Seo Joo Hee, Lee Young Mock, Lee Joon Soo, Kang Hoon Chul, Kim Heung Dong
Department of Pediatrics, Pediatric Epilepsy Clinic, Severance Children's Hospital, Brain Research Institute, Yonsei University College of Medicine, Seodaemun Gu, Seoul, Korea.
Epilepsia. 2007 Apr;48(4):801-5. doi: 10.1111/j.1528-1167.2007.01025.x. Epub 2007 Mar 26.
The ketogenic diet (KD) has been considered a highly potent antiepileptic treatment for intractable childhood epilepsy. In this study, we compared the antiepileptic efficacy and diet tolerability of two different diets with lipid:nonlipid ratios of 3:1 and 4:1.
Seventy-six patients with refractory childhood epilepsy were randomly placed into two groups and were started on KD diets with nonlipid:lipid ratios of either 3:1 or 4:1. Antiepileptic efficacy and diet tolerability were evaluated 3 months after initiating the diet. Patients showing seizure-free outcome with the 4:1 diet were changed to the 3:1 diet, and those without a seizure-free outcome on the 3:1 diet were changed to the 4:1 diet, for three more months, after which time their progress was monitored.
(1) Antiepileptic efficacy was higher for the 4:1 than the 3:1 diet (p < 0.05). Twenty-two (55.0%) of 40 patients on the 4:1 diet and 11 (30.5%) of 36 patients on the 3:1 diet became seizure free. Seizure reduction of over 90% was observed in 2 (5.0%) patients on the 4:1 diet, and 2 (5.6%) on the 3:1 diet. (2) Dietary tolerability was better for the 3:1 than the 4:1 diet. Gastrointestinal symptoms were observed in 5 (13.9%) patients with the 3:1 diet and 14 (35.0%) patients with the 4:1 diet (p < 0.05). (3) For seizure-free patients who started on the 4:1 diet, antiepileptic efficacy was maintained after changing to the 3:1 diet, while 10 (83.3%) of 12 patients who were not seizure free with the 3:1 diet showed increased seizure reduction after changing to the 4:1 diet. (4) Complications from the KD and laboratory data were not significantly different between the two groups.
The 4:1 KD showed greater antiepileptic efficacy than the 3:1 diet with higher seizure-free outcome. In most cases, seizure free outcome was maintained even after changing the ratio to 3:1. Dietary tolerability was better in the 3:1 diet than the 4:1 with less frequent gastrointestinal symptoms.
生酮饮食（KD）被认为是治疗儿童难治性癫痫的一种高效抗癫痫疗法。在本研究中，我们比较了两种不同的脂肪与非脂肪比例分别为3:1和4:1的饮食的抗癫痫疗效和饮食耐受性。
76例儿童难治性癫痫患者被随机分为两组，并开始采用非脂肪与脂肪比例为3:1或4:1的生酮饮食。在开始饮食3个月后评估抗癫痫疗效和饮食耐受性。在采用4:1饮食方案后实现无癫痫发作的患者改为3:1饮食方案，而在3:1饮食方案下未实现无癫痫发作的患者改为4:1饮食方案，再持续3个月，之后监测他们的进展情况。
（1）4:1饮食方案的抗癫痫疗效高于3:1饮食方案（p < 0.05）。采用4:1饮食方案的40例患者中有22例（55.0%）实现无癫痫发作，采用3:1饮食方案的36例患者中有11例（30.5%）实现无癫痫发作。采用4:1饮食方案的患者中有2例（5.0%）癫痫发作减少超过90%，采用3:1饮食方案的患者中有2例（5.6%）癫痫发作减少超过90%。（2）3:1饮食方案的饮食耐受性优于4:1饮食方案。采用3:1饮食方案的患者中有5例（13.9%）出现胃肠道症状，采用4:1饮食方案的患者中有14例（35.0%）出现胃肠道症状（p < 0.05）。（3）对于开始采用4:1饮食方案的无癫痫发作患者，改为3:1饮食方案后抗癫痫疗效得以维持，而在3:1饮食方案下未实现无癫痫发作的12例患者中有10例（83.3%）在改为4:1饮食方案后癫痫发作减少情况有所改善。（4）两组之间生酮饮食的并发症和实验室数据无显著差异。
4:1生酮饮食方案的抗癫痫疗效优于3:1饮食方案，无癫痫发作率更高。在大多数情况下，即使将比例改为3:1，无癫痫发作的结果仍能维持。3:1饮食方案的饮食耐受性优于4:1饮食方案，胃肠道症状出现频率更低。
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