Ketogen kost - En behandling vid svår epilepsi, men även vissa andra sjukdomstillstånd

Ketogen Kost är en aktiv medicinsk kostbehandling som används för behandling av svår, läkemedelsresistent epilepsi hos barn men även funnit användning hos vuxna och vid andra neurologiska och metabola sjukdomar. Vid några specifika ämnesomsättningssjukdomar ska behandlingen alltid erbjudas. Kosten består av mycket låg andel kolhydrater, nödvändig proteinmängd och mesta energin från fett, helst fleromättat. Ketonkropparna som bildas utgör näringssubstrat för hjärnan när glukostillgången minskas. Användningen måste ske under vägledning och kontroll av ett team med särskild kunskap om metoden. Metabol kontroll behövs liksom vissa näringstillskott.Optimalt använd är behandlingen effektiv och säker men biverkningar finns. Beteende och kognitiva funktioner kan förbättras.Verkningsmekanismerna är flera och samverkande med påverkan på blodfettsammansättning, neuronala signalsubstanser, tarmflorans sammansättning och inflammatoriska reaktioner vilka tillsammans minskar nervcellernas retbarhet och minskar anfallsförekomsten.Ketogenic Diet is an active medical treatment for drug-resistant childhood epilepsy, also used among adults and as adjunct treatment of other neurological diseases and for some rare metabolic diseases it is mandatory. A trained medical team must guide the treatment and offer metabolic surveillance. The diet is composed of a small proportion of carbohydrates, sufficient protein and most energy derives from fat, preferably polyunsaturated, also extra nutrients as needed.Optimally used, it is effective and safe, adverse effects appear and must be handled accordingly. Behaviour and cognitive functions often improve.The mode of action is a combination of changed blood fat composition, neuronal transmitter changes, intestinal bacterial changes and inflammatory decrease to diminish neuronal excitability and reduce seizures. The ketone bodies formed serve as brain energy when glucose availability diminishes

Presurgical language lateralization assessment by fMRI and dichotic listening of pediatric patients with intractable epilepsy

Objective: The aim of this study was to evaluate the clinical use of a method to assess hemispheric language dominance in pediatric candidates for epilepsy surgery. The method is designed for patients but has previously been evaluated with healthy children. Methods: Nineteen patients, 8–18 years old, with intractable epilepsy and candidates for epilepsy surgery were assessed. The assessment consisted of two functional MRI protocols (fMRI) intended to target frontal and posterior language networks respectively, and a behavioral dichotic listening task (DL). Regional left/right indices for each fMRI task from the frontal, temporal and parietal lobe were calculated, and left/right indices of the DL task were calculated from responses of consonants and vowels, separately. A quantitative analysis of each patient's data set was done in two steps based on clearly specified criteria. First, fMRI data and DL data were analyzed separately to determine whether the result from each of these assessments were conclusive or not. Thereafter, the results from the individual assessments were combined to reach a final conclusion regarding hemispheric language dominance. Results: For 14 of the 19 subjects (74%) a conclusion was reached about their hemispheric language dominance. Nine subjects had a left-sided and five subjects had a right-sided hemispheric dominance. In three cases (16%) DL provided critical data to reach a conclusive result. Conclusions: The success rate of conclusive language lateralization assessments in this study is comparable to reported rates on similar challenged pediatric populations. The results are promising but data from more patients than in the present study will be required to conclude on the clinical applicability of the method

Childhood-onset seizures : A long-term cohort study of use of antiepileptic drugs, and drugs for neuropsychiatric conditions

OBJECTIVE: We conducted a long-term follow-up of a cohort of children with newly diagnosed unprovoked seizures to assess treatment with antiepileptic drugs (AEDs), neuroleptics, antidepressants and medication for attention deficit hyperactivity disorder (ADHD) with special attention to the impact of comorbidities on the use of such medication. METHODS: Our study cohort comprised 769 children (28 days-18 years), living in Stockholm Sweden, with a first unprovoked seizure identified between 2001 and 2006. Information on neurodevelopmental comorbidities and Cerebral Palsy (CP) at seizure onset was collected from medical records. Information on treatment with AEDs, neuroleptics, antidepressants and ADHD medication was retrieved by linkage to the Swedish National Prescription Registry between 2005 and 2014. The association between comorbidities and drug treatments was assessed by odds ratios (OR) with 95 % confidence intervals (CI), adjusted for age and sex. RESULTS: Eight years after the index seizure, 31 % of the children were on AEDs, and this was more common among children with any of the comorbidities studied (OR; 4.0 95 % CI 2.9-5.6) compared to those without such comorbidities, and within this group of comorbidities particularly for those with CP (OR; 5.2 95 % CI: 2.9-9.3). Children with neurodevelopmental comorbidity or CP at baseline were more likely to receive neuroleptics (ORs 8 years after the index seizure; 6.9, 95 % CI: 2.4-19.8), antidepressants (OR; 2.3, 95 % CI: 1.0-5.5) and ADHD medication (OR; 3.6, 95 % CI: 1.8-7.2) than children without the studied comorbidities. CONCLUSION: Children with seizures in combination with neurodevelopmental comorbidities or CP, especially CP, have a more frequent use of AEDs, neuroleptics, antidepressants, and ADHD medication up to 13 years following the initial seizure than children without comorbidity. Our data highlight the treatment burden in children with epilepsy and comorbidities