Kumlien Eva, Hallbook Tove, Dahlin Maria
Institutionen för neurovetenskap, Uppsala universitet - Uppsala, Sweden Neuroscience, Uppsala university - Neurology, AS Uppsala, Sweden.
Goteborgs universitet Avdelningen for pediatrik - Goteborg, Sweden Goteborgs universitet Avdelningen for pediatrik - Goteborg, Sweden.
Lakartidningen. 2018 May 22;115:E6MD.
For some people with medically refractory epilepsy adjunct treatment with neurostimulation and ketogenic diet can be an option. Vagal nerve stimulation, VNS, consists of chronic intermittent electrical stimulation of the vagus nerve. VNS is effective and well tolerated in adolescents and adults. There is insufficient evidence on the efficacy of deep brain stimulation, DBS, and brain-responsive neurostimulation, RNS. Ketogenic diet is an established treatment in epilepsy with an increased number of indications, especially in neurometabolic diseases, where dietary therapy can completely eliminate epilepsy and improve cognitive and motor development. Ketogenic diet is a calculated diet consisting of a high amount of fat, the daily need of protein and a minimum of carbohydrates. The fat is converted to ketone bodies and transported across the blood-brain barrier to be used as an alternative energy source in the brain. Strictly calculated menus, regular monitoring and support from a team of dietician, nurse and physician are required.
对于一些药物难治性癫痫患者，神经刺激和生酮饮食辅助治疗可能是一种选择。迷走神经刺激（VNS）包括对迷走神经进行慢性间歇性电刺激。VNS在青少年和成年人中有效且耐受性良好。关于深部脑刺激（DBS）和脑反应性神经刺激（RNS）的疗效，证据不足。生酮饮食是一种已确立的癫痫治疗方法，其适应证不断增加，尤其是在神经代谢疾病中，饮食疗法可完全消除癫痫并改善认知和运动发育。生酮饮食是一种经过计算的饮食，由大量脂肪、每日所需蛋白质和最少的碳水化合物组成。脂肪被转化为酮体，并穿过血脑屏障，用作大脑中的替代能源。需要严格计算的食谱、定期监测以及营养师、护士和医生团队的支持。
