Weijenberg Amerins, van Rijn Margreet, Callenbach Petra M C, de Koning Tom J, Brouwer Oebele F
Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
Department of Pediatrics, Metabolic diseases section, University Medical Center Groningen, University of Groningen, Beatrix Children's Hospital, Groningen, the Netherlands.
Child Neurol Open. 2018 May 29;5:2329048X18779497. doi: 10.1177/2329048X18779497. eCollection 2018.
Ketogenic diet in children with epilepsy has a considerable impact on daily life and is usually adopted for at least 3 months. Our aim was to evaluate whether the introduction of an all-liquid ketogenic diet in an outpatient setting is feasible, and if an earlier assessment of its efficacy can be achieved.
The authors conducted a prospective, observational study in a consecutive group of children with refractory epilepsy aged 2 to 14 years indicated for ketogenic diet. Ketogenic diet was started as an all-liquid formulation of the classical ketogenic diet, KetoCal 4:1 LQ, taken orally or by tube. After 6 weeks, the liquid diet was converted into solid meals. The primary outcome parameter was time-to-response (>50% seizure reduction). Secondary outcome parameters were time to achieve stable ketosis, the number of children showing a positive response, and the retention rate at 26 weeks.
Sixteen children were included. Four of them responded well with respect to seizure frequency, the median time-to-response was 14 days (range 7-28 days). The mean time to achieve stable ketosis was 7 days. The retention rate at 26 weeks was 50%. Of the 8 children who started this protocol orally fed, 6 completed it without requiring a nasogastric tube.
Introduction of ketogenic diet with a liquid formulation can be accomplished in orally fed children without major complications. It allowed for fast and stable ketosis.
生酮饮食对癫痫患儿的日常生活有相当大的影响，通常需采用至少3个月。我们的目的是评估在门诊环境中引入全液体生酮饮食是否可行，以及能否更早地评估其疗效。
作者对一组连续的2至14岁难治性癫痫患儿进行了一项前瞻性观察研究，这些患儿适合采用生酮饮食。生酮饮食开始时采用经典生酮饮食的全液体配方，即口服或通过鼻饲管给予KetoCal 4:1 LQ。6周后，将液体饮食转换为固体食物。主要结局参数是反应时间（癫痫发作减少>50%）。次要结局参数是达到稳定酮症的时间、显示阳性反应的儿童数量以及26周时的保留率。
纳入了16名儿童。其中4名儿童在癫痫发作频率方面反应良好，中位反应时间为14天（范围7 - 28天）。达到稳定酮症的平均时间为7天。26周时的保留率为50%。在开始该方案时采用口服喂养的8名儿童中，有6名无需鼻饲管就完成了该方案。
对于口服喂养的儿童，引入液体配方的生酮饮食可以在无重大并发症的情况下完成。它能实现快速且稳定的酮症。
