This is the first study, to our knowledge, to describe the risk of recurrent seizures after discontinuation of the ketogenic diet. Many prior studies of children who are seizure-free on anticonvulsant drugs have established that the rate of recurrence after discontinuation of anticonvulsant therapy ranges from 30 to 50% (Emerson et al.,1981; Gherpelli et al., 1992; Shinnar et al., 1994; Tennison et al., 1994; Peters et al., 1998; Camfield and Camfield, 2005; Sillanpaa and Schmidt, 2006). The recurrence rate assessed for the ketogenic diet appears to be slightly lower, with 20% having a recurrence. Previously identified risk factors for seizure recurrence in children on anticonvulsants have been well-described in several studies, and include symptomatic epilepsy, age over 12 yr, and moderate to severe mental retardation (Shinnar et al., 1994; Tennison et al., 1994; Peters et al., 1998; Camfield and Camfield, 2005). Symptomatic epilepsy due to a focal cortical lesion(s) increased the risk for ketogenic diet patients, but older age and mental retardation did not.
Evidence from abnormal EEGs suggests a correlation (Emerson et al., 1981; Shinnar et al., 1994; Tennison et al., 1994), with one series of 70 children describing an increased risk if EEG was abnormal in the year before the anticonvulsant taper, similar to our study (Gherpelli et al., 1992). Lastly, the median number of pre-diet seizures was surprisingly lower for patients with recurrent seizures as compared to the seizure-free group. The reason for this is unclear, as these children were neither younger at seizure onset nor more likely to have an epilepsy syndrome with frequent, but typically outgrown seizures (e.g., infantile spasms). Regardless of the explanation, a patient history of even the most severe intractability before success with the ketogenic diet should not dissuade an attempt to discontinue the diet. There are a number of implications for patients who have had a complete response to the ketogenic diet. This study provides evidence that if patients have been seizure-free for at least 6 months; consideration should be given to discontinue the diet. In counseling families, it may be advisable to obtain a recent EEG and review previous MRI results prior to discontinuation.
For patients with epileptiform spikes on EEG or focal abnormalities on MRI, the risk of recurrence is significantly higher and families may choose to keep their children on the diet for a longer duration. If seizures recur, however, the majority will be controlled again, often without the need for the ketogenic diet. Interestingly, three children with an abnormal MRI had tuberous sclerosis complex, all of whom had recurrence of seizures and two of whom continue to have seizures despite diet therapy. Previous studies of the ketogenic diet have reported excellent, even seizure-free, results in children with tuberous sclerosis complex (Kossoff et al., 2005). Perhaps the diet should be maintained for longer than 2 yr, or even indefinitely, in patients with tuberous sclerosis complex if seizure freedom is attained, based on the present results. This study has several limitations. As this was not a prospective study, follow-up after diet discontinuation was not always considered to be necessary. Although a significant majority of patients were successfully contacted, it is possible that the others have had recurrent seizures but changed addresses, did not contact our group, and/or sought neurological care elsewhere. If these patients are excluded, 25% will have had recurrence. In addition, follow-up EEGs were not routinely obtained after diet discontinuation to confirm the absence of epileptiform activity. In conclusion, the risk of seizure recurrence after a seizure-free treatment course with the ketogenic diet appears slightly lower than after stopping use of anticonvulsant drugs, and similar to surgery. The risk of seizures becoming intractable in that situation fortunately was also rare. Children with abnormal MRIs or epileptiform EEGs may be more likely to have recurrences.
Hal ini terjadi bersamaan dengan peningkatan keton, yang memiliki banyak manfaat untuk kesehatan. Dari pada penasaran yuk langsung saja di intip menu diet keto yang bisa Anda contoh saat menjalankan diet keto untuk penurunan berat badan secara mudah dalam seminggu. Sarapan : Bacon, telur dan tomat. Makan siang : Salad ayam dengan minyak zaitun dan keju feta. Makan malam : Salmon dengan asparagus yang dimasak dengan mentega. Sarapan : Telur, tomat, kemangi dan telur dadar keju kambing. Makan Siang : Susu almond, selai kacang, coklat bubuk dan milkshake stevia. Makan Malam : Bakso, keju cheddar dan sayuran. Makan siang : Salad udang dengan minyak zaitun dan alpokat. Makan Malam : Potongan daging dengan keju parmesan, brokoli dan salad. Sarapan : Telur dadar, salsa, paprika, bawang dan rempah-rempah. Makan Siang : Segenggam kacang dan sebatang seledri degan guacamole dan salsa. Makan Malam : Ayam yang diisi dengan krim keju, bersama dengan sayur-sayuran.
Sarapan : Yoghurt bebas gula dengan selai kacang dan bubuk coklat. Makan Siang : Tumis daging yang dimasak dengan minyak kelapa dan sayuran. Makan Malam : Burger tanpa roti manis, telur dan keju. Sarapan : Ham dan telur dadar keju dengan sayuran. Makan Siang : Ham dan irisan keju dengan kacang. Makan Malam : Ikan putih, telur dan bayam yang dimasak dengan minyak kelapa. Sarapan : Telur goreng dengan jamur. Makan Siang : Burger, keju dan guacamole. Makan Malam : Steak dan telur dengan sedikit salad. Cobalah untuk mengganti-ganti sayuran dan daging dalam jangka panjang. Karena setiap jenis makanan tersebut mengandung nutrisi yang berbeda dan dapat memberi manfaat kesehatan yang berbeda. Jadi kesimpulan dari menu diet keto di atas, Anda dapat makan berbagai jenis makanan lezat dan bergizi sesuai selera. Saat menjalankan diet, kadang Anda merasa lapar sebelum waktu makan tiba. Dengan ini saya juga akan berbagi beberapa contoh makanan ringan sehat yang sesuai dengan menu diet keto.
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