生酮饮食添加治疗儿童难治性癫癎的前瞻性研究

Therapeutic effect of ketogenic diet for refractory epilepsy in children: a prospective observational study

目的探讨生酮饮食(ketogenic diet,KD)添加治疗儿童难治性癫癎的临床疗效、脑电图变化及对认知功能的影响。方法研究对象为2012年8月至2013年8月接受KD添加治疗的20例难治性癫癎患儿。KD治疗方案为启动时禁食,脂肪和蛋白质、碳水化合物比例逐渐增高至4:1。疗效评估方法以KD添加治疗前癫癎发作频率为基线,通过家长的癫癎日记,记录发作的频率、类型及程度的变化,并于添加KD前、添加KD后3、6、9个月分别行24 h视频脑电图检查、Gesell发育量表评定。结果 20例患儿中,临床控制无发作6人,完全控制率为30%;有效13人,总有效率为65%。脑电图改善8人,总有效率为40%;Gesell发育量表评定6人提高一个等级,改善率为30%,改善能区主要在大运动及适应性能区。KD治疗不良反应轻微。结论 KD治疗儿童难治性癫癎安全有效;KD治疗后脑电图改变与临床疗效有一定相关性,且对认知功能有一定改善。

Objective To study the clinical efficiency, electroencephalogram （EEG） changes and cognitive improvements of ketogenic diet （KD） in children with refractory epilepsy. Methods Twenty pediatric patients （7-61 months in age） with refractory epilepsy were recruited between August 2012 and August 2013. KD therapy was performed on all participants for at least 3 months based on a fasting initiation protocol with the lipid-to-nonlipid ratio being gradually increased to 4：1. Seizure frequency, type and degree were recorded before and during KD therapy. A 24 hours video-electroencephalogram （V-EEG） examination and Gesell Developmental Scale assessment were performed prior to KD therapy, and 3, 6, 9 months after KD therapy. Results Six patients became seizure free after KD therapy, with a complete control rate of 30%. Seizure frequency reduction occurred in 13 （65%） patients, EEG improvement in 8 （40%） patients, and improvement in Gesell Developmental Scales （gross motor and adaptability in particular） in 6 （30%） patients. The KD therapy-related side effects were mild. Conclusions KD therapy is safety and effective in reducing seizure frequency and improving EEG and cognitive function in children with refractory epilepsy.