APHP, Hôpital Robert Debré, Service de Neurologie Pédiatrique, Paris, France.
Epilepsy Res. 2013 Jul;105(1-2):189-94. doi: 10.1016/j.eplepsyres.2012.11.009. Epub 2013 Jan 26.
Ketogenic diet (KD) is an efficient treatment for refractory epilepsy including infantile spasms (IS). We evaluated the effect of a KD to treat IS as a third-line treatment, after vigabatrin (VGB) and steroids. We evaluated the efficacy and the tolerability of KD in IS using the rate of seizure-free patients at 1 month.
We conducted an open study using the data from a prospective database of two French child neurology departments (Amiens & Robert Debré-Paris, France) over a three-year period. All the patients followed the KD for 6 months. The addition of an antiepileptic drug was allowed after 1 month of KD in the non-seizure-free patients.
17 patients were treated by KD for IS. The KD was initiated at the mean age of 9.4±1.1 months. After 1 month with KD, 6/17 (35%) patients were seizure free while 11/17 (65%) were seizure-free after the third month. However, an additional antiepileptic drug (felbamate or topiramate) was given to all patients that were not seizure-free under KD. The KD was well tolerated.
Our responder rate is similar to previous studies despite an early use (before 1-year-old) and the use of KD after VGB and steroids. The KD was well-tolerated in this population of young infants. Felbamate leads to an increase in the responder rate after the use of KD.
生酮饮食（KD）是一种有效的治疗难治性癫痫的方法，包括婴儿痉挛症（IS）。我们评估了 KD 作为维加特林（VGB）和类固醇之后的三线治疗对 IS 的疗效和耐受性，使用 1 个月时无癫痫发作患者的比例来评估 KD 的疗效。
我们进行了一项开放性研究，使用了法国两个儿童神经病学部门（亚眠和巴黎罗伯特·德布雷-法国）三年期间前瞻性数据库中的数据。所有患者均接受 KD 治疗 6 个月。在非无癫痫发作患者中，在 KD 治疗 1 个月后允许添加抗癫痫药物。
17 名患者因 IS 接受 KD 治疗。KD 在平均 9.4±1.1 个月时开始。在 KD 治疗 1 个月后，17 名患者中有 6 名（35%）无癫痫发作，而在第 3 个月后有 11 名（65%）无癫痫发作。然而，所有无 KD 无癫痫发作的患者均给予了额外的抗癫痫药物（苯妥英或托吡酯）。KD 耐受性良好。
尽管我们在早期（1 岁前）使用 KD，并在 VGB 和类固醇后使用 KD，但我们的应答率与之前的研究相似。KD 在这群年幼婴儿中耐受良好。在使用 KD 后，苯妥英的使用会增加应答率。
