Lin Abigail, Turner Zahava, Doerrer Sarah C, Stanfield Anthony, Kossoff Eric H
School of Medicine, The Johns Hopkins University, Baltimore, Maryland.
Department of Pediatrics, The Johns Hopkins Hospital, Baltimore, Maryland; Department of Neurology, The Johns Hopkins Hospital, Baltimore, Maryland.
Pediatr Neurol. 2017 Mar;68:35-39. doi: 10.1016/j.pediatrneurol.2017.01.007. Epub 2017 Jan 16.
Many centers still admit children for several days to start the ketogenic diet. The exact incidence of adverse effects during the admission and their potential later impact on seizure reduction has not been widely studied.
We performed a retrospective study of children with intractable epilepsy electively admitted for ketogenic diet initiation at our institution from 2011 to 2016. Charts were reviewed for adverse effects during the admission period and then examined for seizure reduction and compliance at three months. A rating scale (1 to 4) was created for severity of any adverse events.
A total of 158 children were included, with the mean age 4.6 years. Potentially attributable adverse effects occurred in 126 (80%) children, most commonly emesis, food refusal, and hypoglycemia. Seventy-three (46%) children received some form of intervention by the medical team, most commonly the administration of juice (24%). Younger age was correlated with an increased likelihood of moderate to severe adverse effects during admission, often repeated hypoglycemia (3.6 versus 4.9 years, P = 0.04). Fasting was more likely to result in lethargy and a single blood glucose in the 30 to 40 mg/dL range, but it was not correlated with emesis, repeated hypoglycemia, or higher adverse effect scores. There was no statistically significant correlation between the severity of adverse effects and the three-month seizure reduction.
Mild easily treated adverse effects occurred in most children admitted for the ketogenic diet. Younger children were at greater risk for significant difficulties and should be monitored closely. Because fasting led to more lethargy and hypoglycemia, it may be prudent to avoid this in younger children.
许多中心仍会让儿童住院数天以开始生酮饮食。住院期间不良反应的确切发生率及其对后期癫痫发作减少的潜在影响尚未得到广泛研究。
我们对2011年至2016年在我院因顽固性癫痫而择期入院开始生酮饮食的儿童进行了一项回顾性研究。查阅病历以了解住院期间的不良反应，然后在三个月时检查癫痫发作减少情况和依从性。针对任何不良事件的严重程度制定了一个评分量表（1至4级）。
共纳入158名儿童，平均年龄4.6岁。126名（80%）儿童出现了可能与之相关的不良反应，最常见的是呕吐、拒食和低血糖。73名（46%）儿童接受了医疗团队某种形式的干预，最常见的是给予果汁（24%）。年龄较小与住院期间出现中度至重度不良反应的可能性增加相关，常为反复低血糖（3.6岁对4.9岁，P = 0.04）。禁食更有可能导致嗜睡和单次血糖在30至40mg/dL范围内，但与呕吐、反复低血糖或更高的不良反应评分无关。不良反应的严重程度与三个月时癫痫发作减少之间无统计学显著相关性。
大多数因生酮饮食入院的儿童出现了轻度且易于治疗的不良反应。年龄较小的儿童出现严重问题的风险更大，应密切监测。由于禁食会导致更多嗜睡和低血糖，对于年龄较小的儿童，谨慎起见应避免禁食。
