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Advisor(s)
Abstract(s)
Introdução: A epilepsia é uma doença cerebral grave, afetando cerca de 50 a 70 milhões
de pessoas em todo o mundo. Trata-se de uma desregulação na atividade elétrica do
cérebro, podendo resultar em crises recorrentes e numa alteração do comportamento.
Apesar dos anticonvulsivantes serem a primeira linha do tratamento clássico da epilepsia,
cerca de 20-40% dos pacientes não respondem aos mesmos, surgindo o conceito de
epilepsia refratária. Deste modo, uma das opções de tratamento que tem sido proposta
cursa com a dieta cetogénica. Assim, avaliar a sua eficácia, a sua segurança, bem como os
seus efeitos adversos têm sido os principais objetivos dos estudos efetuados.
Objetivo: Estudar a eficácia da dieta cetogénica assim como a sua segurança e os seus
efeitos adversos no tratamento da epilepsia. Compreender os mecanismos de cada tipo de
terapêutica dietética, a sua influência ao nível do microbioma intestinal e no controlo de
síndromes epiléticas raras.
Método: Pesquisa e análise da literatura científica disponível nos últimos 5 anos (2018-
2023) na plataforma PubMed escrita em inglês, espanhol e português.
Desenvolvimento: A incidência da epilepsia refratária tem vindo a aumentar, pelo que
este tema tem sido alvo de estudos com o objetivo de encontrar o método dietético mais
eficaz e seguro no tratamento da mesma. A dieta cetogénica baseia-se num consumo de
elevada quantidade de gordura e numa baixa quantidade de hidratos de carbono. Deste
modo, criaram-se 4 tipos de dietas em resposta à palatabilidade e à restrição calórica: a
dieta cetogénica clássica, a dieta de Atkins modificada, o tratamento de baixo índice
glicémico e a dieta cetogénica de triglicerídeos de cadeia média. Estudos têm relatado a
influência da dieta cetogénica no microbioma intestinal, aumentando as bactérias
protetoras e diminuindo as patogénicas; no entanto, a relação entre disbiose intestinal e a
epileptogénese ainda se encontra em estudo. Efeitos adversos gastrointestinais e
cardiovasculares têm sido apontados como motivos para menor adesão desta estratégia
terapêutica por parte dos pacientes. No entanto, a dieta cetogénica tem melhorado o
prognóstico das síndromes epiléticas raras, nomeadamente no estado de mal epilético,
através da redução de crises convulsivas e consequente melhoria na qualidade de vida do
paciente.
Conclusão: A dieta cetogénica apresenta uma considerável eficácia na redução de
convulsões, nomeadamente nas síndromes epiléticas raras. Estudos remetem para mais de
metade dos pacientes sob terapêutica com dieta cetogénica apresentarem redução
superior a 50% na frequência das crises convulsivas. Relativamente à eficácia não foi
encontrada superioridade em nenhum dos 4 tipos de dieta cetogénica. No entanto, esta temática continuará a ser objeto de estudo, em virtude da ausência de amostras
significativas e de estudos atualizados regularmente.
Introduction: Epilepsy is a serious cerebral disease, and it affects around 50 to 70 million of people around the world. It is a deregulation on the electrical activity of the brain, resulting in recurrent crisis and in behaviour disorders. Despite the fact that the anticonvulsants are the first line of classic treatment of epilepsy, almost 20-40% of the patients do not respond to them, because of this the concept of refractory epilepsy emerged. This way, one of the options of treatment that has been proposed for the refractory epilepsy is the ketogenic diet. One of the main objectives of the studies is to evaluate the efficacy, security as well as its adverse effects. Objectives: To study the efficacy of the ketogenic diet as well as the security and the adverse effects in the treatment of epilepsy. Also, to understand the mechanisms of each type of dietetic therapy, as well as its influence on the gut microbiome and in the control of the rare epileptic syndromes. Method: To research and analyse the scientific literature available in the last 5 years (2018-2023) in the Pubmed platform written in English, Spanish and Portuguese. Discussion: The incidence of refractory epilepsy has been increasing; therefore, this theme has been the target of different studies, with the objective of finding the most effective and secure dietetic method in the treatment of this type of epilepsy. The ketogenic diet is based on the consumption of a high quantity of fat and a low quantity of carbohydrates. Four types of diet have been suggested in response to the palatability and to the caloric restriction: the classic ketogenic diet, the modified Atkins diet, the low glycemic index treatment and the medium chain triglyceride ketogenic diet. Studies have been reporting the influence of the ketogenic diet on the gut microbiome, increasing the protective bacteria and decreasing the pathogenic ones. However, the relation between the intestinal dysbiosis and the epileptogenesis continues to be studied. Gastrointestinal and cardiovascular adverse effects have been pointed as a reason for a low adherence of this therapeutic strategy by the patients. However, the ketogenic diet has improved the prognosis of the rare epileptic syndromes, like the status epilepticus, by the reduction of the seizures and the consequent improvement of the quality of life of the patients. Conclusion: The ketogenic diet presents a reasonable efficacy on the reduction of the seizures, namely in the rare epileptic syndromes. Studies have revealed that more than a half of the patients using the ketogenic diet present a reduction higher than 50% on the frequency of the seizures. According to the efficacy it was not found superiority in any of the 4 types of ketogenic diet. However, this theme is yet one of the objects of study in the future because of the absence of significative samples and up to date studies.
Introduction: Epilepsy is a serious cerebral disease, and it affects around 50 to 70 million of people around the world. It is a deregulation on the electrical activity of the brain, resulting in recurrent crisis and in behaviour disorders. Despite the fact that the anticonvulsants are the first line of classic treatment of epilepsy, almost 20-40% of the patients do not respond to them, because of this the concept of refractory epilepsy emerged. This way, one of the options of treatment that has been proposed for the refractory epilepsy is the ketogenic diet. One of the main objectives of the studies is to evaluate the efficacy, security as well as its adverse effects. Objectives: To study the efficacy of the ketogenic diet as well as the security and the adverse effects in the treatment of epilepsy. Also, to understand the mechanisms of each type of dietetic therapy, as well as its influence on the gut microbiome and in the control of the rare epileptic syndromes. Method: To research and analyse the scientific literature available in the last 5 years (2018-2023) in the Pubmed platform written in English, Spanish and Portuguese. Discussion: The incidence of refractory epilepsy has been increasing; therefore, this theme has been the target of different studies, with the objective of finding the most effective and secure dietetic method in the treatment of this type of epilepsy. The ketogenic diet is based on the consumption of a high quantity of fat and a low quantity of carbohydrates. Four types of diet have been suggested in response to the palatability and to the caloric restriction: the classic ketogenic diet, the modified Atkins diet, the low glycemic index treatment and the medium chain triglyceride ketogenic diet. Studies have been reporting the influence of the ketogenic diet on the gut microbiome, increasing the protective bacteria and decreasing the pathogenic ones. However, the relation between the intestinal dysbiosis and the epileptogenesis continues to be studied. Gastrointestinal and cardiovascular adverse effects have been pointed as a reason for a low adherence of this therapeutic strategy by the patients. However, the ketogenic diet has improved the prognosis of the rare epileptic syndromes, like the status epilepticus, by the reduction of the seizures and the consequent improvement of the quality of life of the patients. Conclusion: The ketogenic diet presents a reasonable efficacy on the reduction of the seizures, namely in the rare epileptic syndromes. Studies have revealed that more than a half of the patients using the ketogenic diet present a reduction higher than 50% on the frequency of the seizures. According to the efficacy it was not found superiority in any of the 4 types of ketogenic diet. However, this theme is yet one of the objects of study in the future because of the absence of significative samples and up to date studies.
Description
Keywords
Corpos Cetónicos Dieta Cetogénica Epilepsia Nutrição Restrição Calórica