Institute of Translational Medicine, University of Liverpool, Liverpool, L69 3BX, UK; The Walton Centre NHS Foundation Trust, Liverpool, L9 7LJ, UK.
Department of Biostatistics, University of Liverpool, Liverpool, L69 3BX, UK.
Seizure. 2017 Nov;52:1-6. doi: 10.1016/j.seizure.2017.08.013. Epub 2017 Sep 1.
The ketogenic diet (KD) has been proven to be effective in children with refractory epilepsy and is recommended by the National Institute of Health and Care Excellence (NICE). There is no randomised control trial (RCT) evidence for the clinical or cost effectiveness of KD in adults, for whom the KD is not currently recommended. We assessed the feasibility of the modified ketogenic diet (MKD) in adults with refractory epilepsy along with the willingness of patients to participate in a future RCT.
The service evaluation was undertaken in two parts; questionnaire and diet evaluation.
102 patients completed a questionnaire, of which 51 patients were willing to try the MKD for 3 months to assess effect on seizures. Forty three patients were willing to participate in a clinical trial to investigate deliverability, efficacy and tolerability. Thirty seven of which would still be willing to participate if the trial were randomised. Of the 17 patients who commenced the diet, 9 completed the 12 week period, 7 of which stayed on the diet for the longer term. Constipation (n=6) and loose stools (n=3) were the only reported adverse effects.
Our results indicate that there is demand for a ketogenic diet service in adults. The MKD is well tolerated, feasible and financially viable to deliver to adults with epilepsy in the NHS. There is also interest in and willingness to participate in a UK based RCT that would ultimately inform decisions about commissioning appropriate services.
生酮饮食（KD）已被证明对难治性癫痫儿童有效，被国家卫生与保健卓越研究所（NICE）推荐。对于成年人，KD 对其临床或成本效益尚未有随机对照试验（RCT）证据，因此 KD 目前不被推荐。我们评估了改良生酮饮食（MKD）在难治性癫痫成年患者中的可行性，以及患者对未来 RCT 参与的意愿。
该服务评估分为两部分：问卷调查和饮食评估。
102 名患者完成了问卷调查，其中 51 名患者愿意尝试 MKD 治疗 3 个月，以评估对癫痫发作的影响。43 名患者愿意参加临床试验，以调查其可实施性、疗效和耐受性。其中 37 名患者如果试验是随机的，仍愿意参加。17 名开始饮食的患者中，9 名完成了 12 周的治疗期，其中 7 名长期坚持饮食。唯一报告的不良反应是便秘（n=6）和腹泻（n=3）。
我们的结果表明，成年人对生酮饮食服务有需求。MKD 耐受性良好，在 NHS 中为癫痫患者提供是可行且经济可行的。对于在英国进行的 RCT 也有兴趣和意愿参与，这将最终为关于委托提供适当服务的决策提供信息。
