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HOME > Epilessia e dieta chetogenica. Riduzione degli attacchi fino all’85% dei casi
Epilessia e dieta chetogenica. Riduzione degli attacchi fino all’85% dei casi
Osservata anche una emissione totale degli attacchi nel 55% dei pazienti trattati con un particolare regime alimentare condotto sotto stretto controllo medico che ha come obiettivo quello di indurre e mantenere uno stato cronico di chetosi. Il Gruppo di Studio della Lega Italiana contro l’Epilessia ha presentato i risultati nel corso di un convegno all’Ospedale Pediatrico Bambino Gesù
Una riduzione delle crisi epilettiche fino all’85% dei casi e una remissione totale degli attacchi nel 55% dei pazienti (1). È quanto osservato nelle persone con epilessia farmaco-resistente chiamati a seguire una dieta chetogenica, un particolare regime alimentare condotto sotto stretto controllo medico che ha come obiettivo quello di indurre e mantenere uno stato cronico di chetosi. Sono i dati presentati in occasione del Convegno “Dieta Chetogenica. Stato dell’Arte Esperienza Italiana” organizzato recentemente dal Gruppo di Studio “Dietoterapie in Epilessia” della Lega Italiana contro l’Epilessia presso l’Ospedale Pediatrico del Bambino Gesù di Roma.
A consentire un adeguato livello di chetosi, cioè una condizione metabolica in cui vengono utilizzati corpi chetonici come fonte energetica, sono un basso apporto di carboidrati e un alto apporto di grassi in rapporto controllato. Un piano dietetico, dunque quello chetogenico, dove il 90% della razione alimentare è composta da lipidi, il 7% da proteine e solo il 2-3% da glucidi: una combinazione piuttosto lontana dalla dieta mediterranea che include in linea di massima il 10% di proteine, il 65% di carboidrati e 25% di lipidi.
“Si tratta di una terapia dietetica non adatta a tutti i pazienti – ha sottolineato Oriano Mecarelli, Presidente LICE, Dipartimento di Neuroscienze Umane dell'Università Sapienza di Roma -. Le persone con epilessia candidate al trattamento hanno spesso una storia clinica complessa ed è necessario eseguire uno screening preliminare clinico e biochimico per escludere un problema congenito del metabolismo che possa essere aggravato dalla dieta. Prima di iniziare la dieta chetogenica sono inoltre necessari incontri con le famiglie dei pazienti mirati a fornire informazioni sulla preparazione dei pasti, sulla necessità di somministrare integratori vitaminico-minerali e su come monitorare i livelli di chetosi e gli eventuali effetti collaterali”.
Più precoce è l’inizio del trattamento con la dieta chetogenica maggiore è la possibilità di successo. Ad esempio nell’epilessia mioclono astatica dell’infanzia è stata dimostrata l’efficacia della dieta chetogenica con un forte effetto anticonvulsivante nell’86% dei pazienti. In questi casi, è di oltre il 70% la riduzione delle crisi epilettiche dopo due mesi di dietoterapia (2).
Un trattamento a tutti gli effetti, quello della dieta chetogenica, che però non può essere “somministrato” per tutta la vita tranne in alcune specifiche malattie metaboliche.
Per i bambini che ottengono un controllo delle crisi maggiore del 50%, la dieta può essere proseguita per un periodo anche di due anni, a meno che non si verifichino effetti collaterali che richiedano la sospensione del trattamento. Questo piano dietetico-terapeutico può essere invece adottato per diversi anni dai bambini che raggiungono una remissione del 90% delle crisi epilettiche, con effetti collaterali quasi nulli (3).
“Si tratta di dati estremamente importanti quelli presentati – ha dichiarato Raffaella Cusmai, Responsabile scientifico del Gruppo di Studio ‘Dietoterapie in Epilessia’ LICE, Dipartimento di Neuroscienze e Neuroriabilitazione dell’Ospedale Pediatrico Bambino Gesù -. Attualmente, nonostante l’introduzione di farmaci antiepilettici di nuova generazione, circa il 30% circa dei pazienti risulta farmaco-resistente. Pertanto, l’interesse della ricerca scientifica nei confronti della dieta chetogenica continua a rimanere alto e oggi ci invita ad approfondire alcune nuove prospettive emergenti come quello della relazione tra microbiota intestinale e cervello”.
Tra le novità discusse, infatti, anche quelle relative al legame tra microbiota intestinale ed epilessia, in riferimento alla dieta chetogenica. Secondo un recente studio, alcune specifiche alterazioni del microbiota indotte dalla dieta sono in grado di contribuire ad un effetto antiepilettico.
Note:
1 Ketogenic diets for drug-resistant epilepsy, 2019 Nov 7;11
2 Efficacy of a ketogenic diet in resistant myoclonoastatic epilepsy: a French multicenter retrospective study, 2017, 131:64-69
3 Optical clinical management of children receiving dietary therapies for epilepsy: update reccomenations of the Internatoal Ketogenic Diet Study Group: Epilepsia Open, 3 (2): 175-192, 2018
Articolo scritto su quotidianosanita.it - fonte: www.quotidianosanita.it
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Dieta chetogenica, il cibo come farmaco
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