Division of Pediatric Neurology, Chang Gung Children's Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
Division of Pediatric Critical Care and Pediatric Neurocritical Care Center, Chang Gung Children's Hospital at Linkou, Taoyuan, Taiwan; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
Biomed J. 2020 Jun;43(3):218-225. doi: 10.1016/j.bj.2020.02.002. Epub 2020 Jul 5.
In this review, we summarize the general mechanisms of the ketogenic diet, and the application of a ketogenic diet in pediatric intensive care units for the neurological disorders of children and young infants. A ketogenic diet is a high-fat, low-carbohydrate, adequate-protein diet. It can alter the primary cerebral energy metabolism from glucose to ketone bodies, which involves multiple mechanisms of antiepileptic action, antiepileptogenic properties, neuro-protection, antioxidant and anti-inflammatory effects, and it is potentially a disease-modifying intervention. Although a ketogenic diet is typically used for the chronic stage of pharmacoresistant of epilepsy, recent studies have shown its efficacy in patients with the acute stage of refractory/super-refractory status epilepticus. The application of a ketogenic diet in pediatric intensive care units is a challenge because of the critical status of the patients, who are often in a coma or have a nothing by mouth order. Moreover, a ketogenic diet needs to be started early and sometimes through parenteral administration in patients with critical conditions such as refractory status epilepticus or febrile infection-related epilepsy syndrome. Animal models and some case reports have shown that the neuro-protective effects of a ketogenic diet can be extended to other emergent neurological diseases, such as traumatic brain injury and ischemic stroke.
在这篇综述中，我们总结了生酮饮食的一般机制，以及生酮饮食在儿科重症监护病房中用于儿童和婴儿神经障碍的应用。生酮饮食是一种高脂肪、低碳水化合物、适量蛋白质的饮食。它可以改变大脑的主要能量代谢途径，从葡萄糖转变为酮体，这涉及多种抗癫痫作用机制、抗癫痫发生特性、神经保护、抗氧化和抗炎作用，并且可能是一种疾病修饰干预措施。尽管生酮饮食通常用于耐药性癫痫的慢性阶段，但最近的研究表明，它在难治性/超难治性癫痫持续状态的急性阶段患者中具有疗效。由于患者处于危急状态，通常处于昏迷状态或有禁食医嘱，因此在儿科重症监护病房中应用生酮饮食是一个挑战。此外，对于难治性癫痫持续状态或发热感染相关癫痫综合征等危急情况的患者，生酮饮食需要尽早开始，有时需要通过肠外途径给予。动物模型和一些病例报告表明，生酮饮食的神经保护作用可以扩展到其他紧急神经系统疾病，如创伤性脑损伤和缺血性中风。
