74例儿童难治性癫痫应用生酮饮食疗法效果分析

Efficacy of Ketogenic Diet in the Treatment of 74 Children with Refractory Epilepsy

目的:探讨生酮饮食(KD)治疗儿童药物难治性癫痫的疗效及安全性。方法:收集2013年6月至2020年2月在西安市儿童医院神经内科接受KD治疗的74例癫痫患儿,评估KD治疗的临床疗效、保留率、终止原因及不良反应发生情况。结果:在纳入的74例患儿中,KD治疗启动时平均年龄为27.1个月。KD治疗在3个月末、6个月末、12个月末随访时,保留率分别为87.8%、63.5%、33.8%,有效率分别为37.8%、29.7%、21.6%。KD治疗对不同病因难治性癫痫患儿的疗效比较差异无统计学意义。KD治疗不同癫痫病程组患儿中,病程<6个月组及病程6个月~2年组有效率均优于病程>2年组(P<0.05),病程<6个月组及病程6个月~2年组有效率比较差异无统计学意义(P>0.05),KD治疗不同癫痫病程组比较差异无统计学意义(P>0.05)。KD治疗不同疗程组难治性癫痫患儿中,疗程>6个月组有效率优于疗程<3个月组及3~6个月组(P<0.05)。KD疗程<3个月组、3~6个月组及>6个月组无发作率优于疗程<3个月组及3~6个月组(P<0.05),KD疗程<3个月组及3~6个月组有效率及无发作率比较差异无统计学意义(P>0.05)。大部分患儿不良反应轻微,多为胃肠功能紊乱如拒食、腹泻、呕吐、便秘等,仅3例因严重拒食、2例因泌尿系结石而终止KD治疗。结论:KD治疗儿童难治性癫痫是一项安全、有效的治疗措施。癫痫病程<2年患儿应用KD治疗保留时间>6个月,可能有助于提高KD治疗儿童难治性癫痫的有效率。

Objective:To probe into the efficacy and safety of ketogenic diet(KD)in the treatment of refractory epilepsy in children.Methods:A total of 74 children with epilepsy received KD treatment in the neurology department of Xi’an Children’s Hospital from Jun.2013 to Feb.2020 were collected.The clinical efficacy,retention rate,reason of termination and occurrence of adverse drug reactions of KD were evaluated.Results:Of the 74 children,the mean age at initiation of KD treatment was 27.1 months.At the end of 3 months,6 months and 12 months,the retention rate was respectively 87.8%,63.5%and 33.8%,and the effective rate was 37.8%,29.7%and 21.6%.There was no significant difference in the efficacy of KD in children with refractory epilepsy.Among the children with different epilepsy duration groups treated with KD,the efficiency of the group with duration<6 months and the group with duration from 6 months to 2 years was better than that of the group with duration>2 years(P<0.05),and the difference between the efficiency of the group with duration<6 months and the group with duration from 6 months to 2 years was not statistically significant(P>0.05),and the difference between the groups with different epilepsy duration treated with KD was not statistically significant(P>0.05).In children with refractory epilepsy treated with KD in different treatment groups,the efficiency of the group with duration>6 months was better than that of the group with duration<3 months and the group with duration from 3 to 6 months(P<0.05).The seizure-free rate was better in the KD duration<3 months group,from 3 to 6 months group and>6 months group than in the duration<3 months group and from 3 to 6 months group(P<0.05),and the difference in efficiency and seizure-free rate between the KD duration<3 months group and from 3 to 6 months group was not statistically significant(P>0.05).Most of the children had mild adverse drug reactions,mostly gastrointestinal disorders such as food refusal,diarrhea,vomiting and constipation.Only 3 cases were terminated from KD treatment due to severe food refusal and 2 cases due to urinary crystallization.Conclusion:KD treatment for children with refractory epilepsy is a safe and effective treatment measure.The application of KD treatment for children with epilepsy<2 years of duration retained for>6 months may help to improve the efficiency of KD treatment for refractory epilepsy in children.