Sourbron Jo, Klinkenberg Sylvia, van Kuijk Sander M J, Lagae Lieven, Lambrechts Danielle, Braakman Hilde M H, Majoie Marian
Department of Development and Regeneration, Section Pediatric Neurology, University Hospital KU Leuven, Herestraat 49, box 7003 20, 3000, Leuven, Belgium.
Kempenhaeghe Centre for Neurological Learning Disabilities, Heeze, the Netherlands.
Childs Nerv Syst. 2020 Jun;36(6):1099-1109. doi: 10.1007/s00381-020-04578-7. Epub 2020 Mar 16.
The ketogenic diet (KD), containing high levels of fat and low levels of carbohydrates, has been used to treat refractory epilepsy since the 1920s. In the past few decades, there has been more interest in less restrictive KDs such as the modified Atkins diet (MAD).
Our aim was to review all evidence regarding the efficacy and tolerability of the KD and MAD from randomized controlled trials (RCTs) in children and adolescents with refractory epilepsy.
We reviewed the current literature using Cochrane, EMBASE, and MEDLINE (using PubMed). We implemented predefined criteria regarding dataextraction and study quality.
We identified five RCTs that generated seven publications and recruited 472 children and adolescents with refractory epilepsy (≤ 18 years). The primary outcome (seizure frequency reduction (SFR) ≥ 50%) was attained in 35-56.1% of the participants in the intervention group, compared with 6-18.2% in the control group. Our meta-analysis underlined the significant efficacy of the KD compared with the control group: RR = 5.1 (95% CI 3.18-8.21, p < 0.001). Additionally, only two studies mentioned possible biomarkers to objectively evaluate the efficacy. Secondary outcomes, such as seizure severity and quality of life, were studied in three trials, leading to indecisive generalization of these findings. Gastro-intestinal adverse effects were the most prevalent, and no severe adverse effects were reported.
Despite the heterogeneity between all studies, the beneficial results underline that dietary interventions should be considered for children and adolescents with refractory epilepsy who are not eligible for epilepsy surgery. Future studies should be multi-center and long-term, and evaluate potential biomarkers and adverse effects.
生酮饮食（KD）富含高脂肪和低碳水化合物，自20世纪20年代以来一直用于治疗难治性癫痫。在过去几十年里，人们对限制较少的生酮饮食，如改良阿特金斯饮食（MAD），产生了更多兴趣。
我们的目的是回顾来自随机对照试验（RCT）的关于KD和MAD对难治性癫痫儿童和青少年的疗效和耐受性的所有证据。
我们使用Cochrane、EMBASE和MEDLINE（通过PubMed）回顾当前文献。我们实施了关于数据提取和研究质量的预定义标准。
我们确定了五项RCT，这些研究产生了七篇出版物，招募了472名难治性癫痫（≤18岁）的儿童和青少年。干预组35%-56.1%的参与者达到了主要结局（癫痫发作频率降低（SFR）≥50%），而对照组为6%-18.2%。我们的荟萃分析强调了KD与对照组相比的显著疗效：RR = 5.1（95% CI 3.18 - 8.21，p < 0.001）。此外，只有两项研究提到了可能的生物标志物以客观评估疗效。在三项试验中研究了次要结局，如癫痫发作严重程度和生活质量，这些结果的概括性不明确。胃肠道不良反应最为普遍，未报告严重不良反应。
尽管所有研究之间存在异质性，但有益结果强调，对于不符合癫痫手术条件的难治性癫痫儿童和青少年，应考虑饮食干预。未来的研究应是多中心和长期的，并评估潜在的生物标志物和不良反应。
