Epilepsy and Behavior, 2017, Volume 68, Pages 45-50
Low glycemic index treatment for seizure control in Angelman syndrome-AS: A case series from the Center for Dietary Therapy of Epilepsy at the Massachusetts General Hospital
Grocott, O. R., Herrington, K. S., Pfeifer, H. H., Thiele, E. A., & Thibert, R. L.
Diet med lågt glykemiskt index, GI, är en alternativ kompletterande behandling för behandling av epileptiska anfall vid Angelman syndrom och förefaller också ha andra positiva sidoeffekter för patienterna.
Patients with AS have seizures, abnormally slow EEG background pattern, but also problems with movement, sleep, cognition, gastrointestinal function. The epilepsy can be hard to control with antiepileptic drugs and alternative supportive treatments like ketogenic diet are often necessary. This study discusses about an alternative option (low glycemic index treatment) to ketogenic diet, which might be hard for patients.
The low glycemic index treatment (LGIT), developed by the Center for Dietary Therapy of Epilepsy at the Massachusetts General Hospital (MGH), is similar to the ketogenic diet, but allows for more dietary freedom. The diet does not require a specific meal plan. While the ketogenic diet significantly lowers and controls daily carbohydrate intake, the LGIT aims for an intake of 40-60 g of carbohydrates per day. The carbohydrates must have a low glycemic index that measures the effect of a specific food on blood glucose levels. Foods with higher GI values increase blood glucose levels more than foods with lower GI values.
The parents completed a three-day food record and a food frequency questionnaire that was used by dietitian to make the goals and suggestions for meals, LGIT guidelines were followed using approximately 40-60 g of low glycemic index (< 50) carbohydrates per day. Recommendations were modified throughout the diet based on the needs and the level of seizure control. The study included 23 subjects with AS aged 2 to 31 years. The majority of subjects (78%) were younger than 10 years of age.
In 5 subjects that had daily seizures, 1 (20%) became seizure-free and the remaining 4 (80%) experienced a decrease in seizures. In 3 subjects that had weekly seizures, 1 (33%) became seizure and the remaining 2 (66%) experienced a decrease in seizures. In 2 subjects that had monthly seizures, 1 (50%) became seizure-free and 1 (50%) became seizure. Benefits from the LGIT other than reduced seizure activity were noted for 13 subjects based on parental reports. Cognitive and social improvements included improved speech, communication, focus, eye contact, receptive speech, alertness, attention, confidence, and general cognitive development. Physical improvements included improved mobility, walking skills, and decreased tremor. One parent also noted improved sleep. Some subjects in our cohort had breakthrough seizures when they consumed too many carbohydrates in one sitting or ate carbohydrates with a high glycemic index, which may suggest maintaining a steady blood glucose level contributes to improved seizure.
The LGIT is an alternative add-on treatment for epileptic seizures in Angelman syndrome and seems to also have many other benefits for the patients
Glädje och delaktighet
Scandinavian Journal of Occupational Therapy (2016), 23:5, 366-373,
Different pathways to children’s enjoyment of participation in daily activities
Rosenberg, L. & Bart, O. Department of Occupational Therapy, School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University.
Upplevelse av glädje från av att delta i aktiviteter i vardagen anses relatera till hälsa och välbefinnande. Studien visar på både barnens- och föräldrars perspektiv. Föräldrarnas perspektiv förknippades med hur väl barnet kunde utföra aktiviteter. Barnens perspektiv av tillfredsställelse och glädje förknippades i högre grad av aktiviteters psykosociala funktion.
The enjoyment arising from participating in an activity is considered to be related to health and well-being. However, only a few studies have focused on children’s enjoyment of participation.
To assess the contribution of various individual factors to the total explained variance of children’s enjoyment of participation from the perspectives of parents and children.
Ninety-eight typically developed children were evaluated using motor and cognitive tests; they completed the Children’s Assessment of Participation and Enjoyment. Their parents completed the Children Participation Questionnaire, the Performance Skills Questionnaire, and the Strengths and Difficulties Questionnaire.
Age and gender were found to be significant predictors. Parents perceived enjoyment to be associated with their child’s performance skills and the efficient execution of daily tasks. Children perceived enjoyment to be associated with their psychosocial functioning.
The contribution of performance skills exceeds the contribution of motor or cognitive ability to the total explained variance of a child’s enjoyment of participation. A gap exists, however, between the perspectives of children and parents regarding enjoyment of participation. Enhancing participation is a central goal of the occupational therapy domain and process; our findings may provide insights into possible pathways to accomplish this goal.
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