癫痫患儿应用生酮饮食治疗的效果观察

Observation on the Ketogenic Diet Treatment for Epilepsy Children

目的:观察生酮饮食不同时间治疗不同年龄阶段的癫痫患儿的临床效果,为临床治疗提供指导。方法:将接受生酮饮食治疗的49例患儿进行严格筛选后挑选42名患儿进入临床观察,遂饮食逐步调整为(糖+蛋白质)/脂肪比例为1:2或1:3,并进行随访,将其分为治疗时间组及年龄组进行分别观察。时间组观察入院前3个月及生酮饮食治疗3、6、12个月及以上时间患儿癫痫发作的情况。年龄组观察8个月-5岁、5岁-12岁、12岁-15岁患儿治疗相同时间癫痫发作情况其治疗效果按Engel标准分级进行统计。结果:患儿在应用生酮饮食治疗6个月后与治疗3个月后相比,患儿的癫痫发作频率明显降低(X^2=23.011,P<0.05),与治疗12个月后相比,12个月后大部分患儿癫痫发作可得到有效控制(X^2=65.798,P<0.001).而8个月-5岁的患儿癫痫在治疗3个月时,与5岁-12岁年龄段的患儿相比癫痫发作开始有所减少,但没有明显的差异(X^2=5.782,P=0.123),与12岁-15岁患儿相比有较明显的差异(X^2=10.696,P=0.013),6个月后,8个月-5岁患儿癫痫发作的次数明显降低,与5岁-12岁的患儿癫痫发作次数相比差异更加明显(X^2=12.215,P=0.007).12岁-15岁患儿虽也有改善,但与8个月-5岁相比效果不及低年龄段的患儿(X^2=14.766,P=0.002),治疗12个月后有相同的结果(X^2=11.869、18.290,P=0.007、P<0.001)。坚持生酮饮食治疗时间<12月的患儿愈后情况明显比治疗时间≥12个月的患儿差,差异具有统计学意义(2=9.548,P=0.023)。年龄越小应用生酮饮食治疗患儿的愈后情况越好。差异具有统计学意义(X^2=14.020,P=0.029)。结论:年龄越小的癫痫患儿接受生酮饮食治疗时间越长,治疗效果越好。生酮饮食对于癫痫患儿癫痫的发作有良好的治疗效果。

Objective： To observe the curative effect of ketogenic diet on epilepsy in children who suffered different treatment time and in different age. Methods： We chose 100 cases from 120 children following in the strictly criterion who accepted the treatment of ketogenic diet to observe the effect. According to the children＇s physical condition, they started with the diet of（protein ＋carbohydrates）/fat =1：2 or 1：3. Then they were divided into different age group and different treating time group. We observed the frequency of epileptic seizures within 3 months before treatment and 3/6/9 months after treatment in the treating time group. In the age group, we observed and compared the frequency of epileptic seizures within the same time between subgroups of 8 months-5 years, 5years-12 years and 12 years-15 years. Their treatment effects were calculated and divided into 4 class according to the Engel standard grading. Results： Patients after 6 months＇ treatment had obviously lower epileptic seizure frequency than after 3 months＇ treatment（X^2=23.011, P0.05）. The seizyres of most children can be effectively controlled after 12 months＇ treatment（X^2=65.798, P0.001）. After3 month＇s treatment, the 8 months to 5 years old group had less epileptic seizure than the f 5-12 years old group, but the difference had no statistical significance（ X^2=5.782, P=0.123）. However, such difference was obviously significant as compared to 12 to 15 years old group（ X^2=10.696, P=0.013）. After six months, the 8 months to 5 years old group had markedly lower epilepsy frequency than 5- 12 years old group（X^2=12.215, P=0.007）. Compared with before treatment, the 12-15 years old group also had improvement, but obviously less improvement as compared with the 8 months to 5 years old group（X^2=14.766,P=0.002）. However, they all had the same results after12 months treatment（X^2=11.869, 18.290, P=0.007, P0.001）. Children who had the ketogenic diet less than 12 months had much poorer prognosis than those who had ketogenic diet more than 12 months The difference was statistical（X^2=9.548, P=0.023）. In addition, the younger the children with epilepsy got treatment of ketogenic diet, the better prognosis they got（X^2=14.020, P=0.029）. Conclusion：Ketogenic diet treatment had good effects for children with epilepsy. The epilepsy children had ketogenic diet at their earlier age and for longer treatment time can achieve better therapeutic effects.