Epilepsi Tedavisinde Ketojenik Diyet Kullanımı
Özet
Ketojenik diyet (KD), enerjinin büyük oranla keton cisimlerinden temin edildiği, yüksek yağ ile düşük protein ve karbonhidrat içeren özel bir diyet şeklidir. Klasik 4:1 yağ/protein+karbonhidrat oranının yanı sıra orta zincirli yağ asiti (MCT) diyeti, Modifiye MCT diyeti, düşük glisemik indeksli diyet ve Modifiye Atkins diyeti (MAD) gibi alternatif uygulamaları mevcuttur. İki antikonvülzif ilaca yanıt vermeyen dirençli epilepsilerde önerilen bu diyet, GLUT-1 eksikliği ve Piruvat Dehidrogenaz eksikliğinde ise ilk seçenek tedavidir. Etki mekanizmasında keton cisimlerinin kan-beyin bariyerini geçmesi, GABA seviyelerindeki artış, nöronal membran hiperpolarizasyonu ve mTOR yolağının inhibisyonu rol oynamaktadır. Tedavi öncesinde karnitin eksikliği, beta-oksidasyon defektleri ve porfiri gibi mutlak kontrendikasyonlar değerlendirilmelidir. Uygulama sürecinde gastrointestinal semptomlar, dislipidemi, hipoglisemi, büyüme geriliği ve böbrek taşı gibi yan etkiler görülebileceğinden nörolog, diyetisyen ve hemşireden oluşan uzman bir ekip tarafından hasta yakından izlenmelidir. Tedavinin etkinliğine karar verilebilmesi için en az üç ay sürdürülmesi, fayda sağlayan vakalarda iki yıl devam edilmesi ve diyetin tedricen kesilmesi gerekmektedir.
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