Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
Institute for Clinical and Translational Research, Johns Hopkins University, Baltimore, MD, United States.
Seizure. 2018 Aug;60:132-138. doi: 10.1016/j.seizure.2018.06.019. Epub 2018 Jun 22.
To determine whether use of a ketogenic formula during the first month of the modified Atkins diet (MAD) in adults with drug-resistant epilepsy (DRE) improves seizure reduction and compliance compared to MAD alone.
Eighty adults (age ≥18 years) with DRE and ≥4 reliably quantifiable seizures/month were enrolled. All participants were trained to follow a 20 g/day net carbohydrate limit MAD. Patients were randomized to receive one 8-ounce (237 mL) tetrapak of KetoCal, a 4:1 ketogenic ratio formula, daily in combination with MAD during the first month (treatment arm) or second month (control/cross-over arm). Patients recorded urine ketones, weight, and seizure frequency and followed up at 1 and 2 months.
By 1 month, 84% of patients achieved ketosis (median of 4-4.5 days). At 1 month, the treatment arm had a significantly higher ketogenic ratio and more patients with a ≥1:1 ketogenic ratio compared to the control arm. There was no difference in median seizure frequency, proportion of responders (≥50% seizure reduction), or median seizure reduction from baseline between groups. However, patients treated with KetoCal during the first month were significantly more likely to continue MAD for 6 months or more.
Although supplementing MAD with a ketogenic formula in the first month did not increase the likelihood of reducing seizures compared to MAD alone, significantly more adults remained on MAD long-term with this approach. This suggests a potential strategy for encouraging compliance with MAD in adults with DRE.
确定在耐药性癫痫（DRE）成人的改良 Atkins 饮食（MAD）的第一个月中使用生酮配方是否比单独使用 MAD 更能改善癫痫发作减少和依从性。
招募了 80 名患有 DRE 和≥4 种可靠量化发作/月的成年患者。所有患者均接受了 20 克/天净碳水化合物限制 MAD 的培训。患者被随机分配在第一个月（治疗组）或第二个月（对照/交叉臂）接受每日 1 份 8 盎司（237 毫升）的 KetoCal，这是一种 4:1 的生酮比例配方，与 MAD 一起使用。患者记录尿液酮体、体重和癫痫发作频率，并在 1 个月和 2 个月时进行随访。
在 1 个月时，84%的患者达到了酮症（中位数为 4-4.5 天）。在 1 个月时，治疗组的生酮比例明显更高，且具有≥1:1 生酮比例的患者比例高于对照组。两组之间的中位癫痫发作频率、应答者比例（≥50%的癫痫发作减少）或从基线的中位癫痫发作减少均无差异。然而，在第一个月接受 KetoCal 治疗的患者继续接受 MAD 治疗 6 个月或更长时间的可能性显著更高。
尽管在 MAD 的第一个月中添加生酮配方并没有比单独使用 MAD 更能增加减少癫痫发作的可能性，但这种方法使更多的成年人更长期地继续使用 MAD。这表明对于鼓励 DRE 成人遵守 MAD 来说，这是一种潜在的策略。
