Division of Neurology, Departments of Pediatrics and Neurology, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A.
Epilepsia. 2014 Apr;55(4):579-83. doi: 10.1111/epi.12583. Epub 2014 Mar 27.
Few studies have examined the long-term sustainability of complete seizure freedom on the ketogenic diet (KD). The purpose of this study was to describe the risk of seizure recurrence in children who achieved at least 1 month of seizure freedom on the KD, and to assess clinical features associated with sustained seizure freedom.
Records of patients initiated on the KD at The Children's Hospital of Philadelphia (CHOP) from 1991 to 2009 were reviewed. Subjects who attained seizure freedom for at least 1 month within 2 years were included in the study. Seizure frequency was recorded based on caregiver-reported seizure diaries as unchanged, improved, or worse compared to baseline. Those patients with seizure freedom ≥1 year were compared to those with seizure freedom <1 year in terms of demographics, age of seizure onset, number of antiepileptic drugs (AEDs) prior to KD, and epilepsy classification.
Of 276 patients initiated on the KD, 65 patients (24%) attained seizure freedom for a minimum of 1 month. The majority of these patients had daily seizures. The median time to seizure freedom after KD initiation was 1.5 months. Seizures recurred in 53 patients (82%), with a median time to seizure recurrence of 3 months. However, seizure frequency after initial recurrence remained far less than baseline. No clinical features were identified as risk factors for seizure recurrence.
Seizure recurrence on the KD after 1 month of seizure freedom most often occurred as occasional breakthrough seizures and not a return to baseline seizure frequency. This study provides evidence to support the continued use of the KD in patients with initial seizure freedom even after breakthrough seizures. A PowerPoint slide summarizing this article is available for download in the Supporting Information section here.
很少有研究检查生酮饮食（KD）完全无癫痫发作的长期可持续性。本研究的目的是描述在 KD 上实现至少 1 个月无癫痫发作的儿童癫痫复发的风险，并评估与持续无癫痫发作相关的临床特征。
回顾了 1991 年至 2009 年在费城儿童医院（CHOP）开始接受 KD 的患者的记录。纳入本研究的患者在 2 年内至少有 1 个月无癫痫发作。根据照顾者报告的癫痫日记，记录癫痫发作频率为无变化、改善或较基线恶化。将无癫痫发作≥1 年的患者与无癫痫发作<1 年的患者进行比较，比较的内容包括人口统计学特征、癫痫发作年龄、KD 前使用的抗癫痫药物（AED）数量和癫痫分类。
在 276 例开始 KD 的患者中，有 65 例（24%）至少有 1 个月无癫痫发作。这些患者中的大多数有每日癫痫发作。KD 开始后达到无癫痫发作的中位时间为 1.5 个月。53 例（82%）患者癫痫复发，中位复发时间为 3 个月。然而，初始复发后的癫痫发作频率仍远低于基线。没有发现临床特征是癫痫复发的危险因素。
KD 治疗 1 个月后无癫痫发作的患者癫痫复发最常表现为偶发性突破发作，而不是恢复到基线癫痫发作频率。本研究为 KD 治疗初始无癫痫发作后出现突破发作的患者继续使用 KD 提供了证据。本文的幻灯片总结可在此处的支持信息部分下载。
