生酮饮食治疗难治性癫癎的初步观察

Preliminary Observation of Ketogenic Diet Therapy for Children with Intractable Epilepsy

目的观察生酮饮食治疗小儿难治性癫癎的疗效及其安全性。方法选择15例难治性癫癎患儿用合适中国人膳食习惯的生酮饮食方案进行治疗。随访其依从性、临床发作频率及不良反应。结果12例(80%)坚持治疗1个月,其中10例(87.5%)癫癎发作减少>50%;10例(66.6%)坚持治疗3个月,其中8例(80%)癫癎发作减少>50%;5例(33.3%)坚持治疗6个月以上,其中5例(100%)癫癎发作减少均>50%,4例(80%)癫癎发作减少>90%,3例(60%)癫癎发作完全控制。1例已随访2年以上,发作减少>90%。10例出现轻重不一的不良反应(恶心、呕吐、腹泻、便秘、低血糖、高血脂、肝功能受损),经对症治疗后均可缓解。结论适合中国人膳食习惯的生酮饮食方案治疗小儿难治性癫癎有效而安全。其疗效与发作类型无明显关系。

Objective To observe the therapeutic effect of ketogenic diet therapy for children with intractable epilepsy and its safety.Methods Fifteen patients with intractable epilepsy were treated with ketogenic diet that was modified specifically for Chinese people.The compliance,seizure frequency and side effects were followed up.Results Twelve patients maintained on the treatment for 1 month.Among them,the reduction of seizure frequency in 10 patients exceed 50%.Ten patients maintained on the treatment for 3 months.Among them,the reduction of seizure frequency in 8 patients exceed 50%.Five patients maintained on the treatment for more than 6 months.The reduction of seizure frequency all exceed 50%.The reduction of seizure frequency in 4 patients exceed 90%.The seizures of 3 patients were controlled completely.Ten patients among all cases had various adverse effect,such as nausea,vomiting,diarrhea,constipation,hypoglycemia（nonsymptomatic）,hyperlipemia and damage of liver function and so on,which could eliminate by anti-symptomatic treatment.Conclusions Ketogenic diet is effective and safe in Chinese children with intractable epilepsy with modified methods specifically for Chinese.The effect is unrelated with seizure types obviously.