fa تأثیر رژیم غذایی کتوژنیک در درمان صرع مقاوم بيماريهاي مغز و اعصاب (نورولوژی) بيماريهاي مغز و اعصاب (نورولوژی) مروری Review <span lang="AR-SA" style="FONT-FAMILY: "B Zar" FONT-SIZE: 12pt mso-fareast-font-family: 'Times New Roman' mso-ansi-language: EN-US mso-fareast-language: EN-US mso-bidi-language: AR-SA mso-ascii-font-family: 'Times New Roman' mso-hansi-font-family: 'Times New Roman'" dir="rtl">صرع بیماری مزمنی است که می_­تواند از دوران شیرخوارگی شروع شود و شیوع آن حدود </span><span lang="AR-SA" style="FONT-FAMILY: "B Zar" FONT-SIZE: 10pt mso-fareast-font-family: 'Times New Roman' mso-ansi-language: EN-US mso-fareast-language: EN-US mso-bidi-language: AR-SA mso-ascii-font-family: 'Times New Roman' mso-hansi-font-family: 'Times New Roman'" dir="rtl">1-5/0 </span><span lang="AR-SA" style="FONT-FAMILY: "B Zar" FONT-SIZE: 12pt mso-fareast-font-family: 'Times New Roman' mso-ansi-language: EN-US mso-fareast-language: EN-US mso-bidi-language: AR-SA mso-ascii-font-family: 'Times New Roman' mso-hansi-font-family: 'Times New Roman'" dir="rtl">درصد جمعیت عمومی می_­باشد. یک سوم بیماران به درمان_­های دارویی ضدتشنج مقاوم هستند که منجر به ایجاد چالش در زمینه درمان و مراقبت_­های آنها می_­گردد. رژیم کتوژنیک درمان موثری برای موارد مقاوم به درمان است. رژیم کتوژنیک شامل یک رژیم غذایی با کربوهیدرات بسیار پایین، چربی بالا و پروتئین به میزان حداقل ضروری است و روی هم رفته میزان کالری دریافتی به حدود </span><span lang="AR-SA" style="FONT-FAMILY: "B Zar" FONT-SIZE: 10pt mso-fareast-font-family: 'Times New Roman' mso-ansi-language: EN-US mso-fareast-language: EN-US mso-bidi-language: AR-SA mso-ascii-font-family: 'Times New Roman' mso-hansi-font-family: 'Times New Roman'" dir="rtl">75 </span><span lang="AR-SA" style="FONT-FAMILY: "B Zar" FONT-SIZE: 12pt mso-fareast-font-family: 'Times New Roman' mso-ansi-language: EN-US mso-fareast-language: EN-US mso-bidi-language: AR-SA mso-ascii-font-family: 'Times New Roman' mso-hansi-font-family: 'Times New Roman'" dir="rtl">درصد مطلوب بر اساس سن کاهش می</span>_{<span style="FONT-FAMILY: "Times New Roman","serif" FONT-SIZE: 12pt mso-fareast-font-family: 'Times New Roman' mso-bidi-font-family: 'B Zar' mso-ansi-language: EN-US mso-fareast-language: EN-US mso-bidi-language: AR-SA">­</span>}<span lang="AR-SA" style="FONT-FAMILY: "B Zar" FONT-SIZE: 12pt mso-fareast-font-family: 'Times New Roman' mso-ansi-language: EN-US mso-fareast-language: EN-US mso-bidi-language: AR-SA mso-ascii-font-family: 'Times New Roman' mso-hansi-font-family: 'Times New Roman'" dir="rtl">یابد. میزان پروتئین دریافتی براساس سن بیمار متفاوت است، کربوهیدرات به میزان </span><span lang="AR-SA" style="FONT-FAMILY: "B Zar" FONT-SIZE: 10pt mso-fareast-font-family: 'Times New Roman' mso-ansi-language: EN-US mso-fareast-language: EN-US mso-bidi-language: AR-SA mso-ascii-font-family: 'Times New Roman' mso-hansi-font-family: 'Times New Roman'" dir="rtl">10-5 </span><span lang="AR-SA" style="FONT-FAMILY: "B Zar" FONT-SIZE: 12pt mso-fareast-font-family: 'Times New Roman' mso-ansi-language: EN-US mso-fareast-language: EN-US mso-bidi-language: AR-SA mso-ascii-font-family: 'Times New Roman' mso-hansi-font-family: 'Times New Roman'" dir="rtl">گرم در روز توصیه می</span>_{<span style="FONT-FAMILY: "Times New Roman","serif" FONT-SIZE: 12pt mso-fareast-font-family: 'Times New Roman' mso-bidi-font-family: 'B Zar' mso-ansi-language: EN-US mso-fareast-language: EN-US mso-bidi-language: AR-SA">­</span>}<span lang="AR-SA" style="FONT-FAMILY: "B Zar" FONT-SIZE: 12pt mso-fareast-font-family: 'Times New Roman' mso-ansi-language: EN-US mso-fareast-language: EN-US mso-bidi-language: AR-SA mso-ascii-font-family: 'Times New Roman' mso-hansi-font-family: 'Times New Roman'" dir="rtl">شود و مابقی کالری مورد نیاز توسط چربی_­ها تامین می_­گردد. نسبت چربی به کربوهیدرات به اضافه پروتئین بین </span><span lang="AR-SA" style="FONT-FAMILY: "B Zar" FONT-SIZE: 10pt mso-fareast-font-family: 'Times New Roman' mso-ansi-language: EN-US mso-fareast-language: EN-US mso-bidi-language: AR-SA mso-ascii-font-family: 'Times New Roman' mso-hansi-font-family: 'Times New Roman'" dir="rtl">2 </span><span lang="AR-SA" style="FONT-FAMILY: "B Zar" FONT-SIZE: 12pt mso-fareast-font-family: 'Times New Roman' mso-ansi-language: EN-US mso-fareast-language: EN-US mso-bidi-language: AR-SA mso-ascii-font-family: 'Times New Roman' mso-hansi-font-family: 'Times New Roman'" dir="rtl">به </span><span lang="AR-SA" style="FONT-FAMILY: "B Zar" FONT-SIZE: 10pt mso-fareast-font-family: 'Times New Roman' mso-ansi-language: EN-US mso-fareast-language: EN-US mso-bidi-language: AR-SA mso-ascii-font-family: 'Times New Roman' mso-hansi-font-family: 'Times New Roman'" dir="rtl">1 </span><span lang="AR-SA" style="FONT-FAMILY: "B Zar" FONT-SIZE: 12pt mso-fareast-font-family: 'Times New Roman' mso-ansi-language: EN-US mso-fareast-language: EN-US mso-bidi-language: AR-SA mso-ascii-font-family: 'Times New Roman' mso-hansi-font-family: 'Times New Roman'" dir="rtl">تا </span><span lang="AR-SA" style="FONT-FAMILY: "B Zar" FONT-SIZE: 10pt mso-fareast-font-family: 'Times New Roman' mso-ansi-language: EN-US mso-fareast-language: EN-US mso-bidi-language: AR-SA mso-ascii-font-family: 'Times New Roman' mso-hansi-font-family: 'Times New Roman'" dir="rtl">4 </span><span lang="AR-SA" style="FONT-FAMILY: "B Zar" FONT-SIZE: 12pt mso-fareast-font-family: 'Times New Roman' mso-ansi-language: EN-US mso-fareast-language: EN-US mso-bidi-language: AR-SA mso-ascii-font-family: 'Times New Roman' mso-hansi-font-family: 'Times New Roman'" dir="rtl">به </span><span lang="AR-SA" style="FONT-FAMILY: "B Zar" FONT-SIZE: 10pt mso-fareast-font-family: 'Times New Roman' mso-ansi-language: EN-US mso-fareast-language: EN-US mso-bidi-language: AR-SA mso-ascii-font-family: 'Times New Roman' mso-hansi-font-family: 'Times New Roman'" dir="rtl">1 </span><span lang="AR-SA" style="FONT-FAMILY: "B Zar" FONT-SIZE: 12pt mso-fareast-font-family: 'Times New Roman' mso-ansi-language: EN-US mso-fareast-language: EN-US mso-bidi-language: AR-SA mso-ascii-font-family: 'Times New Roman' mso-hansi-font-family: 'Times New Roman'" dir="rtl">مناسب است. مکانیسم اثر رژیم کتوژنیک هنوز بخوبی شناخته نشده است. به نظر می_­رسد فواید آن مرتبط با اسیدوز، کتوز، محدودیت کالری و کاهش گلوکز خون باشد. رژیم کتوژنیک منجر به کاهش گلوکز خون و تولید اجسام کتونی توسط بتااکسیداسیون چربی_­ها می_­شود. برخی مطالعات نشان داده_­اند که رژیم کتوژنیک با مکانیسم پورینرژیک، تنظیم<font size="3"><font face="B Zar"><span style="mso-spacerun: yes">  </span>تحریک_­پذیری وابسته به گلوکز<span style="mso-spacerun: yes">  </span>را در هیپوکامپ تحت تاثیر قرار می_­دهد. عوارض جانبی رژیم کتوژنیک شامل یبوست، تشدید ریفلاکس، اسیدوز، خستگی و سنگ کلیه می_­باشد. همچنین، از عوارض بالقوه آن می_­تواند کندی رشد در کودکان کوچکتر باشد.</font></font></span> <span style="FONT-FAMILY: "Times New Roman","serif" FONT-SIZE: 11pt mso-fareast-font-family: 'Times New Roman' mso-bidi-font-family: 'B Zar' mso-ansi-language: EN-US mso-fareast-language: EN-US mso-bidi-language: AR-SA">Epilepsy is a chronic disease with onset in infancy affecting 0.5-1% of the population. One third of the patients are refractory to antiepileptic drugs and they pose a challenge for the health care team. Ketogenic diet is an effective treatment for refractory epilepsy. The ketogenic diet is a very low carbohydrate, high fat, and low to adequate protein diet that includes some restriction of total calories (</span><span style="FONT-FAMILY: "Times New Roman","serif" FONT-SIZE: 9pt mso-fareast-font-family: 'Times New Roman' mso-bidi-font-family: 'B Zar' mso-ansi-language: EN-US mso-fareast-language: EN-US mso-bidi-language: AR-SA">≈</span><span style="FONT-FAMILY: "Times New Roman","serif" FONT-SIZE: 11pt mso-fareast-font-family: 'Times New Roman' mso-bidi-font-family: 'B Zar' mso-ansi-language: EN-US mso-fareast-language: EN-US mso-bidi-language: AR-SA">75% of age rec­ommendations). The amount of protein is based on age requirement, carbohydrates are only 5 to 10 g/day, and the remaining calories come from fat. The ratio of fat to protein plus carbohydrate ranges from 2 : 1 to 4 : 1. The mechanism of the ketogenic diet is not well under­stood. Its benefit may be related to acidosis, ketosis, calorie restriction and decrease in blood glucose, dehydration, or increase in certain lipids. A ketogenic diet limits blood glucose, and produces ketone bodies from β-oxidation of lipids. Studies have explored changes in ketone bodies and/or glucose in the effects of the ketogenic diet, and glucose is increasingly implicated in neurological conditions. Some studies reveal that a ketogenic diet sensitizes glucose-based regulation of excitability via purinergic mechanisms in the hippocampus. Adverse effects of the ketogenic diet include constipation and worsening of reflux, acidosis,</span><span dir="rtl"></span><span dir="rtl"></span><span style="FONT-FAMILY: "B Zar" FONT-SIZE: 11pt mso-fareast-font-family: 'Times New Roman' mso-ansi-language: EN-US mso-fareast-language: EN-US mso-bidi-language: AR-SA mso-ascii-font-family: 'Times New Roman' mso-hansi-font-family: 'Times New Roman'" dir="rtl"><span dir="rtl"></span><span dir="rtl"></span> </span><span style="FONT-FAMILY: "Times New Roman","serif" FONT-SIZE: 11pt mso-fareast-font-family: 'Times New Roman' mso-bidi-font-family: 'B Zar' mso-ansi-language: EN-US mso-fareast-language: EN-US mso-bidi-language: AR-SA">unexplained fatigue<font face="Times New Roman"><span style="mso-spacerun: yes"><font size="3">  </font></span>and renal calculi. The potential adverse effect of decreased growth is most likely to occur in the youngest chil­dren.</font></span><span style="FONT-FAMILY: "Times New Roman","serif" COLOR: black FONT-SIZE: 10pt mso-fareast-font-family: 'Times New Roman' mso-ansi-language: EN-US mso-fareast-language: EN-US mso-bidi-language: AR-SA"> </span> صرع, درمان, رژیم, کتوژنیک. Epilepsy, Treatment, Diet, Ketogenic. 85 94 http://ce.mazums.ac.ir/browse.php?a_code=A-10-26-31&slc_lang=fa&sid=1 Athena Sharifi Razavi آتنا شریفی رضوی athena.sharifi@yahoo.com 1003194753284600764 1003194753284600764 Yes Nasim Tabrizi نسیم تبریزی 1003194753284600765 1003194753284600765 No Narges Karimi نرگس کریمی 1003194753284600766 1003194753284600766 No Hamed Cheraghmakani حامد چراغمکانی 1003194753284600767 1003194753284600767 No