儿童难治性癫痫门诊生酮饮食治疗与住院生酮饮食治疗的疗效、有效性及长期保留率比较分析

Efficacy and long-term retention rate comparision of ketogenic diet (KD) for children with intractable epilepsy in outpatient department and inpatient department

目的观察并比较分析门诊生酮饮食(Ketogenic diet,KD)与住院KD治疗儿童难治性癫痫的疗效、有效性及长期保留率。方法回顾性分析2014年6月-2015年12月在重庆医科大学附属儿童医院神经康复中心门诊部收集的44例采用改良经典KD治疗的难治性癫痫患儿随访情况。通过3、6、12个月门诊随访,记录发作控制及不良反应,与同期第三军医大学新桥医院神经康复科住院KD治疗难治性癫痫患儿的疗效、有效性及保留率进行比较分析。结果随访12个月,44例患儿中有34例完成观察,其中15例完全缓解,2例显著缓解,5例部分缓解,12例发作无明显变化,总有效率为64.7%(22/34),KD治疗12个月的保留率为71%。同期住院患儿104例中有18例完成观察,其中3例完全缓解,2例部分缓解,13例发作无明显变化,总有效率为27.8%(5/18),KD治疗12个月的保留率为17.3%。结论门诊KD治疗儿童难治性癫痫疗效较好,其有效性、长期保留率较住院KD治疗高,为国内因床位紧张而无法住院接受KD治疗的难治性癫痫患儿提供了较好的方法。

Objective To compare the efficacy and compliance of children children with refractory epilepsy receiving ketogenic diet( KD) in outpatient department with children receiving KD treatment in inpatient department. Methods A retrospective study of 44 children with intractable epilepsy receiving the modified classical ketogenic diets in outpatient department from June 2014 to December 2015,who were followed-up during the third,sixth and twelfth month. Records of epileptic seizures and adverse reactions were used to evaluate the efficacy and retention rate of inpatient department KD treatment in children with refractory epilepsy,and compared with 104 children receiving KD treatment in inpatient department at the same period. Results Thirty-four of the forty-four children comleted observation after 12-month follow-up,15 cases had been seizure freedom,22 cases had more than 50% reduction in seizure frequency,12 patients had less than 50% reduction in seizure frequency. The total effective rate of the KD therapy in outpatient department was 64. 7%,and the retention rate was 71%. 18 of of the 104 children with KD treatment in inpatient department at the same period comleted observation after 12-month follow-up,3 cases had been seizure freedom,5 cases had more than 50% reduction in seizure frequency,13 cases had less than 50%reduction in seizure frequency. The total effective rate of the KD therapy in inpatient department was 27. 8%,and the retention rate was 17. 3%. Conclusion The KD therapy in outpatient department is effective to children with intractable epilepsy,and there is a highly efficacy and compliance of children receiving KD in outpatient department comparing with children receiving KD in inpatient department. Therefore,it's optional to children with refractory epilepsy who can' t received KD by inpatient department because of insufficient number of beds.