Peran Diet Ketogenik dalam Tata Laksana Epilepsi
DOI:
https://doi.org/10.55175/cdk.v49i11.318Keywords:
Benda keton, diet ketogenik, epilepsi, epilepsi refrakter, ketosis, restriksi karbohidratAbstract
Sejak diperkenalkan pertama kali pada awal abad 19, penggunaan diet ketogenik dalam terapi epilepsi terus berkembang, khususnya untuk kasus epilepsi yang refrakter terhadap terapi farmakologi. Berbagai mekanisme terkait peran diet ketogenik dalam memperbaiki kondisi epilepsi telah diajukan, mulai keterlibatannya dalam regulasi GABA dan glutamat, efek antioksidan, perbaikan metabolisme energi, hingga koreksi kondisi disbiosis. Diet ketogenik adalah terapi non-farmakologis epilepsi yang menjanjikan, saat ini telah masuk dalam guideline NICE di Inggris untuk kasus epilepsi anak yang resisten terhadap terapi obat anti-epilepsi.
Since its introduction in the early 19th century, ketogenic diet for the treatment of epilepsy is still being developed, especially for refractory cases. Various mechanisms have been proposed, ranging from its involvement in GABA and glutamate regulation, antioxidant effects, improvement of energy metabolism, to correction of dysbiosis conditions. Ketogenic diet is a promising non-pharmacological therapy for epilepsy; it has been included in UK NICE guidelines for pharmacologically-resistant pediatric epilepsy cases.
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References
Stafstrom CE, Carmant L. Seizures and epilepsy: An overview for neuroscientists. Cold Spring Harb Perspect Med. 2015;5(6):a022426.
The 2014 definition of epilepsy: A perspective for patients and caregivers // International League Against Epilepsy [Internet]. [cited 2022 Jul 13]. Available from: https://www.ilae.org/guidelines/definition-and-classification/the-2014-definition-of-epilepsy-a-perspective-for-patients-and-caregivers
Epilepsy [Internet]. [cited 2022 Jul 11]. Available from: https://www.who.int/news-room/fact-sheets/detail/epilepsy
Epilepsy surgery in Indonesia: Achieving a better result with limited resources | Bali Med J. [cited 2022 Jul 13]; Available from: https://jurnal.harianregional.com/index.php/bmj/article/view/4545
Kerr MP. The impact of epilepsy on patients’ lives. Acta Neurol Scand Suppl. 2012;194:1–9.
Beghi E. Does diagnostic delay impact on the outcome of epilepsy? Epilepsia Open. 2021;6(3):470–1.
Scheffer IE, Berkovic S, Capovilla G, Connolly MB, French J, Guilhoto L, et al. ILAE classification of the epilepsies: Position paper of the ILAE Commission for Classification and Terminology. Epilepsia. 2017;58(4):512–21.
Epilepsy [Internet]. 2017 [cited 2022 Jul 13]. Available from: https://www.nhs.uk/conditions/epilepsy/
Perbedaan dari masing2 dd (definisi) 2. Status epileptikus a. Definisi yang perlu diketahui? b. Penyebabnya apa? 3. Epilepsi a. Apa arti epilepsi? - PDF Free Download [Internet]. [cited 2022 Aug 4]. Available from: https://docplayer.info/65132604-1-perbedaan-dari-masing2-dd-definisi-2-status-epileptikus-a-definisi-yang-perlu-diketahui-b-penyebabnya-apa-3-epilepsi-a-apa-arti-epilepsi.html
Fisher RS, Cross JH, French JA, Higurashi N, Hirsch E, Jansen FE, et al. Operational classification of seizure types by the International League Against Epilepsy: Position paper of the ILAE commission for classification and terminology. Epilepsia 2017;58(4):522–30.
Bromfield EB, Cavazos JE, Sirven JI. Basic mechanisms underlying seizures and epilepsy. An introduction to epilepsy. American Epilepsy Society [Internet]. 2006 [cited 2022 Jul 15]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK2510/
Ponisio MR, Zempel JM, Day BK, Eisenman LN, Miller-Thomas MM, Smyth MD, et al. The role of SPECT and PET in epilepsy. Am J Roentgenol. 2021;216(3):759–68.
Mitchell JW, Seri S, Cavanna AE. Pharmacotherapeutic and non-pharmacological options for refractory and difficult-to-treat seizures: J Cent Nerv Syst Dis [Internet]. 2012 Jun 19 [cited 2022 Jul 15]; Available from: https://journals.sagepub.com/doi/10.4137/JCNSD.S8315
Masood W, Annamaraju P, Uppaluri KR. Ketogenic diet. StatPearls [Internet]. 2022 [cited 2022 Jul 12]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK499830/
Manninen AH. Metabolic effects of the very-low-carbohydrate diets: Misunderstood “villains” of human metabolism. J Int Soc Sports Nutr. 2004;1(2):7–11.
Ketosis vs ketoacidosis: Differences, symptoms, and causes [Internet]. 2019 [cited 2022 Jul 15]. Available from: https://www.medicalnewstoday.com/articles/324237
Figure 1, Metabolic pathways involved in ketogenic diet (KD) treatment - Jasper’s basic mechanisms of the epilepsies - NCBI Bookshelf [Internet]. [cited 2022 Jul 13]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK98219/figure/masino.f1/
Crosby L, Davis B, Joshi S, Jardine M, Paul J, Neola M, et al. Ketogenic diets and chronic disease: Weighing the benefits against the risks. Front Nutr. 2021;8:702802.
The Internet Classics Archive | On the sacred disease by Hippocrates [Internet]. [cited 2022 Jul 13]. Available from: http://classics.mit.edu/Hippocrates/sacred.html
Höhn S, Dozières-Puyravel B, Auvin S. History of dietary treatment: Guelpa & Marie first report of intermittent fasting for epilepsy in 1911. Epilepsy Behav. 2019;94:277–80. 21. The man who cured everything | Only human [Internet]. WNYC Studios. [cited 2022 Jul 13]. Available from: https://www.wnycstudios.org/podcasts/onlyhuman/episodes/man-who-cured-everything
Rogovik AL, Goldman RD. Ketogenic diet for treatment of epilepsy. Can Fam Physician 2010;56(6):540–2.
History of the ketogenic diet. News-Medical.net [Internet]. 2010 [cited 2022 Jul 11]. Available from: https://www.news-medical.net/health/History-of-the-Ketogenic-Diet.aspx
Zarnowska IM. Therapeutic use of the ketogenic diet in refractory epilepsy: What we know and what still needs to be learned. Nutrients 2020;12(9):2616.
Neuroprotective and disease-modifying effects of the ketogenic diet - PubMed [Internet]. [cited 2022 Jul 15]. Available from: https://pubmed.ncbi.nlm.nih.gov/16940764/
Medium chain triglyceride (MCT) diet. Epilepsy Foundation [Internet]. [cited 2022 Jul 13]. Available from: https://www.epilepsy.com/treatment/dietary-therapies/medium-chain-triglyceride-diet
CFtest. About us. Charlie Foundation [Internet]. [cited 2022 Jul 13]. Available from: https://charliefoundation.org/about-us/
van der Louw E, van den Hurk D, Neal E, Leiendecker B, Fitzsimmon G, Dority L, et al. Ketogenic diet guidelines for infants with refractory epilepsy. Eur J Paediatr Neurol EJPN Off J Eur Paediatr Neurol Soc. 2016;20(6):798–809.
Food for thought: The ketogenic diet as epilepsy treatment // International League Against Epilepsy [Internet]. [cited 2022 Jul 13]. Available from: https://www.ilae.org/journals/epigraph/epigraph-vol-22-issue-5-fall-2020/food-for-thought-the-ketogenic-diet-as-epilepsy-treatment
Youngson NA, Morris MJ, Ballard JWO. The mechanisms mediating the antiepileptic effects of the ketogenic diet, and potential opportunities for improvement with metabolism-altering drugs. Seizure 2017;52:15–9.
Frontiers | Metabolic therapy for temporal lobe epilepsy in a dish: Investigating mechanisms of ketogenic diet using electrophysiological recordings in Hippocampal slices [Internet]. [cited 2022 Jul 13]. Available from: https://www.frontiersin.org/articles/10.3389/fnmol.2016.00112/full
Masino SA, Li T, Theofilas P, Sandau US, Ruskin DN, Fredholm BB, et al. A ketogenic diet suppresses seizures in mice through adenosine A1 receptors. J Clin Invest. 2011;121(7):2679–83.
Greco T, Glenn TC, Hovda DA, Prins ML. Ketogenic diet decreases oxidative stress and improves mitochondrial respiratory complex activity. J Cereb Blood Flow Metab. 2016;36(9):1603–13.
Nathan J, Bailur S, Datay K, Sharma S, Khedekar Kale D. A switch to polyunsaturated fatty acid based ketogenic diet improves seizure control in patients with drug-resistant epilepsy on the mixed fat ketogenic diet: A retrospective open label trial. Cureus. 11(12):e6399.
Anticonvulsant mechanisms of the ketogenic diet and caloric restriction - ScienceDirect [Internet]. [cited 2022 Jul 14]. Available from: https://www.sciencedirect.com/science/article/abs/pii/S0920121120305507
Yang H, Guo R, Wu J, Peng Y, Xie D, Zheng W, et al. The antiepileptic effect of the glycolytic inhibitor 2-deoxy-D-glucose is mediated by upregulation of K(ATP) channel subunits Kir6.1 and Kir6.2. Neurochem Res. 2013;38(4):677–85.
Frontiers | Microbiota–gut–brain axis and epilepsy: A review on mechanisms and potential therapeutics [Internet]. [cited 2022 Aug 4]. Available from: https://www.frontiersin.org/articles/10.3389/fimmu.2021.742449/full
Attaye I, van Oppenraaij S, Warmbrunn MV, Nieuwdorp M. The role of the gut microbiota on the beneficial effects of ketogenic diets. Nutrients 2021;14(1):191.
Sourbron J, Klinkenberg S, van Kuijk SMJ, Lagae L, Lambrechts D, Braakman HMH, et al. Ketogenic diet for the treatment of pediatric epilepsy: review and meta-analysis. Childs Nerv Syst ChNS Off J Int Soc Pediatr Neurosurg. 2020;36(6):1099–109.
Liu H, Yang Y, Wang Y, Tang H, Zhang F, Zhang Y, et al. Ketogenic diet for treatment of intractable epilepsy in adults: A meta-analysis of observational studies. Epilepsia Open 2018;3(1):9–17.
Ketogenic diets for drug-resistant epilepsy [Internet]. [cited 2022 Jul 14]. Available from: https://www.cochrane.org/CD001903/EPILEPSY_ketogenic-diets-drug-resistant-epilepsy
Ruan Y, Chen L, She D, Chung Y, Ge L, Han L. Ketogenic diet for epilepsy: An overview of systematic review and meta-analysis. Eur J Clin Nutr. 2022;1–11.
Asif M. Role of various vitamins in the patients with epilepsy. Int J Pharmacol Res. 2013;3(1):1-5.
Raskind JY, El-Chaar GM. The role of carnitine supplementation during valproic acid therapy. Ann Pharmacother. 2000;34(5):630–8.
KetoCal family of ketogenic medical foods (ketogenic formulas) [Internet]. [cited 2022 Jul 15]. Available from: https://www.myketocal.com/
The ketogenic diet in a bottle? Epilepsy Foundation [Internet]. [cited 2022 Jul 15]. Available from: https://www.epilepsy.com/stories/ketogenic-diet-bottle
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