWEs undergoing ketogenic diet (KD) treatment, considering the social and economic difficulties faced by healthcare teams in resource-poor countries, such as Brazil. During the pandemic, financial strain was the main impediment to following KD. The pandemic increased socioeconomic insecurity and access to KD-related products, as well as increasing anxiety in 71% of PWE, impacting their KD treatment follow-up. The challenges of telemedicine in Brazil include not only social and economic issues but also access to food, healthcare services, and education for the population, in addition to digital inclusion.
Assuntos
COVID-19/epidemiologia , Dieta Cetogênica/tendências , Epilepsia Resistente a Medicamentos/dietoterapia , Epilepsia Resistente a Medicamentos/epidemiologia , Programas Nacionais de Saúde/tendências , Telemedicina/tendências , Adulto , Brasil/epidemiologia , Dieta Cetogênica/métodos , Feminino , Humanos , Masculino , Pandemias , Telemedicina/métodos , Resultado do TratamentoRESUMO
The ketogenic diet (KD) is currently a well-established treatment for patients with medically refractory, nonsurgical epilepsy. However, despite its efficacy, the KD is highly restrictive and constitutes a treatment with serious potential adverse effects, and often with difficulties in its implementation and compliance. Patients on the KD require strict follow-up and constant supervision by a medical team highly experienced in its management in order to prevent complications. Other alternative treatments for patients with refractory epilepsy include vagus nerve stimulation (VNS), new-generation antiepileptic drugs (AEDs), corpus callosotomy (CC), and responsive focal cortical stimulation (RNS). In this review, we explain not only the difficulties of the KD as a therapeutic option for refractory epilepsy but also the benefits of other therapeutic strategies, which, in many cases, have proven to have better efficacy than the KD itself.
Assuntos
Dieta Cetogênica/métodos , Epilepsia/terapia , Anticonvulsivantes/uso terapêutico , Corpo Caloso/cirurgia , Dieta Cetogênica/tendências , Humanos , Estimulação do Nervo VagoRESUMO
PURPOSE: In this Argentinean retrospective, collaborative, multicenter study, we examine the efficacy and tolerability of the ketogenic diet (KD) for different epilepsy syndromes. MATERIALS AND METHODS: we evaluated the clinical records of 216 patients started on the KD between March 1, 1990 and December 31, 2010. RESULTS: One hundred forty of the initial patients (65%) remained on the diet at the end of the study period. Twenty-nine patients (20.5%) became seizure free and 50 children (36%) had a 75-99% decrease in seizures. Thus, 56.5% of the patients had a seizure control of more than 75%. The best results were found in patients with epilepsy with myoclonic-astatic seizures, Lennox-Gastaut syndrome, and West syndrome. Good results were also found in patients with Dravet syndrome, in those with symptomatic focal epilepsy secondary to malformations of cortical development, and in patients with tuberous sclerosis. Seizures were significantly reduced in four patients with fever-induced refractory epileptic encephalopathy in school-age children and in two patients with epileptic encephalopathy with continuous spikes and waves during slow sleep. The median period of follow-up after discontinuation of the diet was 6 years. Twenty patients who had become seizure free discontinued the diet, but seizures recurred in five (25%). Of 40 patients with a seizure reduction of more than 50% who discontinued the diet, 10 presented with recurrent seizures. CONCLUSION: The ketogenic diet is a good option in the treatment of refractory epilepsy. After discontinuing the diet, seizures recurrence occurred in few patients.
Assuntos
Dieta Cetogênica/tendências , Epilepsia/dietoterapia , Epilepsia/epidemiologia , Adolescente , Argentina/epidemiologia , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Lactente , Masculino , Estudos Retrospectivos , Fatores de TempoRESUMO
We present an update of our experience with the ketogenic diet (KD) in patients with Dravet syndrome (DS) to evaluate the efficacy and tolerability and our short experience with vagus nerve stimulation (VNS) in the treatment of this syndrome. Between March 1, 1990 and May 31, 2007, 59 patients who met diagnostic criteria for DS were studied in our department. Twenty-four of them were placed on the KD and were followed up for a minimum of 2 years. Three patients were treated with VNS. Sixteen (66.6%) of 24 patients remained on the diet. Two patients (12.5%) became seizure free, 10 children (62.5%) had a 75-99% decrease in seizures, and the remaining 4 children (25%) had a 50-74% decrease in seizures. Six patients have been off the diet for >2 years; one of them is seizure free, two have sporadic seizures, and three, who abandoned the diet after 3 years of adhering to it, relapsed. As to the efficacy of VNS, two patients had a 50-74% decrease in seizures and in the other seizure frequency remained unchanged. The device was well tolerated in all patients without significant complications. Considering the severity and refractarity of seizures in patients with DS, the fact that 12 of 16 children who remained on the diet had a significant reduction in number of seizures shows that the KD is at present an interesting therapeutic option. VNS may be a good alternative treatment for DS.