Division of Pediatric Neurology, Department of Neurology, Amrita Institute of Medical Sciences, Amrita University, Kochi, Kerala, India.
Division of Pediatric Neurology, Department of Neurology, Amrita Institute of Medical Sciences, Amrita University, Kochi, Kerala, India.
Seizure. 2018 May;58:41-46. doi: 10.1016/j.seizure.2018.03.020. Epub 2018 Mar 21.
Significant challenges exist for Ketogenic Diet (KD) programs in many populations, mainly due to the variations in local dietary preferences. Here we report a single center experience of KD therapy in a cohort of South Indian children with pharmaco-resistant epilepsies.
Children aged 0-18 years, enrolled in the KD program for pharmacoresistant epilepsies of Amrita institute of Medical Sciences, Kochi, Kerala, India (2010 - 2015) were included in this pragmatic study. Diet efficacy was evaluated according to reduction in seizure frequency and in the number of antiepileptic drugs (AED). Duration of retention, reasons for discontinuation and the rate of adverse events were used for assessing KD tolerability.
Seventy four children were enrolled in the KD program. Four children could not complete the initiation process. Median age at KD initiation was 4.2years. 53 children had developmental delay. 89% were on 3 or more AEDs. Baseline seizure frequency was >5/day in 52 children. KD was continued for a median duration of 10.43 months. At the last contact, 59.4% reported seizure reduction of more than 50%. More than 90% reduction was noted in 25 children (33.7%). 6(8.1%) of them became completely seizure free. Four children expired during the study period and four children reported major adverse events necessitating KD withdrawal. Main reasons for discontinuation of KD were poor compliance, lack of response to diet and relapse of seizures.
KD may be a safe and effective option for children with pharmacoresistant epilepsies even while on a traditional carbohydrate rich South Indian diet.
由于当地饮食偏好的差异， ketogenic diet（KD）方案在许多人群中存在重大挑战。在此，我们报告了印度喀拉拉邦科钦市 Amrita 医学科学研究所 KD 治疗方案在一组对药物难治性癫痫的南印度儿童中的单中心经验。
本实用研究纳入了 2010 年至 2015 年期间在印度喀拉拉邦科钦市 Amrita 医学科学研究所参加 KD 治疗方案的药物难治性癫痫儿童。根据发作频率和抗癫痫药物（AED）数量的减少来评估饮食的疗效。保留时间、停药原因和不良事件发生率用于评估 KD 的耐受性。
共有 74 名儿童参加了 KD 项目。4 名儿童无法完成启动过程。KD 开始时的中位年龄为 4.2 岁。53 名儿童有发育迟缓。89%的儿童服用 3 种或更多 AED。52 名儿童的基线发作频率>5/天。KD 持续时间的中位数为 10.43 个月。在最后一次接触时，59.4%的儿童报告发作减少了 50%以上。25 名儿童（33.7%）的减少超过 90%。其中 6 名（8.1%）儿童完全无发作。4 名儿童在研究期间死亡，4 名儿童报告因严重不良事件需要停止 KD。KD 停止的主要原因是依从性差、对饮食无反应和癫痫复发。
即使在传统的碳水化合物丰富的南印度饮食中，KD 也可能是药物难治性癫痫儿童的一种安全有效的选择。
