生酮饮食添加治疗儿童难治性癫痫的临床效果

Clinical effect of ketogenic diet addition in the treatment of refractory epilepsy in children

目的探讨生酮饮食(KD)添加治疗儿童难治性癫痫的临床效果。方法回顾性选取2013年6月至2019年4月于西安市儿童医院神经内科接受KD添加治疗的47例难治性癫痫患儿为研究对象。采用Engel分级评估KD添加治疗的临床疗效,同时评估KD添加治疗的终止原因及不良反应发生情况。结果接受KD添加治疗的47例患儿中,KD添加治疗开始时的平均年龄为(23.8±23.2)个月。KD添加治疗终止前最后一次随访中,治疗有效患儿共27例(57.4%),治疗无效患儿共20例(42.6%)。治疗有效患儿的KD添加治疗保留时长中位数大于治疗无效患儿,癫痫首次发作至KD添加治疗开始时病程中位数小于治疗无效患儿,差异具有统计学意义(P<0.05)。在KD添加治疗儿童难治性癫痫患儿中,共有37例终止治疗,终止原因有无效、拒食、依从性差、无发作逐渐过过渡到正常饮食等。KD添加治疗儿童难治性癫痫的不良反应轻微,多为胃肠功能紊乱如拒食、腹泻、便秘等。结论KD可作为儿童难治性癫痫的一项安全、有效的治疗方案,加强临床医生及患儿家属对KD的了解,早期使用,可提高患儿的依从性;延长KD添加治疗保留时长,可能有助于提高KD添加治疗儿童难治性癫痫的有效率。

Objective To investigate the clinical effect of ketogenic diet(KD)addition in the treatment of refractory epilepsy in children.Methods Forty seven children with refractory epilepsy who received KD addition therapy in the neurology department of Xi'an children's hospital from June 2013 to April 2019 were selected retrospectively.The clinical efficacy of KD addition therapy was evaluated by Engel classification,and the termination causes and adverse reactions of KD addition therapy were evaluated.Results Among the 47 children who received KD addition therapy,the average age at the beginning of KD addition therapy was(23.8±23.2)months.In the last follow-up before the termination of KD addition therapy,there were 27 cases(57.4%)with effective treatment and 20 cases(42.6%)with ineffective treatment.The median duration of KD addition treatment retention in children with effective treatment was greater than that in children with ineffective treatment,the median duration of the first seizure of epilepsy to the beginning of KD addition treatment was less than that in children with ineffective treatment,and the differences were statistically significant(P<0.05).Among the children with intractable epilepsy treated with KD,a total of 37 cases terminated the treatment.The reasons for termination were ineffective,food refusal,poor compliance,no seizure,gradual transition to normal diet and so on.The side effects of KD addition in the treatment of refractory epilepsy in children were mild,mostly gastrointestinal dysfunction,such as food refusal,diarrhea and constipation.Conclusion KD can be used as a safe and effective treatment scheme for children with refractory epilepsy.Strengthening the KD understanding of clinicians and children's families and early use can improve children's compliance;prolonging the retention time of KD addition treatment may help to improve the efficiency of KD addition in the treatment of refractory epilepsy in children.