Nei Maromi, Ngo Ly, Sirven Joseph I, Sperling Michael R
Jefferson Comprehensive Epilepsy Center, Philadelphia, PA, United States; Department of Neurology, Jefferson Medical College, Philadelphia, PA, United States.
Virtua Voorhees Medical Center, Voorhees, NJ, United States.
Seizure. 2014 Jun;23(6):439-42. doi: 10.1016/j.seizure.2014.02.015. Epub 2014 Mar 12.
The ketogenic diet is an alternative treatment for patients with refractory epilepsy. Most studies to date report dietary response in children. There are limited data evaluating the efficacy of the ketogenic diet in adults. This is a report of the long-term outcome in a largely adult population of patients treated with the ketogenic diet for epilepsy.
Twenty-nine adult and adolescent patients (mean age 32 years, range 11-51) were initiated on the ketogenic diet and followed until diet discontinuation. Clinical response and adverse effects were noted during the duration of the diet.
Fifty-two percent of patients had a significant reduction in seizure frequency on the ketogenic diet, including 45% with ≥50% reduction in seizure frequency. Thirty-one percent had no improvement, seven percent were unable to successfully initiate the diet, and 10% had a >50% increase in seizure frequency. The diet was continued for a mean of 9 months (range 0.13-35 months), with five patients completing ≥23 months. There was a trend toward better response and better tolerability/longer duration in patients with symptomatic generalized epilepsy. The diet was generally well-tolerated, but undesired weight loss and constipation were the most frequent adverse effects.
The ketogenic diet can be used safely in the adult and adolescent population, with a response rate similar to those seen in children. Patient with symptomatic generalized epilepsy may be particularly good candidates for this type of dietary treatment.
生酮饮食是难治性癫痫患者的一种替代治疗方法。迄今为止，大多数研究报告的是儿童的饮食反应。评估生酮饮食对成年人疗效的数据有限。本文报告了在以生酮饮食治疗癫痫的成年患者群体中的长期治疗结果。
29名成年和青少年患者（平均年龄32岁，范围11 - 51岁）开始采用生酮饮食，并随访至饮食停止。在饮食期间记录临床反应和不良反应。
52%的患者在生酮饮食期间癫痫发作频率显著降低，其中45%的患者癫痫发作频率降低≥50%。31%的患者无改善，7%的患者未能成功开始饮食，10%的患者癫痫发作频率增加>50%。饮食持续的平均时间为9个月（范围0.13 - 35个月），5名患者完成了≥23个月的治疗。症状性全身性癫痫患者有反应更好、耐受性更好/持续时间更长的趋势。该饮食总体耐受性良好，但体重减轻和便秘是最常见的不良反应。
生酮饮食可安全用于成人和青少年群体，其反应率与儿童相似。症状性全身性癫痫患者可能是这种饮食治疗的特别合适人选。
