Die Ketogene Diät, Renaissance einer vergessenen Therapie: Grundlagen, Indikationen und Effektivität

Zsuammenfassung

Die Ketogene Diät ist eine therapeutische Ernährungsform, die durch ihren hohen Fettanteil sowie durch die Reduktion von Kohlenhydraten zur Ketonämie führt. Die Arbeit gibt einen Überblick über die für das Verständnis der Ketogenen Diät wichtigen physiologischen und biochemischen Grundlagen. Darauf aufbauend folgt die Darstellung der Indikationen sowie der Effektivität der Ketogenen Diät bei verschiedenen Erkrankungen.

Summary

The ketogenic diet is a therapeutic diet, inducing ketonemia by a high content of fat and the reduction of carbohydrates. We give a synopsis of the physiological and biochemical basis of the ketogenic diet, followed by the description of the indications and the efficacy of the ketogenic diet.

Schlüsselwörter

Ketogene Diät - Indikationen - Effektivität

Keywords

Ketogenic diet - indications - efficacy

• Literatur

• 1 Bainbridge JL, Gidal BE, Ryan M. The ketogenic diet. Pharmacotherapy 1999; 19: 782-6.
• 2 Baumeister FAM, Liebhaber GM, Riemann E. Efficacy of the ketogenic diet for the treatment of refractory epilepsy in children. Neuropediatrics 2002; 33: A23.
• 3 Ben-Menachem E. New antiepileptic drugs and non-pharmacological treatments. Curr Opin Neurol 2000; 13: 165-70.
• 4 Cederbaum SD, Blass JP, Minkoff N, Brown WJ, Cotton ME, Harris SH. Sensitivity to carbohydrate in a patient with familial intermittend lactic acidosis and pyruvate dehydrogenase deficiency. Pediatr Res 1976; 10: 713-20.
• 5 Chungani HAT, Conti JR. Etiologic classification of infantile spasms in 140 cases: role of positron emission tomography. J Child Neurol 1996; 11: 44-8.
• 6 Chungani HAT, Da Silva E, Chungani DCA. Infantile spasms: III. Prognostic implications of bitemporal hypometabolism on positron emission tomography. Ann Neurol 1996; 39: 643-9.
• 7 Cornford EM, Hyman Sh, Cornford EM, Landaw EM, Delgado-Escueta AV. Interictal seizure resections show two configurations of endothelial Glut 1 glucose transporter in the human blood-brain barrier. J Cereb Blood Flow Metab 1998; 18: 26-42.
• 8 Duncan JS. Positron emission tomography studies of cerebral blood flow and glucose metabolism. Epilepsia 1997; 38 (Suppl. 10) 42-7.
• 9 Falk RE, Cederbaum SD, Blass JP, Gibson GE, Pieter Kark RA, Carrel RE. Ketogenic diet in the management of pyruvate dehydrogenase deficiency. Pediatrics 1976; 58: 713-21.
• 10 Freeman JM, Kelly MJ, Freeman JB. The epilepsy diet treatment: An Introduction to the ketogenic diet. 2. Aufl. New York: Demos Publications; 1996
• 11 Freeman JM, Vining PG, Pillas DJ, Pyzik PL, Casey JC, Kelly MT. The efficacy of the Ketogenic Diet-1998: A prospective evaluation of intervention in 150 children. Pediatrics 1998; 102: 1358-63.
• 12 Gilbert DL, Pyzik PL, Freeman JM. The ketogenic diet: Seizure control correlates better with serum β-Hydroxybutyrate than with urine Ketones. J Child Neurol 2000; 15: 787-90.
• 13 Haas RH, Rice MA, Trauner DA, Merritt TA. Therapeutic effects of a ketogenic diet in Rett syndrome. Am J Med Genet 1986; 1: 225-46.
• 14 Hassan AM, Keene DL, Whiting ShE, Jacob PJ, Champagne JR, Humphreys P. Ketogenic diet in the treatment of refractory epilepsy in childhood. Pediatr Neurol 1999; 21: 548-52.
• 15 Hemingway C, Freeman JM, Pillas DJ, Pyzik PL. The Ketogenic Diet: A 3- to 6-year follow-up of 150 children enrolled prospectively. Pediatrics 2001; 108: 898-905.
• 16 Hoffmann GF, Lehnert W. Leitlinien zur Erblichen Laktatazidose. In: Leitlinien Kinderheilkunde und Jugendmedizin der Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften 1997 http://www.uni-duesseldorf.de
• 17 Janigro D. Blood-brain barrier, ion homeostasis and epilepsy: possible implications towards the understanding of ketogenic diet mechanisms. Epilepsy Research 1999; 37: 223-32.
• 18 Katyal NG, Koehler AN, McGhee B, Foley CM, Crumrine PK. The ketogenic diet in refractory epilepsy: The experience of children’s hospital of Pittsburgh. Clin Pediatr 2000; 39: 153-9.
• 19 Klepper J, Santer R, Baethmann M, De Vivo DC, Voit T. Angeborene Störungen des Glukosetransports. Monatsschr Kinderkeilkd 2000; 148: 2-11.
• 20 Klepper J, Burkart P, Ecker D, Brockmann K, Baumeister FAM. Indikation und Anwendung der Ketogenen Diät im Kindesalter. 1. Workshop Ketogene Diät, 14.-15. Dezember 2000 Essen. Monatsschr Kinderheilkd 2001; 149: 1383-90.
• 21 Laffel L. Ketonkörper: Ein Überblick über Physiologie, Pathophysiologie und Anwendung bei der Überwachung von Diabetes. Diabetes Metab Res Rev 1999; 15: 412-26.
• 22 Lefevre F, Aronson N. Ketogenic diet for the treatment of refractory epilepsy in children: A systematic review of efficacy. Pediatrics 2000; 105: 1-7.
• 23 Leino RL, Gerhart DZ, Duelli R, Enerson BE, Drewes LR. Diet-induced ketosis increases monocarboxylate transporter (MCT 1) levels in rat brain. Neurochemistry International 2001; 38: 519-27.
• 24 Matalon R, Stumpf DA, Michals K, Hart RD, Parks JK, Goodman SI. Lipoamide dehydrogenase deficiency with primary lactic acidosis: Favorable response to treatment with oral lipoic acid. J Pediatr 1984; 104: 65-9.
• 25 Muller-Schwarze AB, Tandon P, Liu Z, Yang Y, Holmes GL, Stafstrom CE. Ketogenic diet reduces spontaneous seizures and mossy fiber sprouting in kainic acid model. Neuro Report 1999; 10: 1517-22.
• 26 Nordli DR, De Vivo DC. The ketogenic diet revisited: Back to the future. Epilepsia 1997; 38: 743-9.
• 27 Nordli DR, Kuroda MM, Carroll J, Koenigsberger DY, Hirsch LJ, Bruner HJ, Seidel WT, De Vivo DC. Experience with the ketogenic diet in infants. Pediatrics 2001; 108: 129-33.
• 28 Pan JW, Bedin EM, Chu WJ, Hetherington HP. Ketosis and epilepsy: 31P spectroscopic imaging at 4.1 T. Epilepsia 1999; 40: 703-7.
• 29 Pulsifer MB, Gordon JM, Brandt J, Vining EPG, Freeman JM. Effects of ketogenic diet on development and behavior: preliminary report of a prospective study. Developmental Medicine & Child Neurology 2001; 43: 301-6.
• 30 Schmidt D, Elger CE. Praktische Epilepsiebehandlung. 2.Aufl. Stuttgart: Thieme; 2002
• 31 Schmidt D, Bourgeois B. A risk-benefit assessment of therapies for Lennox-Gastaut Syndrome. Drug Safety 2000; 22: 467-77.
• 32 Schwartzkroin PA. Mechanisms underlying the anti-epileptic efficacy of the ketogenic diet. Epilepsy Research 1999; 37: 171-80.
• 33 Scriver CR, Beaudet AL, Sly WS, Valle D. The metabolic and molecular bases of inherited disease. 7th ed.. New York: Mc Graw-Hill; 1995
• 34 Siemes H, Bourgeois BFD. Anfälle und Epilepsien bei Kindern und Jugendlichen. Stuttgart: Thieme; 2001
• 35 Stafstrom CE. Animal models of the ketogenic diet: what have we learned, what can we learn?. Epilepsy Research 1999; 37: 241-59.
• 36 Stafstrom CE, Spencer S. The ketogenic diet: A therapy in search of an explanation. Neurology 2000; 54: 282-3.
• 37 Swink TD, Vining EPG, Freeman JM. The ketogenic diet:1997. Advances in Pediatrics 1997; 44: 297-329.
• 38 Swoboda KJ, Specht L, Jones HR, Shapiro F, DiMauro S, Korson M. Infantile phosphofructokinase deficiency with arthrogryposis: Clinical benefit of a ketogenic diet. J Pediatr 1997; 131: 932-4.
• 39 Wexler ID, Hemalatha SG, McConnell J, Buist NRM, Dahl H-HM, Berry SA, Cederbaum SD, Patel MS, Kerr DS. Outcome of pyruvate dehydrogenase deficiency treated with ketogenic diets. Studies in patients with identical mutations. Neurology 1997; 49: 1655-61.
• 40 Wheless JW, Ashwal S. The Ketogenic diet. In: Swaiman KF, Ashwal S. (ed). Pediatric Neurology: Principles & practice. 3rd ed.. St. Louis: Mosby; 1999: 719-28.
• 41 Wheless JW. Vagus nerve stimulation and the ketogenic diet. Neurologic Clinics 2001; 19: 371-407.
• 42 Wijburg FA, Barth PG, Bindoff LA, Birch-Machin MA, van der Blij JF, Ruitenbeek W, Turnbull DM, Schutgens RBH. Leigh syndrome associated with a deficiency of the pyruvate dehydrogenase complex: Results of treatment with a ketogenic diet. Neuropediatrics 1992; 23: 147-52.
• 43 Wilder RM. The effect of ketonemia on the course of epilepsy. Bull Mayo Clin 1921; 2: 307-8.