改良阿特金斯氏饮食治疗成人耐药性癫痫的系统综述

A systematic review of modified Atkins diet for adult drug-resistant epilepsy

目的探讨改良阿特金斯氏饮食(MAD)治疗成人耐药性癫痫的疗效及不良反应。方法检索PubMed、Embase、Cochrane图书馆、中国期刊全文数据库、中国全文科技期刊数据库、万方数据知识服务平台2018年11月3日前的文献,非随机对照研究的方法学质量评价使用非随机研究方法学指标,随机对照试验质量评价使用Cochrane偏倚风险评估工具。结果最终纳入9篇文献,包括7项非随机对照研究及2项随机对照研究,共计357例患者。在治疗成人耐药性癫痫第1个月时,MAD已显效且有效率较高,各研究间有效率为17.6%~63%不等。在整个治疗期间,几乎所有研究均显示出MAD治疗有效率随时间推移逐次减低,治疗初期最高。在完成治疗的患者中常见的不良反应为体质量减轻或体质量指数(BMI)下降,血脂异常也较为常见。结论对于不能接受手术或神经调控治疗的成人耐药性癫痫患者,MAD可作为辅助治疗方法使部分患者从中获得癫痫发作减少甚至无癫痫发作。该治疗方法可能导致的体质量减轻或BMI下降的不良反应使其更适用于伴有超重或肥胖的癫痫患者。

Objective To explore the efficacy and side effects of modified Atkins diet(MAD) in the treatment of adult drug-resistant epilepsy. Methods The database of PubMed, EMBASE, Cochrane library, China national knowledge infrastructure, Chinese science and technology periodical full-text database and Wan fang database before November 3, 2018 were searched. Methodological index for non-randomized studies was used to evaluate the quality of the non-randomized control trial and Cochrane bias risk assessment tool was used to evaluate the quality of the randomized control trial. Results Finally, 9 articles were included, including 7 non-randomized controlled studies and 2 randomized controlled studies, with a total of 357 patients. In the first month of treatment of adult drug-resistant epilepsy, the MAD had been effective and efficient, with an effective rate ranging from 17.6% to 63%. During the entire treatment period,almost all studies had shown that the effectiveness of the MAD was decreasing over time and was highest in the early stages of treatment. Common side effects in patients who complete treatment were weight loss or decreased body mass index, and dyslipidemia was also more common. Conclusions For adult drug-resistant epilepsy patients who cannot undergo surgery or neuromodulation therapy, the MAD can be used as an adjunct therapy to reduce seizures or even seizure-free in some people. The side effects of weight loss or decreased body mass index that result from this treatment make it more suitable for patients with epilepsy who are overweight or obese.