改良阿特金斯饮食治疗学龄期儿童难治性癫痫的效果及神经保护作用

Efficacy and neuroprotective effect of modified Atkins diet in the treatment of refractory epilepsy in schoolage children

目的 探讨改良阿特金斯饮食(MAD)治疗学龄期儿童难治性癫痫的效果及神经保护作用。方法 选择2018年6月至2021年6月徐州儿童医院学龄期难治性癫痫患儿58例,使用随机数字表法分为药物组、MAD组,各29例。药物组应用抗癫痫药物治疗,MAD组在抗癫痫药物基础上增加MAD治疗,治疗周期均为6个月。比较两组治疗前后认知状况(以韦氏儿童智力量表(WISC)评价)、血清抗氧化指标[总抗氧化能力(TAC)、超氧化物歧化酶(SOD)、丙二醛(MDA)]、神经损伤指标[神经元特异性烯醇化酶(NSE)、S-100β蛋白、基质金属蛋白酶-9 (MMP-9)]水平,并统计临床疗效、脑电图(EEG)监测情况。结果 治疗6个月后,MAD组总有效率86.21%高于药物组58.62%(P<0.05);经治疗,MAD组EEG改善情况优于药物组(P<0.05);与治疗前比较,两组治疗6个月后操作智商、言语智商及总智商均提高(P<0.05),且MAD组治疗6个月后操作智商、言语智商及总智商提高幅度更大(P <0.05);与治疗前比较,两组治疗6个月后血清TAC、SOD水平均提高,血清MDA、NSE、S-100β蛋白、MMP-9水平均降低(P <0.05),且MAD组治疗6个月后血清TAC、SOD水平提高更显著,血清MDA、NSE、S-100β蛋白、MMP-9水平降低更显著(P<0.05)。结论 MAD治疗学龄期儿童难治性癫痫可改善机体抗氧化、神经损伤指标水平,进而改善EEG及认知情况,提升疗效。

Objective To investigate the effect and neuroprotective effect of modified Atkins diet(MAD) in the treatment of refractory epilepsy in school-aged children.Methods A total of 58 school-age children with refractory epilepsy in our hospital from June 2018 to June 2021 were selected and divided into a drug group and a MAD group by random number table method,with 29 cases in each group.The drug group was treated with anti-epileptic drugs,and the MAD group was treated with anti-epileptic drugs,and the treatment period was 6 months.To compare the cognitive status of the two groups before and after treatment(assessed by the Wechsler Intelligence Scale for Children(WISC)),serum antioxidant indicators [total antioxidant capacity(TAC),superoxide dismutase(SOD),malondialdehyde(MDA)],nerve injury indicators [neuron-specific enolase(NSE),S-100β protein,matrix metalloproteinase-9(MMP-9)] levels,and statistics of clinical efficacy and EEG monitoring.Results After 6 months of treatment,the total effective rate of the MAD group was 86.21% higher than that of the drug group 58.62%(P<0.05);after treatment,the improvement of electroencephalogram(EEG) in the MAD group was better than that of the drug group(P<0.05);compared with before treatment,The operational IQ,verbal IQ and total IQ of the two groups increased after 6 months of treatment(P<0.05),and the increase in operational IQ,verbal IQ and total IQ of the MAD group was greater after 6 months of treatment(P<0.05);Compared with before treatment,after 6 months of treatment,the serum TAC and SOD levels of the two groups increased,and the serum MDA,NSE,S-100β protein,and MMP-9 levels decreased(P<0.05),and after 6 months of treatment in the MAD group Serum TAC and SOD levels increased more significantly,and serum MDA,NSE,S-100βprotein,and MMP-9 levels decreased more significantly(P<0.05).Conclusion MAD treatment of intractable epilepsy in school-age children can improve the body’s anti-oxidation and nerve damage index levels,thereby improving EEG and cognition,and enhancing the efficacy.