The ketogenic diet is used to treat complex epilepsy in children when pharmacological treatment alone is unsuccessful. The treatment presupposes that the child, for a specific period of time, follows a carefully calculated, high-fat diet that covers daily protein needs and provides the minimum in carbohydrates to liquidate joint pain. The fat that this food provides is altered in the liver by ketones, which the body uses as its primary source of energy.
The patient is in a catabolic state and secretes a large amount of ketones in the urine due to diet. However, blood pH is normal, basal surplus is normal or low, and blood sugar is at normal levels.
In the case of infections, with symptoms mainly from the gastrointestinal tract, such as vomiting or diarrhea, the patient on the ketogenic diet may develop severe ketosis and acidosis more quickly.
The diet is adapted to provide the same amount of calories compared to the diet that the patient did before depending on his weight and age.
If the patient is overweight or otherwise underweight, the diet is calculated according to his ideal weight in relation to his age.
The diet is usually made up of 80% fat and 20% carbohydrates and protein.
Evaluation of ketogenic diet therapy should be performed at regular intervals.
The key to success with ketogenic diet therapy is the proper information and assistance from the patient’s parents and the entire family.
Parents should understand that this diet requires planning, that the food must be weighed, and that the diet must be strictly adhered to.
Therefore, at the beginning of treatment, parents should be able to meet with the pediatric neurologist and dietitian.
List of seizure record for 3 months before starting treatment.
Patient record of the patient’s diet for 4 days prior to treatment with the aim of informing the attending physician about the amount of calories the patient receives daily as well as the dietary preferences that vary from child to child.
Patient growth curves.
Hospital admission is mandatory at the beginning of the diet.
The patient must be fasting for the first 24 hours.
The necessary blood tests must be performed and a vein catheter should be inserted where saline is provided to ensure adequate hydration of the patient.
The diet is gradually introduced from day two. The amount of fat gradually increases to a final level that varies from child to child. The ratio of fat to protein and carbohydrates is about 3: 1 in younger children and 4: 1 in older children.
The first few days of dieting give parents the opportunity to obtain planning information about the details and any side effects that may occur during treatment.
Most children can leave the hospital after four days and continue their diet at home with frequent contact with the pediatrician and dietitian on an external basis.
The diet is followed for a minimum of three months and usually for one year.
FORM OF DIET
The diet is based on calculating the patient’s diet by measuring the amount of calories, protein and carbohydrates per kilogram relative to the child’s age. This results either from lists for calculating protein / day or in some cases using calorimetry.
For example, a 4-month-old child weighing 6 kilograms is estimated to need 648 kcal / day.
In young children this diet is in the form of 3: 1 which means 3 parts fat and part protein and carbohydrates together.
In our example, the amount of fat is calculated at 63 g / day, the amount of protein at 13.2 g / day and the amount of carbohydrates at 7.8 g / day.
The ketogenic diet seems to be effective in all types of epilepsy by improving the general condition of the patient, reducing the incidence of epileptic seizures and sometimes bringing them under complete control.
A percentage of children may gradually stop taking medication.
The diet consists of children with complicated epilepsy and often episodes of seizures who have tried a combination of at least two antiepileptic drugs with no effect.
The ketogenic diet is the treatment of choice for certain epileptic syndromes. In more detail:
Infantile spasms Myoclonic asthmatic epilepsy or Doose syndrome
Lack of glycoprotein (GLUT 1)
syndrome Lennox-Gastaut syndrome.
Diet is not the first choice in patients with cortical dysplasia that can be operated, is contraindicated in certain metabolic disorders, in particular carnitine and fatty acids, in particular:
Lack of carnitine.
Lack of carnitine translocase.
Lack of palmitic transferase.
Damages to β-oxidation of fatty acids:
Short chain acyl anhydrase deficiency (SCAD deficiency).
Lack of moderate chain acyl anhydrase (MCAD deficiency).
Lack of long chain acyl anhydrase (LCAD deficiency).
Lack of 3 moderate chain hydroxyacylsynzenzyme A.
Lack of 3 long-chain A hydroxyacylsinenzyme A.
Lack of pyruvate carboxylase.
The side effects of the ketogenic diet are well known and treated with proper treatment. Thus, at the beginning of the hospital diet, the patient may develop hypoglycaemia and / or metabolic acidosis. Later on when the patient continues the diet at home he may develop constipation, nausea, lack of weight and height gain and in some cases kidney stones.
The ketogenic diet is that treatment for epilepsy, based on a diet high in fat and low in carbohydrates, and which has a very positive profile in relation to other forms of treatment, with minimal side effects. However, it requires careful planning and rigorous discipline. For this reason it is not the first choice for forms of epilepsy that respond positively to drug therapy.