改良生酮饮食治疗成人耐药性癫痫：有效改善发作频率、发作严重程度和生活质量。
Modified ketogenic diets in adults with refractory epilepsy: Efficacious improvements in seizure frequency, seizure severity, and quality of life.
机构信息
Rush University Medical Center, 1725 West Harrison Street, Suite 885, Chicago, IL 60612, United States of America.
Rush University Medical Center, 1725 West Harrison Street, Suite 885, Chicago, IL 60612, United States of America; Stanford University, 213 Quarry Road, 4th Floor, Palo Alto, CA 94304, United States of America.
出版信息
Epilepsy Behav. 2019 Apr;93:113-118. doi: 10.1016/j.yebeh.2018.12.010. Epub 2019 Mar 10.
OBJECTIVE
This study evaluates the efficacy of a modified ketogenic diet (MKD) on seizure frequency, severity, and quality of life (QOL), as well as potential complications of MKD therapy among adults with drug-resistant epilepsy (DRE).
METHODS
Changes in seizure frequency, severity, QOL, and side effects were retrospectively examined among adults, ≥17 years of age, with DRE (≥2 antiepileptic drugs [AEDs]), after 3 months of MKD therapy. Attention was paid to medication or vagus nerve stimulator (VNS) changes as well to evaluate potential confounders.
RESULTS
A total of 60% (n = 33) of the 55 individuals reported ≥50% seizure frequency improvement, 42 (76%) reported improvement in seizure severity, and 48 (87%) reported improvement in QOL. More patients following a modified ketogenic diet - 15 g net carbohydrate daily (MKD-15) (95%) compared with a MKD-50 (69%) reported improvement in QOL (p = 0.02). Weight among the entire sample declined from 77.5 (20) kg to 73.9 (19.0) kg (p < 0.0001), and total cholesterol (TC), low density lipoprotein (LDL), and total cholesterol:high density lipoprotein (TC:HDL) increased significantly (p = 0.03, p = 0.04, and p = 0.02, respectively). Free carnitine values were available for a select number of patients, 26 (47%) at baseline, and 7 (13%) at follow-up, of which 8 (31%) at baseline, and 2 (29%) at follow-up had carnitine deficiency (<25 nmol/mL). Constipation was noted in 5 patients (9%), and no kidney stones were reported during the study period. There were no statistical differences in number or dose changes for AED or VNS during the study period.
SIGNIFICANCE
Modified ketogenic diet therapies reduce seizure frequency and severity and improve QOL among adults with DRE with few side effects outside of weight loss, a desired outcome among many adults with DRE. More restrictive MKDs may offer improved seizure severity and QOL. Modified ketogenic diet therapy increases LDL cholesterol, which may be cardioprotective if related to an increase in LDL particle size with high saturated fat intake; however, more research is needed examining LDL particle size changes among those receiving MKD therapy.
目的
本研究评估了改良生酮饮食（MKD）对耐药性癫痫（DRE）成人的癫痫发作频率、严重程度和生活质量（QOL）的疗效，以及 MKD 治疗的潜在并发症。
方法
回顾性分析了 3 个月 MKD 治疗后≥17 岁、DRE（≥2 种抗癫痫药物[AED]）的成年人的癫痫发作频率、严重程度、QOL 和不良反应变化。同时注意药物或迷走神经刺激器（VNS）的变化，以评估潜在的混杂因素。
结果
共有 55 名患者中的 60%（n=33）报告癫痫发作频率改善≥50%，42 名（76%）报告癫痫发作严重程度改善，48 名（87%）报告 QOL 改善。与 MKD-50（69%）相比，遵循改良生酮饮食-15g 净碳水化合物（MKD-15）的患者中有更多患者（95%）报告 QOL 改善（p=0.02）。整个样本的体重从 77.5（20）kg 下降到 73.9（19.0）kg（p<0.0001），总胆固醇（TC）、低密度脂蛋白（LDL）和总胆固醇：高密度脂蛋白（TC：HDL）显著增加（p=0.03、p=0.04 和 p=0.02）。仅少数患者可获得游离肉碱值，基线时为 26 例（47%），随访时为 7 例（13%），其中基线时为 8 例（31%），随访时为 2 例（29%）有肉碱缺乏症（<25nmol/mL）。5 名患者（9%）出现便秘，研究期间无肾结石报告。研究期间，AED 或 VNS 的数量或剂量变化无统计学差异。
意义
改良生酮饮食疗法可降低 DRE 成人的癫痫发作频率和严重程度，提高 QOL，且除体重减轻外，很少有其他副作用，这是许多 DRE 成人所期望的结果。更严格的 MKD 可能会改善癫痫发作严重程度和 QOL。改良生酮饮食疗法增加了 LDL 胆固醇，如果与高饱和脂肪摄入相关的 LDL 颗粒大小增加有关，则可能具有心脏保护作用；然而，需要更多的研究来检查接受 MKD 治疗的患者的 LDL 颗粒大小变化。
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