Epilepsy Research Centre, Austin Health, The University of Melbourne, Heidelberg, Vic., Australia.
Neurosciences Unit, Great Ormond Street Hospital, UCL Institute of Child Health, London, UK.
Dev Med Child Neurol. 2018 Jul;60(7):718-723. doi: 10.1111/dmcn.13687. Epub 2018 Feb 16.
Ketogenic diet therapies have proven efficacy for refractory epilepsy. There are many reports of their use in the genetic developmental and epileptic encephalopathies; however, little attention has been paid as to whether the diet is also effective in individuals with an acquired structural aetiology. We observed remarkable efficacy of the diet in two patients with hypoxic-ischaemic encephalopathy. We then analysed our cases with refractory structural epilepsies of acquired origin to characterize their response to the ketogenic diet.
The classical ketogenic diet was implemented with dietary ratios of 3:1 to 4.4:1. Seizure frequency at 1 month, 3 months, 6 months, 1 year, and 2 years was ascertained. A responder was defined as greater than 50% seizure reduction compared to baseline.
Seven of the nine patients were responders at 3 months.
Somewhat surprisingly we found that the ketogenic diet was effective in patients with a developmental and epileptic encephalopathy due to an acquired structural aetiology. This cohort may not be routinely considered for the ketogenic diet because of their structural and acquired, rather than genetic, basis. The ketogenic diet should be considered early in the management of patients with acquired structural encephalopathies as it can improve seizure control with the potential to improve developmental outcome.
The ketogenic diet was effective in children with epilepsy associated with an acquired structural aetiology.
生酮饮食疗法已被证明对难治性癫痫有效。有许多关于其在遗传性发育性和癫痫性脑病中应用的报道；然而，对于饮食是否对获得性结构性病因的个体也有效，关注甚少。我们观察到生酮饮食在两名缺氧缺血性脑病患者中具有显著疗效。然后，我们分析了我们患有获得性结构性难治性癫痫的病例，以确定其对生酮饮食的反应。
实施经典生酮饮食，饮食比例为 3:1 至 4.4:1。确定 1 个月、3 个月、6 个月、1 年和 2 年时的癫痫发作频率。定义应答者为与基线相比，癫痫发作减少 50%以上。
9 名患者中有 7 名在 3 个月时为应答者。
令人有些惊讶的是，我们发现生酮饮食对由获得性结构性病因引起的发育性和癫痫性脑病患者有效。由于其结构和获得性，而不是遗传性基础，这些患者可能不会常规考虑使用生酮饮食。由于生酮饮食有可能改善发育结局，因此应在获得性结构性脑病患者的管理早期考虑使用该饮食，以改善癫痫控制。
生酮饮食对与获得性结构性病因相关的癫痫儿童有效。
