Epilepsi Tedavisinde Ketojenik Diyet Kullanımı
Synopsis
The ketogenic diet (KD) is a special diet high in fat and low in protein and carbohydrates, where energy is derived largely from ketone bodies. In addition to the classic 4:1 fat to protein+carbohydrate ratio, alternative applications such as the medium-chain triglyceride (MCT) diet, Modified MCT diet, low glycemic index diet, and Modified Atkins Diet (MAD) are available. Recommended for drug-resistant epilepsy that does not respond to two anticonvulsant drugs, this diet is the first-line treatment in GLUT-1 deficiency and Pyruvate Dehydrogenase deficiency. Its mechanism of action involves ketone bodies crossing the blood-brain barrier, an increase in GABA levels, neuronal membrane hyperpolarization, and inhibition of the mTOR pathway. Prior to treatment, absolute contraindications such as carnitine deficiency, beta-oxidation defects, and porphyria must be evaluated. Since side effects such as gastrointestinal symptoms, dyslipidemia, hypoglycemia, growth retardation, and kidney stones may occur during implementation, the patient must be closely monitored by a specialized team consisting of a neurologist, dietitian, and nurse. The diet should be maintained for at least three months to evaluate its effectiveness, continued for two years in benefiting cases, and discontinued gradually.
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