Kang Hoon-Chul, Kim Heung Dong
Department of Pediatrics, Epilepsy Center, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea.
Epileptic Disord. 2006 Dec;8(4):309-16.
Since the resurgence of the ketogenic diet (KD) in the mid 1990s, this diet has been used worldwide for the treatment of refractory pediatric epilepsy, including in Asian countries. However, the KD is not a convenient therapy, especially because the customary diets of Asian countries contain substantially less fat than traditional Western diets. In addition, there are various complications associated with the diet that should be considered. Unfortunately, no international protocols have been developed with the exceptions of the Johns Hopkins Hospital protocol adopted by a substantial number of hospitals. While the Hopkins protocol has been the basic model, several revisions of the initial protocol have been suggested. Changes to the applicable ages, seizure types, etiologies, the initiation of the diet, the ratio of constituents to reduce the fat content, the duration of the diet, and revised formulae, such as ketogenic milk or the all-liquid KD, have attempted to extend the indications of the KD and increase its tolerability and palatability. Recently, less restrictive KDs, including a modified Atkins diet and low-glycemic-index treatment, have been clinically tested. Here, we review these approaches toward a safer and more convenient therapeutic diet for refractory pediatric epilepsy.
自20世纪90年代中期生酮饮食（KD）再度兴起以来，这种饮食方式已在全球范围内用于治疗难治性小儿癫痫，亚洲国家也不例外。然而，KD并非一种便捷的治疗方法，特别是因为亚洲国家的日常饮食所含脂肪比传统西方饮食要少得多。此外，该饮食还存在各种需要考虑的并发症。遗憾的是，除了大量医院采用的约翰·霍普金斯医院方案外，尚未制定国际规范。虽然霍普金斯方案一直是基本模式，但也有人建议对初始方案进行几次修订。对适用年龄、癫痫类型、病因、饮食起始、降低脂肪含量的成分比例、饮食持续时间以及修订配方（如生酮奶或全液体KD）等方面做出的改变，试图扩大KD的适用范围并提高其耐受性和适口性。最近，包括改良阿特金斯饮食和低血糖指数治疗在内的限制较少的KD已进行了临床试验。在此，我们综述这些旨在为难治性小儿癫痫提供更安全、更便捷治疗饮食的方法。
