Department of Nutrition, Hospital de Pediatria Juan P Garrahan, Combate de los Pozos 1881, C1245 CABA, Buenos Aires, Argentina.
Department of Neurology, Hospital de Pediatria Juan P Garrahan, Combate de los Pozos 1881, C1245 CABA, Buenos Aires, Argentina.
Epilepsy Res. 2020 Jul;163:106340. doi: 10.1016/j.eplepsyres.2020.106340. Epub 2020 Apr 14.
Despite the rapid increase of clinical and basic-science knowledge on ketogenic diet therapies over the past years, it has not always been easy to determine the adequate indications of this treatment. Over the nearly 100 years of use, from being a last resource in the therapeutic algorithm, the diet has become one of the four main treatments for patients with difficult-to-control epilepsy together with antiepileptic drugs, surgery, and vagus nerve stimulation. The use of the diet has also changed. The current paper will briefly discuss the history of the diet together with a review of the literature regarding its most important indications and how they have evolved. The concept of the importance of defining the type of seizure, type of syndrome, and etiology in the selection of patients and timing of diet initiation has been gaining importance. This paper explores how the indications of the diet changed together with the shifting focus of epilepsy teams towards its use in different types of epilepsy and epilepsy syndromes and according to etiologies and as an alternative option in refractory and superrefractory status epilepticus.
尽管近年来关于生酮饮食疗法的临床和基础科学知识迅速增加，但确定这种治疗的适当适应症并不总是那么容易。在近 100 年的使用过程中，生酮饮食已从治疗方案的最后手段之一，发展成为抗癫痫药物、手术和迷走神经刺激治疗之外的四种主要癫痫治疗方法之一。生酮饮食的应用也发生了变化。本文将简要讨论生酮饮食的历史，并回顾其最重要适应症的文献，以及这些适应症是如何演变的。定义患者的发作类型、综合征类型和病因在选择患者和开始饮食时间方面的重要性的概念已经得到重视。本文探讨了生酮饮食的适应症如何随着癫痫治疗团队对其在不同类型癫痫和癫痫综合征中的应用的关注重点的转移而发生变化，并根据病因以及作为难治性和超难治性癫痫持续状态的替代选择。
