Nathan Janak, Khedekar Kale Dhanashri, Naik Vidula D, Thakker Forum, Bailur Sonal
Neurology, Shushrusha Hospital, Mumbai, IND.
Clinical Nutrition & Dietetics, Dr. Nathan Sanjiv Clinic, Mumbai, IND.
Cureus. 2019 Aug 7;11(8):e5341. doi: 10.7759/cureus.5341.
A 60-year-old man presented with a history of an acute episode of mono-ocular involvement and several acute spinal cord episodes from 1988 to 1991. Multiple MRIs of the spinal cord and brain and cerebrospinal fluid analysis were consistent with a clinical diagnosis of multiple sclerosis (MS). Following this, there was a quiescent period of four to five years, after which he reported progressive weakness and spasticity of lower limbs with urgency and precipitancy of urine. He was put on a ketogenic diet (KD) as a monotherapy in 2016. Within one month of starting the KD, his balance and weakness improved, and there was good bladder control. He continued KD for 18 months, after which he followed it inconsistently and eventually stopped KD, going back to his original diet. His weakness increased gradually until he was wheelchair-bound, and his precipitancy greatly worsened. He was put back on KD and has improved again to the extent that his stamina has increased, he can walk with the help of a cane, and his continence is good. Dietary therapy has a large role in the management of secondary progressive multiple sclerosis (SPMS) and, as in this case, may be effective even as a single-mode therapy. This is probably the first reported case of improvement in SPMS using KD as a monotherapy.
一名60岁男性患者，自1988年至1991年期间有单眼受累急性发作史及多次急性脊髓发作史。脊髓和脑部的多次磁共振成像（MRI）以及脑脊液分析结果与多发性硬化症（MS）的临床诊断相符。此后，有四到五年的静止期，之后他报告出现下肢进行性无力和痉挛，伴有尿急和急迫性尿失禁。2016年，他开始采用生酮饮食（KD）进行单一疗法治疗。开始KD治疗后的一个月内，他的平衡能力和无力症状有所改善，膀胱控制良好。他持续进行KD治疗18个月，之后依从性变差，最终停止KD治疗，恢复到原来的饮食。他的无力症状逐渐加重，直至需要依靠轮椅行动，急迫性尿失禁也大大恶化。他再次接受KD治疗后，又有了改善，体力增强，能够借助拐杖行走，尿失禁情况良好。饮食疗法在继发进展型多发性硬化症（SPMS）的管理中发挥着重要作用，就像这个病例一样，即使作为单一疗法也可能有效。这可能是首例使用KD单一疗法使SPMS病情改善的报道病例。
