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Las enfermedades neurológicas suponen una causa importante de morbilidad en los países desarrollados y, con frecuencia, conllevan alteraciones en el nivel de conciencia o en los mecanismos de la deglución que pueden hacer necesario un soporte nutricional artificial. La presente revisión tratará de evaluar, basándose en la mejor evidencia científica disponible, el soporte nutricional en la enfermedad cerebrovascular aguda, la demencia y la esclerosis lateral amiotrófica, así como la utilidad de la dieta cetogénica en el tratamiento de la epilepsia. Se realizó una búsqueda bibliográfica en MEDLINE (PubMed) y en la Cochrane Library Plus en español, y se seleccionaron estudios clínicos aleatorizados, revisiones sistemáticas y metaanálisis. Existen escasos ensayos prospectivos aleatorizados sobre soporte nutricional en enfermedades neurológicas. El estudio FOOD muestra que la sonda nasogástrica es mejor vía que la gastrostomía endoscópica percutánea para la nutrición enteral en el primer mes tras un ictus. En el caso de la demencia y otras enfermedades neurodegenerativas, las evidencias disponibles son débiles. No hay pruebas fiables procedentes de ensayos controlados aleatorizados que apoyen el uso de dietas cetogénicas en los pacientes con epilepsia.
Palabras clave:
Soporte nutricional
Nutrición enteral
Nutrición parenteral
Accidente cerebrovascular
Enfermedades neurodegenerativas
Demencia
Esclerosis lateral amiotrófica
Epilepsia
Dieta cetogénica
Abstract
Neurological disease causes considerable morbidity in developed countries and frequently leads to alterations in the level of consciousness or in the mechanisms of swallowing, which may necessitate artificial nutritional support. The present review aims to evaluate nutritional support in acute cerebral vascular disease, dementia and amyotrophic lateral sclerosis, as well as the utility of a ketogenic diet in the treatment of epilepsy, based on the best available scientific evidence. A literature search was performed in Medline (PubMed) and in the Cochrane Library Plus in Spanish. Randomized clinical studies, systematic reviews, and metaanalyses were selected. There are few prospective randomized studies on nutritional support in neurological diseases. The FOOD study shows that the nasogastric tube is a better route of administration than percutaneous endoscopic gastrostomy for enteral nutrition in the first month after stroke. In the case of dementia and other neurodegenerative diseases, the available evidence is weak. There are no reliable data from randomized controlled trials that support the use of ketogenic diets in patients with epilepsy.
Keywords:
Nutritional support
Enteral nutrition
Parenteral nutrition
Stroke
Neurodegenerative diseases
Dementia
Amyotrophic lateral sclerosis
Epilepsy
Ketogenic diet
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