Sharma Suvasini, Gulati Sheffali, Kalra Veena, Agarwala Anuja, Kabra Madhulika
Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India.
Seizure. 2009 Jul;18(6):446-9. doi: 10.1016/j.seizure.2009.04.001. Epub 2009 May 7.
This study evaluated the efficacy and tolerability of the ketogenic diet (KD) in young Indian children with refractory epilepsy. The changes in biochemical and lipid profile with KD were also assessed.
Children aged 6 months to 5 years who had daily seizures (or at least 7 seizures/week) despite the appropriate use of at least three antiepileptic drugs were enrolled. KD was introduced using a non-fasting gradual initiation protocol. Seizure frequency, biochemical profile (liver and kidney function tests, fasting lipid profile, and spot urinary calcium-creatinine ratio) and adverse effects were recorded. Patients continuing KD were followed up for a minimum period of 12 months.
Twenty-seven children were enrolled. Non-fasting gradual KD initiation was well tolerated. Eighty-eight percent remained on KD at 3 months, 55% remained on KD at 6 months, and 37% remained on it at 1 year. Intention-to-treat analysis revealed that 48% (13 of 27) had >50% reduction in seizures, and four children (15 %) were seizure free at 6 months. At 1 year, 37% had >50% reduction in seizures and five children (18.5%) were seizure free. Adverse effects included constipation (74%), weight loss (14.8%), edema due to hypo-albuminemia (7.4%) and renal stones (3.7%). Biochemical profile did not reveal significant changes over time, except for reduced serum albumin and increased spot urinary calcium-creatinine ratio.
KD is an effective and well-tolerated treatment option in young Indian children with refractory epilepsy. However, careful ongoing medical supervision is needed.
本研究评估生酮饮食（KD）对患有难治性癫痫的印度幼儿的疗效和耐受性。同时还评估了KD对生化指标和血脂谱的影响。
纳入年龄在6个月至5岁之间、尽管适当使用了至少三种抗癫痫药物仍每日发作（或每周至少发作7次）的儿童。采用非禁食逐步启动方案引入KD。记录癫痫发作频率、生化指标（肝功能和肾功能检查、空腹血脂谱以及随机尿钙肌酐比值）和不良反应。持续接受KD治疗的患者随访至少12个月。
共纳入27名儿童。非禁食逐步启动KD耐受性良好。3个月时88%的儿童仍在接受KD治疗，6个月时为55%，1年时为37%。意向性分析显示，48%（27名中的13名）的儿童癫痫发作减少>50%，4名儿童（15%）在6个月时无癫痫发作。1年时，37%的儿童癫痫发作减少>50%，5名儿童（18.5%）无癫痫发作。不良反应包括便秘（74%）、体重减轻（14.8%）、低白蛋白血症引起的水肿（7.4%）和肾结石（3.7%）。除血清白蛋白降低和随机尿钙肌酐比值升高外，生化指标随时间未显示出显著变化。
KD是治疗患有难治性癫痫的印度幼儿的一种有效且耐受性良好的治疗选择。然而，需要持续进行仔细的医学监测。
