Mir Ali, Albaradie Raidah, Alamri Abdullah, AlQahtani Mohammed, Hany Entisar, Hussain Aqeel, Joseph Mary, Bashir Shahid
Department of Pediatric Neurology Neuroscience Center King Fahad Specialist Hospital Dammam Saudi Arabia.
College of Medicine Imam Abdulrahman Bin Faisal University Dammam Saudi Arabia.
Epilepsia Open. 2020 Nov 25;5(4):596-604. doi: 10.1002/epi4.12442. eCollection 2020 Dec.
Due to the possibility of serious adverse events (AE), patients are commonly admitted to hospital for 3-5 days for ketogenic diet (KD) initiation. This study examined the incidence of potential AE during admission for KD initiation to investigate the possibility of safely initiating a KD at home.
Children with drug-resistant epilepsy (DRE) who were admitted to hospital for 5 days for KD initiation were retrospectively studied.
A total of 66 children (59% female) were analyzed. The mean age at the initiation of the KD was 48.0 ± 38.4 months, and the mean weight was 14.6 ± 6.3 kg. The median number of anticonvulsant medications used at the time of KD initiation was 3. The etiology of the DRE was structural in 4.5%, hypoxic ischemic encephalopathy in 10.6%, genetic/metabolic in 31.8%, acquired in 10.6%, and unknown in 42.2%. The potential AE occurred in 28.7% of patients, including hypoglycemia (20%), hypoactivity (6.1%), somnolence (3%), and vomiting (7.6%). A univariate analysis of the clinical characteristics of the AE and no AE groups showed a statistically significant difference in weight ( = 0.003) and age ( = 0.033). The concurrent use of topiramate was found to have a near-significant association ( = 0.097) between the groups. The groups' urine ketone levels on all 5 days were compared, and a statistically significant difference was found on day 3 ( = 0.026). A statistically significant difference in the serum bicarbonate levels ( = 0.038) was found between the patients taking topiramate and those not taking it.
The incidence of AE during admission for KD initiation was found to be low. The AE either required no intervention or were easily managed with simple interventions. Thus, in carefully selected patients, it may be possible to initiate a KD at home if the parents are adequately prepared and monitored.
由于存在严重不良事件（AE）的可能性，患者通常会住院3 - 5天以开始生酮饮食（KD）。本研究调查了开始KD住院期间潜在AE的发生率，以探讨在家中安全开始KD的可能性。
对因开始KD而住院5天的耐药性癫痫（DRE）儿童进行回顾性研究。
共分析了66名儿童（59%为女性）。开始KD时的平均年龄为48.0±38.4个月，平均体重为14.6±6.3千克。开始KD时使用的抗惊厥药物中位数为3种。DRE的病因中，结构性占4.5%，缺氧缺血性脑病占10.6%，遗传/代谢性占31.8%，后天性占10.6%，不明原因占42.2%。28.7%的患者发生了潜在AE，包括低血糖（20%）、活动减少（6.1%）、嗜睡（3%）和呕吐（7.6%）。对AE组和无AE组的临床特征进行单因素分析，发现体重（P = 0.003）和年龄（P = 0.033）存在统计学显著差异。发现托吡酯的同时使用在两组之间有接近显著的关联（P = 0.097）。比较了两组在所有5天的尿酮水平，在第3天发现有统计学显著差异（P = 0.026）。服用托吡酯的患者和未服用托吡酯的患者之间血清碳酸氢盐水平存在统计学显著差异（P = 0.038）。
发现开始KD住院期间AE的发生率较低。这些AE要么无需干预，要么通过简单干预即可轻松处理。因此，在精心挑选的患者中，如果家长有充分准备并受到监测，在家中开始KD是有可能的。
