Dietary Treatment of Epilepsy (eBook)

Practical Implementation of Ketogenic Therapy

Elizabeth Neal (Herausgeber)

eBook Download: PDF

2012
John Wiley & Sons (Verlag)
978-1-118-34548-1 (ISBN)

Infos

Epilepsy is a common chronic neurological disorder characterised by recurrent unprovoked seizures, and affects 50 million people worldwide. Approximately 30% of these do not have seizure control even with the best available medications, hence renewed and increasing interest in the use of dietary treatments to treat epilepsy. These treatments include the traditional ketogenic diets but also the newer modified Atkins diet and low glycaemic index treatment.

 The ketogenic diet is a high-fat, adequate-protein, low-carbohydrate diet that in medicine is used primarily to treat refractory epilepsy in children, and requires the dedicated support of a multi-disciplinary team including  doctors and dietitians. Dietary Treatment of Epilepsy: Practical Implementation of Ketogenic Therapy provides comprehensive and practical training on all aspects of implementing and managing dietary treatments for epilepsy, with key chapters on assessment, calculations, implementation, monitoring and complications.

 Edited by a highly respected expert in the field supported by a strong team of contributors, this is a must-have resource for paediatric dietitians and other members of the therapy team.

Elizabeth Neal has both clinical and research experience in the dietary treatment of epilepsy, with a PhD in ketogenic diets. She is based at the Institute of Child Health in London, and Matthew's Friends charity and clinics.

Inhalt

Dietary Treatment of Epilepsy: Practical Implementation of Ketogenic Therapy 5
Contents 7
Contributors 9
Foreword 11
A personal note 12
Section 1 Introduction and Overview 15
1 Introduction to the ketogenic diet and other dietary treatments 17
Historical overview 17
The classical and medium-chain triglyceride KD 18
Alternative KD therapies 20
Other non- KD treatments 21
Application and availability of KD therapy 21
References 22
2 Epilepsy and epileptic seizures 25
Diagnosis 25
Prevalence and incidence 27
Epileptic seizure and syndrome diagnosis 27
Treatment: what and why 30
Prognosis 31
Summary 32
Further reading 32
3 Treatment options in the paediatric epilepsy clinic 33
Further trials of medication 33
The place of dietary therapy 34
Epilepsy surgery 35
Deep brain stimulation and vagal nerve stimulation 35
Evaluation: is this child a candidate for surgery, DBS or VNS ? 36
Palliative care 36
Summary 37
Acknowledgements 37
References 37
4 Efficacy of ketogenic dietary therapy: what is the evidence? 38
How well does it work overall? 38
Who should it be used for? 41
Evidence for ‘alternative’ ketogenic diets 42
Ages older than childhood 43
Efficacy beyond seizure control 44
Summary 44
References 45
5 The biochemical basis of dietary therapies for neurological disorders 48
Components of different diets 48
Fat absorption and metabolism 49
Mechanisms of action of ketogenic diet 51
Conclusion 55
Acknowledgements 55
References 56
Section 2 Clinical Implementation 59
6 Preparing for dietary treatment 61
Ketogenic dietary therapy: the multidisciplinary team 61
Assessment of suitability for dietary treatment 61
Pre-diet evaluation 62
Pre-diet laboratory tests and medical investigations 65
Preparing families for dietary treatment 66
Deciding which dietary treatment to use 67
Advice on pre-diet meal manipulation 67
Summary 69
Acknowledgements 69
References 69
Supplement to chapter 70
7 The challenge of therapeutic diets in children with pre-existing feeding problems 72
Physical feeding difficulties 72
Growth and energy requirements 74
Behavioural feeding difficulties 75
Feeding problems and autistic spectrum disorder 75
Summary 78
References 78
8 The classical ketogenic diet 80
The energy prescription 80
The protein prescription 81
The diet ratio 82
Diet prescription 83
Meal planning 85
Ketoshake meal replacements 88
An alternative method for implementing a classical KD that uses exchanges 88
Conclusion 91
References 91
9 The medium-chain triglyceride ketogenic diet 92
Energy prescription 92
Dietary prescription 92
Daily meal plan 94
Additional considerations relating to use of exchange lists 95
Introduction of the MCT 98
Ketoshake meal replacements 99
Conclusion 100
Acknowledgements 100
References 102
10 The modified Atkins diet 103
The Johns Hopkins MAD protocol 103
Modified Atkins diet in the UK and Ireland 106
Conclusion 112
Acknowledgement 112
References 112
11 The Low Glycaemic Index Treatment 114
Background and development 114
Efficacy 115
Initiation of an individualized treatment 116
Follow-up 117
Fine tuning 117
Micronutrient supplementation 119
Side effects 120
Sick day management 120
Diet discontinuation 120
Conclusion 121
References 121
12 Managing dietary treatment: further dietetic issues 123
Supplementation of vitamins, minerals and trace elements 123
Essential fatty acids 124
Free foods, sweeteners and sugar alcohols 125
Reading labels 126
Fluids 126
Special occasions 127
Food allergy or intolerance 127
Topical creams and toothpaste 127
Concluding comment 129
References 129
13 Managing dietary treatment: a parent’s perspective 130
Background: parental fears and anxieties 130
Preparation for the diet and getting started: advice for the family 131
Shopping for the diet 132
Tips for low-carbohydrate meals 134
Eating away from home 134
Solving everyday problems 136
14 Enteral feeding 138
Calculating ketogenic enteral feeds for existing enteral feeders 139
Transition to ketogenic enteral feed from an existing enteral feed 139
Medium-chain triglyceride ketogenic enteral feeds 141
Existing KD therapy patients who subsequently require enteral feeding 142
Reflux 143
Jejunal feeding 143
Constipation 144
Weaning off a ketogenic enteral feed 144
References 144
15 Dietary initiation 145
Initiation protocols 145
Blood glucose and ketone levels during initiation 146
References 148
16 Ketone monitoring and management of illness 149
Measurement of urine ketones 149
Blood measurement of ketosis 150
Management of illness 152
Medications 154
References 155
17 Fine tuning 156
Protein manipulation 157
Carbohydrate manipulation 158
Fat manipulation 160
Energy manipulation 161
Conclusion 162
Reference 162
18 Monitoring and side effects 163
Haematology and biochemistry 163
Monitoring efficacy 165
Growth 165
Kidney stones 166
Gastrointestinal side effects 167
Other side effects 169
Conclusion 169
References 169
19 Dietary treatments and bone health 173
Osteoporosis 173
Peak bone mass 174
Epilepsy, fractures and antiepileptic drugs 174
Nutrition and physical activity 174
Ketogenic diet 175
Modified diets 176
Monitoring and treatment(s) 176
References 177
20 Carnitine 180
Background 180
Carnitine and the ketogenic diet 182
Assessing carnitine status and supplementation 183
Conclusion 184
References 185
21 Switching or discontinuing dietary treatment 186
Switching dietary treatment 186
Discontinuation of dietary treatment 187
References 192
Section 3 Broader Applications 193
22 Dietary treatment of epilepsy in infants 195
Use of the ketogenic diet in infants 195
Infantile spasms 196
Commercially available formulas for use in the KD 197
Implementation of the KD in infants 198
Monitoring the KD in infants 200
Conclusion 201
References 201
23 Dietary treatment of epilepsy in adults 203
The evidence 203
Additional benefits 203
Increasing demand for treatment 204
Who should be considered for adult KD therapy? 205
Implementation of adult KD therapy 207
Which dietary treatment? 207
Enteral feeding 208
Barriers to use of dietary treatment in adults 210
Future directions 211
References 211
24 Ketogenic dietary therapy in India 212
Introduction to use of the ketogenic diet in India 212
Use of soy 213
Use of spices 214
Normalization of lipids 214
Maintaining uric acid in the normal range 215
Use of blood ketones to improve efficacy 215
Use of high PUFA to improve efficacy 215
Use of KD in other neurological conditions 218
Spreading the use of KD in India 218
Acknowledgements 218
References 218
25 Ketogenic dietary therapy in East Asia 220
Implementation of diet therapy 221
Development of a liquid formula of ketogenic milk 223
Development of diverse KD menus 224
Modified Atkins diet 227
Concluding remarks 227
Acknowlegement 227
References 227
26 Ketogenic dietary therapy in Africa 229
Background 229
Food choices 230
Implementation of the KD 231
Modified diets 232
References 232
27 Ketogenic dietary therapy in neurometabolic disease 234
The ketogenic diet in GLUT1 deficiency syndrome 235
The ketogenic diet in pyruvate dehydrogenase deficiency 236
The ketogenic diet in other neurometabolic conditions 237
References 237
28 Beyond epilepsy: ketogenic diet use in other disease states 239
Alzheimer disease 239
Parkinson disease 240
Amyotrophic lateral sclerosis 241
Ageing 241
Post-ischaemia models 241
Mitochondrial cytopathies 242
Neurotrauma 242
Cancer 242
Conclusion 243
Acknowledgements 243
References 243
Afterword 246
References 247
Appendix 248
Index 249

Produkt-Details

• Erscheint lt. Verlag: 3.7.2012
• Sprache: englisch
• Themenwelt: Sachbuch/Ratgeber ► Gesundheit / Leben / Psychologie
• Themenwelt: Medizin / Pharmazie ► Allgemeines / Lexika
• Themenwelt: Medizin / Pharmazie ► Medizinische Fachgebiete ► Neurologie
• Schlagworte: approximately • Atkins • available • Best • Chronic • Common • Diätetik • Diätetik • dietary treatments • Dietetics • Epilepsy • Gesundheits- u. Sozialwesen • Health & Social Care • hence • Index • Medications • neurological disorder characterised • newer • People • recurrent • seizure control • Seizures • Traditional • Treat • unprovoked • use
• ISBN-10: 1-118-34548-7 / 1118345487
• ISBN-13: 978-1-118-34548-1 / 9781118345481