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Objective:To evaluate the efficacy and safety of modified Atkins diet (MAD) in treating global growth retardation (GDD).Methods:A prospective multicenter clinical controlled study was conducted.The children were included from 8 departments of children′s rehabilitation in Henan Province from July 2017 to October 2017.A total of 154 children who met the inclusion criteria were randomly assigned into the routine treatment group (88 cases) and MAD therapy group (66 cases). A total of 62 children in MAD therapy group and 59 children in routine treatment group completed the study for 15 months.The routine treatment group was provided comprehensive rehabilitation training, and the MAD therapy group was given MAD treatment on the basis of rehabilitation training.Two-way repeated-measures ANOVA was used to compare the differences among datas at different time points. Results:After 3 months, there were significant differences in the scores of the Chinese Version of Urban Infant-Toddler Social and Emotional Assessment (CITSEA)/Achenbach Children′s Behavior Scale (CBCL) between the 2 groups (all P<0.05). Significant improvement was seen in the MAD group.After 6 months, the MAD therapy group had significantly higher scores on the Gesell Developmental Scale for language and social behavior than the routine treatment group (all P<0.05). After 9 months, the scores of the children in the MAD therapy group were better than those in the routine treatment group in the Gesell Developmental Scale adaptive energy area and the infant-junior high school student social life scale (S-M scale), and the differences were statistically significant (all P<0.05). After 15 months, the fine motor in the MAD therapy group was better than that in the routine treatment group ( P<0.05). At the early stage of MAD therapy, 28 patients showed mild adverse reactions that were reversed after symptomatic treatment.No severe adverse reactions were observed. Conclusions:MAD therapy can improve the neuro-development, emotional and social behaviors, and adaptive behaviors with no severe adverse effects.
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Introdução: A dieta cetogênica é um tratamento adjuvante para pacientes pediátricos com epilepsia e pode ser vantajoso para adultos. Objetivos: Fazer uma revisão bibliográfica narrativa de estudos envolvendo o tema Dieta Cetogênica (DC) no tratamento de pacientes com epilepsia adultos e disseminar o conhecimento deste tratamento. Métodos: Fez-se uma revisão de artigos publicados, sem limite de tempo, nas bases de dados eletrônicas Medical Literature Analysis and Retrieval System Online (Medline/PubMed), Google Acadêmico e The Scientific Electronic Library Online (SciELO). O primeiro passo foi a busca pelos descritores "ketogenic diet", "ketogenic diet for adults", "modified Atkins diet", "modified Atkins diet for adults", "medium chain tryglyceride diet", "low glycemic index treatment", "dieta cetogênica", "dieta cetogênica em adultos", "dieta de Atkins modificada" e "dieta de Atkins modificada em adultos". Resultados: Encontrou-se um total de 230 artigos por meio de busca nas bases de dados Medline/PubMed, SciELO e Google Acadêmico. De todos esses 231 artigos apenas 41 deles realmente abordavam o tema "dieta cetogênica em pacientes adultos com epilepsia" e estes foram lidos integralmente. Excluiu-se 189 artigos pois estes não abordavam o tema DC em adultos, abordavam a DC em outras doenças e não somente em epilepsia, utilizavam outra faixa etária que não somente adultos, estavam em outro idioma que não inglês ou português. Dos 41 artigos lidos na íntegra, 17 foram escolhidos para de fato compor o estudo. Conclusão: A dieta cetogênica é um tratamento eficaz e bem tolerado para pacientes adultos com epilepsia.
Introduction: The ketogenic diet is an adjunctive treatment for pediatric patients with epilepsy and may be of benefit to adults. Objectives: To perform a bibliographic review of studies involving the topic Ketogenic Diet in the treatment of patients with adult epilepsy and disseminate the knowledge of this treatment. Methods: A review of published articles was published, without time limit, in the electronic databases Medical Literature Analysis and Retrieval System Online (Medline / PubMed), Google Scholar and The Scientific Electronic Library Online (SciELO). The first step was to search for the descriptors "ketogenic diet", "ketogenic diet for adults", "modified Atkins diet", "modified Atkins diet for adults", "medium chain tryglyceride diet", "low glycemic index treatment" ketogenic diet in adults, modified Atkins diet, and modified Atkins diet in adults. Results: A total of 230 articles were found by searching the databases Medline / PubMed, SciELO and Google academic. Of all 231 articles only 41 of them actually addressed the topic "ketogenic diet in adult patients with epilepsy" and these were read in full. We excluded 189 articles because they did not address the topic DC in adults, they approached CD in other diseases and not only in epilepsy, used another age group that not only adults, were in a language other than English or Portuguese. Of the 41 articles read in their entirety, 17 were chosen to actually compose the study. Conclusion: The ketogenic diet is an effective and well tolerated treatment for adult patients with epilepsy.
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La dieta cetogénica se considera un tratamiento eficaz y bien tolerado para la epilepsia refractaria. Nuestro trabajo suministra información práctica sobre el uso de la dieta cetogénica, realizando una revisión acerca de las indicaciones clásicas y las nuevas que permiten ampliar el uso de la misma. Detallamos cómo implementar la dieta, los controles médicos en el seguimiento y la forma de actuar en situaciones especiales, tales como la anestesia o la enfermedad aguda. Se enfatiza la i mportancia del trabajo de los profesionales de las distintas especialidades y la familia como equipo, detallando los roles que ocupa cada uno en este interesante pero laborioso tratamiento.
The ketogenic diet is an established, effective and well-tolerated treatment in refractory epilepsy. This paper provides practical information on the administration of ketogenic diet. It goes over the standardized protocols and the new ones that allow to broaden the scope regarding the clinical management of the ketogenic diet. It addresses issues such as the implementation, counseling and follow-up as well as the application and how to proceed in special situations such as anesthesia or acute illness. Finally, the aim of this paper is to highlight the relevance of the multidisciplinary teamwork and the family support throughout this laborious but interesting treatment.
Subject(s)
Humans , Diet, Ketogenic/classification , Diet, Ketogenic/adverse effects , Drug Resistant Epilepsy/diet therapy , Drug Resistant Epilepsy/therapy , Interdisciplinary Studies , Diet, High-Protein Low-CarbohydrateABSTRACT
A ketogenic diet (KD) is a dietary approach to treat intractable epilepsy. The KD begins with hospitalization and the child and their parents can adapt to the KD for 1-2 weeks. Recently, various type of dietary intervention such as the modified Atkins diet (MAD) and the low glycemic index treatment (LGIT) have been performed. Since 2010, we carried out the KD, MAD, and LGIT for total of 802 patients; 489 patients (61%) for the KD, 147 patients (18.3%) with the MAD, and 166 patients (20.7%) for the LGIT. In this report, application of these dietary practices in Severance Hospital is shared.
Subject(s)
Child , Humans , Diet, Carbohydrate-Restricted , Epilepsy , Glycemic Index , Hospitalization , Diet, Ketogenic , Meals , ParentsABSTRACT
La dieta de Atkins modificada (DAM) es una alternativa dietaria terapéutica en el tratamiento de la epilepsia fármaco-resistente. Consiste en una dieta con un aporte de 60% de grasas, 30% de proteínas y 10% de carbohidratos. El objetivo es presentar una serie de 9 pacientes con diagnóstico de epilepsia refractaria de diferentes etiologías, que recibieron tratamiento con DAM en nuestro hospital. En nuestro grupo de 9 pacientes, obtuvimos resultados similares a los publicados por otros autores, con buena adherencia, tolerancia y respuesta. Del total de pacientes, dos lograron una reducción en más del 90% del número de crisis; cuatro, del 50-90%; dos, menos del 50% de control; y solo uno no presentó respuesta a la DAM. Ningún paciente presentó aumento del número de crisis, y fue bien tolerada en todos los casos
The modified Atkins diet (MAD) is an alternative therapeutic diet for the treatment of drug-resistant epilepsy. It consists of a diet with 60% energy from fat, 30% from protein, and 10% from carbohydrates. The objective of this article is to present a series of nine patients diagnosed with refractory epilepsy of different etiologies treated with the MAD at our hospital. In our group of nine patients, results obtained were similar to those published by other authors, with adequate adherence, tolerance and response. Of all patients, two achieved a reduction of more than 90% in the number of seizures; four experienced a reduction of 50-90%; two had a reduction of less than 50% in seizure control; and only one patient did not respond to the MAD. No patient had an increase in the number of seizures, and the diet was well-tolerated in all cases.
Subject(s)
Humans , Male , Female , Child, Preschool , Child , Adolescent , Young Adult , Diet, Carbohydrate-Restricted , Drug Resistant Epilepsy/drug therapyABSTRACT
Objective To simplify the manipulation of ketogenic diet recipes through software design.Methods Based on a Chinese food composition database,the software included 3 separate modules for the calculation of recipes for the classic ketogenic diet,modified Atkins diet and low glycemic index diet.It was applied in 10 refractory epilepsy patients,including 8 children and 2 adults,aged from 1 to 34 years,who took an average of 2.7 kinds of medication.Eight patients had daily seizures ;the other 2 cases had seizures 4-15 times per month.Two patients used the classic 4 ∶ 1 ketogenic diet module;4 patients started with the classic 4 ∶ 1 ketogenic diet and then shifted to 1 ∶ 1 to 4 ∶1 modified Atkins diet module after 2 to 5 months;4 patients used the 1 ∶ 1 to 4 ∶ 1 modified Atkins diet module.The software could automatically display the daily recommended intake value of total energy,fat,carbohydrate and protein according to the input of age,height,weight,activity level and the proportion of fat/(carbohydrate and protein),then patients or dietitians were allowed to select a different modules for recipe design.Results Forty percents(4/10 cases) of the patients had seizure reduced to 50％-90％,20％ (2/10 cases) of the patients had seizure reduced to 90％ 99％,and 20％ (2/10 cases) of the patients became seizure free.Half-year retention rate reached 70％ (7/10 cases).Conclusions This specially designed software for Chinese epilepsy patients can help simplify the operation of the ketogenic diet and modified Atkins diet and improve retention rates.It can be used in classic and non-classical ketogenic diets.
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INTRODUÇÃO: A dieta cetogênica (DC) e a dieta de Atkins modificada (DAM) são dietas terapêuticas mundialmente utilizadas no tratamento da epilepsia refratária em crianças e adultos. No Brasil estas modalidades de tratamento são pouco indicadas, restringindo a poucos centros. METODOLOGIA: Revisão de literatura sobre a utilização da DC e DAM no tratamento da epilepsia refratária. CONCLUSÕES: A DC e a DAM são opções terapêuticas eficazes e seguras no tratamento da epilepsia refratária. O acompanhamento destes pacientes deve ser rigoroso, com equipe treinada, prevendo os riscos potenciais e realizando dietas palatáveis e diversificadas.
INTRODUCTION: Ketogenic Diet (KD) and Modified Atkins Diet (MAD) are world-widely therapeutic diets used in the treatment of intractable epilepsy in children and adults. In Brazil those therapies are few indicated and restricted for some centers. METHODS: Revision of literature for the application of KD and MAD in the treatment of intractable epilepsy. CONCLUSIONS: KD and MAD are effective and secure in the treatment of intractable epilepsy. The follow up of these patients must be rigorous, with a trained staff to anticipate the potential risks and elaborating diversified and palatable diets.