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饮食疗法:儿童耐药性癫痫治疗的新兴范式:基于第六届 I.C. Verma 博士卓越研究奖演讲。

Dietary Therapies: Emerging Paradigms in Therapy of Drug Resistant Epilepsy in Children : Based on 6th Dr. I. C. Verma Excellence in Research Award Oration.

机构信息

Child Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India.

出版信息

Indian J Pediatr. 2018 Nov;85(11):1000-1005. doi: 10.1007/s12098-018-2779-9. Epub 2018 Sep 21.

Abstract

About one-third of childhood epilepsy ultimately becomes drug resistant epilepsy. Only about one-third of drug resistant epilepsy is amenable for epilepsy surgery. Epilepsy surgery and vagal nerve stimulation is still beyond the reach of huge proportion of children with pharmacoresistant epilepsy. Ketogenic diet (KD) has been in use for almost a century now all over the world for drug resistant epilepsy, although in between there was a decline in its popularity with advent of newer antiepileptic drugs like valproate, phenytoin and carbamazepine. Again from 1990s there was resurgence of interest in KD for pharmacoresistant epilepsy and in the last two decades several randomized controlled trials and systemic reviews have proved its efficacy beyond any suspicion. Ketogenic diet is a high fat low carbohydrate and low protein diet, which has been found to reduce epileptogenesis in body most probably by production of ketone bodies. Modified Atkin's Diet (MAD) first introduced in 2003 and Low Glycemic Index Treatment (LGIT) first introduced in 2005 are another two dietary therapies, which are less restrictive, more palatable with fewer adverse effects and comparable efficacy. MAD is also a high fat, low carbohydrate diet, in which high sugar foods are discouraged and protein and fluids are unrestricted. In LGIT, only carbohydrates with Glycemic Index <50 are allowed and carbohydrate intake is restricted to 40-60 g per day. Medium Chain Triglyceride KD (MCT KD) is another alternative, in which there are more food choices as compared to classic KD, with comparable efficacy.

摘要

大约三分之一的儿童癫痫最终会发展为难治性癫痫。只有大约三分之一的耐药性癫痫患者适合进行癫痫手术。癫痫手术和迷走神经刺激仍然超出了大量耐药性癫痫儿童的承受范围。生酮饮食(KD)在全世界用于治疗耐药性癫痫已有近一个世纪的历史,尽管在新型抗癫痫药物如丙戊酸钠、苯妥英和卡马西平问世后,其受欢迎程度有所下降。从 20 世纪 90 年代开始,人们对 KD 治疗耐药性癫痫又重新产生了兴趣,在过去的二十年里,几项随机对照试验和系统评价证明了其疗效毋庸置疑。生酮饮食是一种高脂肪、低碳水化合物和低蛋白质的饮食,它通过产生酮体来减少体内的癫痫发生,这一点已被证实。改良的阿特金斯饮食(MAD)于 2003 年首次引入,低血糖指数治疗(LGIT)于 2005 年首次引入,这两种饮食疗法限制较少,更美味,不良反应更少,疗效相当。MAD 也是一种高脂肪、低碳水化合物的饮食,其中高糖食品被禁止,蛋白质和液体不受限制。在 LGIT 中,只允许血糖指数<50 的碳水化合物,并且将碳水化合物的摄入量限制在每天 40-60 克。中链甘油三酯 KD(MCT KD)是另一种替代方法,与经典 KD 相比,它有更多的食物选择,疗效相当。

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