Nikanorova Marina, Miranda Maria J, Atkins Mary, Sahlholdt Lene
Childrens Department, Danish Epilepsy Centre, Dianalund, Denmark.
Epilepsia. 2009 May;50(5):1127-31. doi: 10.1111/j.1528-1167.2008.01958.x. Epub 2009 Feb 12.
To evaluate the effect of the ketogenic diet on electroclinical characteristics and cognitive function in children with continuous spikes and waves during slow sleep (CSWS).
Five children (four boys, one girl) aged between 8 and 13 years with CSWS refractory to conventional antiepileptic drugs (AEDs), including levetiracetam, and steroids were included. The prospective electroclinical assessment was performed prior to the ketogenic diet and once every 6 months post initiation during the 2-year period. All children underwent neuropsychological testing prior to the ketogenic diet and four of the children again 12 months after the diet's introduction. In case 4 the testing has been performed after 7 months and the diet was withdrawn after 9 months because of the lack of efficacy and the parent's wishes. In two patients the cognitive functions were also evaluated after 24 months since the diet's initiation. During the period on the ketogenic diet the concomitant AED treatment was unchanged.
Electrographic evaluation after 24 months on the ketogenic diet showed CSWS resolution in one patient, mild decrease of the spike-wave index in one, and lack of response in three patients. The ketogenic diet did not influence the neuropsychological outcome, and intelligence quotient (IQ) scores remained low at the end of the follow-up period. However, in two patients an improvement in attention and behavior was demonstrated.
This is the first study evaluating the efficacy of the ketogenic diet in children with CSWS. Five presented cases were refractory to AEDs and steroids. Only one case responded with complete CSWS disappearance; in one the effect of the ketogenic diet was partial and intermittent, whereas in three patients no response has been observed. These results show that the ketogenic diet did not appear to influence the neuropsychological outcome; however, the absence of a control group makes it impossible to conclude with certainty.
评估生酮饮食对慢波睡眠期持续棘慢波（CSWS）儿童的电临床特征及认知功能的影响。
纳入5例年龄在8至13岁之间、对包括左乙拉西坦在内的传统抗癫痫药物（AEDs）及类固醇治疗无效的CSWS儿童（4例男孩，1例女孩）。在生酮饮食前进行前瞻性电临床评估，并在开始后的2年期间每6个月进行一次评估。所有儿童在生酮饮食前均接受神经心理学测试，其中4名儿童在饮食引入12个月后再次接受测试。病例4在7个月后进行了测试，由于缺乏疗效且家长意愿，在9个月后停用了饮食。2例患者在饮食开始24个月后也进行了认知功能评估。在生酮饮食期间，伴随的AED治疗保持不变。
生酮饮食24个月后的脑电图评估显示，1例患者CSWS消失，1例患者棘慢波指数轻度下降，3例患者无反应。生酮饮食未影响神经心理学结果，随访期末智商（IQ）分数仍较低。然而，2例患者的注意力和行为有改善。
这是第一项评估生酮饮食对CSWS儿童疗效的研究。5例呈现的病例对AEDs和类固醇均无效。仅1例病例CSWS完全消失；1例中生酮饮食的效果是部分且间歇性的，而3例患者未观察到反应。这些结果表明，生酮饮食似乎未影响神经心理学结果；然而，由于缺乏对照组，无法得出确定性结论。
