生酮饮食对癫痫持续状态的疗效及脑保护作用研究

Evaluation of outcome and cerebral protective effects for ketogenic diet therapy to status epilepticus

目的：探讨生酮饮食（ ketogenic diet,KD）治疗癫痫持续状态（ status epilepticus,SE）的疗效及是否有脑保护作用,为SE患儿的合理个体化治疗及脑保护、改善预后提供新思路。方法2013年9月至2015年1月深圳市儿童医院PICU和神经内科诊断为SE的患儿均建议应用KD治疗,家属拒绝的患儿归于对照组,同意应用KD治疗的患儿为治疗组。根据SE处理原则,对照组应用传统抗惊厥治疗方法,治疗组除了给予传统药物治疗外,还给予KD治疗。治疗前及癫痫控制后抽静脉血检测神经元特异性烯醇化酶（ neuron specific enolase,NSE）和S蛋白（ S100β）水平,并记录癫痫获得控制的时间。结果治疗组共10例,3例患儿治疗后癫痫完全控制；6例患儿临床发作明显减少,治疗总有效率（9/10例）高于对照组（5/8例）（P〈0．01）。治疗组癫痫获得控制的时间明显短于对照组[（5．2±2．9）d vs．（9．8±1．5） d,P〈0．01]。治疗后,两组患儿的血清NSE和S100β水平较治疗前均有明显下降（ P〈0．001或P〈0．05）；治疗后,治疗组患儿的血清NSE和S100β水平下降较对照组明显,差异有统计学意义（P〈0．05）。结论癫痫频繁发作和SE患儿存在脑损伤,积极控制癫痫发作能减轻脑损伤严重程度,KD能有效控制癫痫发作,具有神经保护作用。

Objective To explore the efficacy of ketogenic diet（ KD） in the treatment of status epi-lepticus（ SE） and whether KD could protect the brain,and propose a new thought on SE patients′reasonably individualized treatment, brain protection and prognosis improvement. Methods From Sep 2013 to Jan 2015,all the patients diagnosed as SE were advised to apply KD treatment; the patients who refused KD treatment were included in the control group,while the patients who accepted KD treatment were included in the treatment group. Based on the SE treatment principles,the control group applied traditional anti-convulsive therapy,while the treatment group applied traditional therapy combined with KD treatment. Before the treat-ment and after the epilepsy control,the patients′ serum was collected to test neuron specific enolase（ NSE） and S100βlevels,and the duration of epilepsy control was recorded. Results The treatment group included a total of 10 patients; 3 patients had a good efficacy and obtained seizure-free after the treatment; clinical seizures declined significantly in 6 patients. The treatment group′s overall response rate was 9/10,which was higher than that of the control group（5/8）（P〈0. 01）. The treatment group′s duration to gain efficacy was shorter than that of the control group[（5. 2 ± 2. 9） d vs. （9. 8 ± 1. 5） d,P〈0. 01]. After the treatment,the patients′NSE and S100β in both groups were significantly decreased than those before the treatment （ P〈0. 001 or P〈0. 05）. After the treatment,the serum NSE and S100β of the patients in the treatment group were lower than those in the control group,with statistically significant difference（P〈0. 05）. Conclusion Frequent epileptic seizures and SE would impair the patient′s brain. Controlling the epileptic seizures actively could lower the severity of brain injury. KD could effectively control the epileptic seizure and had neuropro-tective effects.