Experiencia y hallazgos en el manejo de la dieta cetogénica en niños con epilepsia refractaria, estudio de 10 casos

Abstract

Refractory epilepsy is due to that drug-resistant epilepsy in which there is no improvement after the applica-tion of various antiepileptic drugs (AEDs). The Telethon Children's Rehabilitation Center cares for a large population of children with some type of epilepsy. Recently, the application of the home intervention proto-col for the ketogenic diet (DC) has increased. A few years ago, DC was only attended with extreme surveil-lance in a hospital center under rigid schemes. With this background, the objective of this study was to describe the experience and findings of a series of 10 cases of children with refractory epilepsy treated with this DC protocol over the course of at least 1 year. All the cases of children (n = 10) attended at the Telethon Children's Rehabilitation Center, Aguascalientes, Mexico, who were treated with the ketogenic diet between the dates of February 2010 and June 2015, were reviewed by means of an electronic clinical record criteria for refractory epilepsy, as well as surveillance for pediatric neurology and nutrition. The DC home interven-tion protocol was established under the criteria of Lambruschini-Nilo & Gutierrez-Sanchez, where it started with a classic type DC with a 2: 1 ratio during the first week of adaptation and then went on to the 3: 1 or 4 ratio: 1 corresponding according to patient tolerance. The reduction in the number of crises was measured at 3 months and one year after surgery. A one-way ANOVA general linear model with repeated measures was applied to measure the efficacy at 3 months and one year of treatment, finding statistical significance when comparing the results means of the number of epileptic events before the diet (p = <0.006). . The most frequent type of epilepsy was West Syndrome in 4 patients, Lennox Gastaut Syndrome in 3 patients, Severe Myoclonic Epilepsy of Childhood and other types of epilepsy, 3 patients. The most common side effects were constipation in 60% of the population, and the least common were hypoalphalipoproteinemia-like dyslipidemia in 30%, reflux in 20%, and kidney stones in 10%.