Departments of Neurology and Pediatrics, The John M. Freeman Pediatric Epilepsy Center, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
Curr Opin Neurol. 2012 Apr;25(2):173-8. doi: 10.1097/WCO.0b013e3283515e4a.
Despite myriad anticonvulsants available and in various stages of development, there are thousands of children and adults with epilepsy worldwide still refractory to treatment and not candidates for epilepsy surgery. Many of these patients will now turn to dietary therapies such as the ketogenic diet, medium-chain triglyceride diet, modified Atkins diet, and low glycemic index treatment.
In the past several years, neurologists are finding new indications to use these dietary treatments, perhaps even as first-line therapy, including infantile spasms, myoclonic-astatic epilepsy (Doose syndrome), Dravet syndrome, and status epilepticus (including FIRES syndrome). Adults are also one of the most rapidly growing populations being treated nowadays; this group of patients previously was not typically offered these treatments. In 2009, two controlled trials of the ketogenic diet were published, as well as an International Expert Consensus Statement on dietary treatment of epilepsy. Ketogenic diets are also now being increasingly studied for neurological conditions other than epilepsy, including Alzheimer's disease and cancer. Insights from basic science research have helped elucidate the mechanisms by which metabolism-based therapy may be helpful, in terms of both an anticonvulsant and possibly a neuroprotective effect.
Dietary therapy for epilepsy continues to grow in popularity worldwide, with expanding use for adults and conditions other than epilepsy.
尽管有大量的抗癫痫药物可供选择，并且处于不同的开发阶段，但全世界仍有成千上万的癫痫儿童和成人对治疗无反应，且不符合癫痫手术的条件。现在，许多这些患者将转向饮食疗法，如生酮饮食、中链甘油三酯饮食、改良的阿特金斯饮食和低血糖指数治疗。
在过去的几年中，神经科医生发现了这些饮食治疗的新适应症，甚至可能将其作为一线治疗，包括婴儿痉挛、肌阵挛-失张力癫痫（Doose 综合征）、Dravet 综合征和癫痫持续状态（包括 FIRES 综合征）。成年人也是现在治疗中增长最快的人群之一；这组患者以前通常不提供这些治疗。2009 年，发表了两项关于生酮饮食的对照试验，以及一份关于饮食治疗癫痫的国际专家共识声明。生酮饮食也越来越多地被用于除癫痫以外的神经疾病的研究，包括阿尔茨海默病和癌症。基础科学研究的见解有助于阐明代谢相关治疗可能具有帮助的机制，无论是在抗惊厥作用方面，还是在神经保护作用方面。
癫痫的饮食治疗在全世界范围内越来越受欢迎，其应用范围扩大到成人和癫痫以外的疾病。
