Division of Pediatric Neurology, Department of Pediatrics, Gazi University Faculty of Medicine, Ankara, Turkey.
Turk J Pediatr. 2021;63(5):735-742. doi: 10.24953/turkjped.2021.05.001.
Although the ketogenic diet (KD) is a well-established non-pharmacologic treatment for intractable epilepsy in pediatric patients, it is still perceived as theoretical information contained within textbooks rather than implementation in daily clinical practice. The aim of the present study was to primarily determine KD implementation frequency in daily clinical practice, the number of pediatric patients with intractable epilepsy, the conditions that hindered or facilitated KD implementation, and to provide a roadmap to improve patient outcomes.
A total of 27 pediatric neurologists, who were experienced in intractable epileptic pediatric patients and the implementation of KDs, responded to a 24-question survey. The survey was structured to outline patient selection criteria for KDs, prevalent treatment approaches in daily clinical practice for intractable epilepsy, level of physician awareness and impediments in KD implementation.
Intractable epilepsy was diagnosed predominantly in children within the 7 to 12-year age group (44%). KD implementation was hindered mainly by lack of an adequate number of personnel (53.8%), lack of a dietitian (52%), inadequate training of patients (24%), and inadequate experience of healthcare professionals (23.1%). Lack of guidance in treatment, physician`s hesitations due to probable problems, inadequate time spent for each patient, lack of awareness for KD therapy, and loss of appetite in these patients were also emphasized by the participants (each 16.7%). Additional drawbacks were non-appealing taste (76.9%), need for continuous supervision (76.9%), and low patient motivation (73.1%). The treatment failure causes for KDs were ranked as imprecise cooking of recipes (94%), inadequate family support (92.3%), inadequate consumption of meals (73%), incorrect indication (53.9%), and inefficiency of KD despite correct application (42.3%).
The panoramic view of KDs in Turkey indicates that a National Guideline would increase both physician awareness level for KD, and the rate of structured therapy implementation in pediatric patients, who suffer from inadequate treatment.
尽管生酮饮食（KD）是治疗儿科难治性癫痫的一种成熟的非药物治疗方法，但它仍然被视为教科书上的理论信息，而不是在日常临床实践中的应用。本研究的主要目的是确定 KD 在日常临床实践中的实施频率、接受难治性癫痫治疗的儿科患者数量、阻碍或促进 KD 实施的条件，并提供改善患者预后的路线图。
共 27 名对儿童难治性癫痫患者和 KD 实施有经验的儿科神经科医生回答了 24 个问题的调查。该调查的结构旨在概述 KD 的患者选择标准、难治性癫痫日常临床实践中的常见治疗方法、医生对 KD 的认识水平以及实施 KD 的障碍。
难治性癫痫主要诊断于 7 至 12 岁的儿童（44%）。KD 实施的主要障碍是缺乏足够数量的人员（53.8%）、缺乏营养师（52%）、患者培训不足（24%）和医疗保健专业人员经验不足（23.1%）。治疗缺乏指导、医生因可能出现的问题而犹豫不决、每位患者的时间不足、对 KD 治疗的认识不足以及这些患者的食欲下降也被参与者强调（每个占 16.7%）。另外的缺点是味道不可口（76.9%）、需要持续监督（76.9%）和患者动机不足（73.1%）。KD 治疗失败的原因依次为食谱烹饪不精确（94%）、家庭支持不足（92.3%）、膳食摄入不足（73%）、指示不当（53.9%）和尽管正确应用但 KD 无效（42.3%）。
土耳其 KD 的全景图表明，国家指南将提高医生对 KD 的认识水平，并提高接受不充分治疗的儿科患者结构化治疗的实施率。
