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2015 ; 10
(ä): 120
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Ketogenic diet in a patient with congenital hyperinsulinism: a novel approach to
prevent brain damage
#MMPMID26399329
Maiorana A
; Manganozzi L
; Barbetti F
; Bernabei S
; Gallo G
; Cusmai R
; Caviglia S
; Dionisi-Vici C
Orphanet J Rare Dis
2015[Sep]; 10
(ä): 120
PMID26399329
show ga
BACKGROUND: Congenital hyperinsulinism (CHI) is the most frequent cause of
hypoglycemia in children. In addition to increased peripheral glucose
utilization, dysregulated insulin secretion induces profound hypoglycemia and
neuroglycopenia by inhibiting glycogenolysis, gluconeogenesis and lipolysis. This
results in the shortage of all cerebral energy substrates (glucose, lactate and
ketones), and can lead to severe neurological sequelae. Patients with CHI
unresponsive to medical treatment can be subjected to near-total pancreatectomy
with increased risk of secondary diabetes. Ketogenic diet (KD), by reproducing a
fasting-like condition in which body fuel mainly derives from beta-oxidation, is
intended to provide alternative cerebral substrates such ketone bodies. We took
advantage of known protective effect of KD on neuronal damage associated with
GLUT1 deficiency, a disorder of impaired glucose transport across the blood-brain
barrier, and administered KD in a patient with drug-unresponsive CHI, with the
aim of providing to neurons an energy source alternative to glucose. METHODS: A
child with drug-resistant, long-standing CHI caused by a spontaneous GCK
activating mutation (p.Val455Met) suffered from epilepsy and showed
neurodevelopmental abnormalities. After attempting various therapeutic regimes
without success, near-total pancreatectomy was suggested to parents, who asked
for other options. Therefore, we proposed KD in combination with
insulin-suppressing drugs. RESULTS: We administered KD for 2 years. Soon after
the first six months, the patient was free of epileptic crises, presented
normalization of EEG, and showed a marked recover in psychological development
and quality of life. CONCLUSIONS: KD could represent an effective treatment to
support brain function in selected cases of CHI.
|Brain Injuries/*diet therapy/etiology/*prevention & control
[MESH]