Cervenka Mackenzie C, Wood Susan, Bagary Manny, Balabanov Antoaneta, Bercovici Eduard, Brown Mesha-Gay, Devinsky Orrin, Di Lorenzo Cherubino, Doherty Colin P, Felton Elizabeth, Healy Laura A, Klein Pavel, Kverneland Magnhild, Lambrechts Danielle, Langer Jennifer, Nathan Janak, Munn Jude, Nguyen Patty, Phillips Matthew, Roehl Kelly, Tanner Adrianna, Williams Clare, Zupec-Kania Beth
Department of Neurology (MCC), Johns Hopkins University School of Medicine, Baltimore, MD; Matthew's Friends Clinics for Ketogenic Dietary Therapies (SW), Lingfield, Surrey, United Kingdom; Complex Epilepsy and Sleep Service (MB, JM), The Barberry, Birmingham, United Kingdom; Department of Neurology (AB, KR), Rush University Medical Center, Chicago, IL; Department of Neurology (EB), University of Toronto, Ontario, Canada; Department of Neurology (M-GB), University of Colorado, Denver; Department of Neurology (OD), New York University School of Medicine; Department of Medico-Surgical Sciences and Biotechnologies (CDL), Sapienza University of Rome Polo Pontino, Italy; Academic Unit of Neurology (CPD), Trinity College Dublin & FutureNeuro, Ireland; Department of Neurology (EF), UW Health, Madison; Department of Clinical Nutrition (LAH), St James' Hospital, Dublin, Ireland; Mid-Atlantic Epilepsy and Sleep Center (PK), Bethesda, MD; National Center for Epilepsy (MK), Oslo, Norway; Department of Neurology (DL), Academic Center for Epileptology, Kempenhaeghe and Maastricht University Medical Center, Heeze, The Netherlands; Department of Neurology (JL), University of Virginia, Charlottesville; Department of Neurology (JN), Shushrusha Hospital, Mumbai, India; Charles Dent Metabolic Unit (PN), University College London Hospitals NHS Foundation Trust, United Kingdom; Department of Neurology (MP), Waikato Hospital, Hamilton, New Zealand; Mercy Health Hauenstein Neurosciences (AT), Grand Rapids, MI; Department of Dietetics and Foodservices (CW), Mater Group, South Brisbane, QLD, Australia; and The Charlie Foundation for Ketogenic Therapies (BZ-K), Santa Monica, CA.
Neurol Clin Pract. 2021 Oct;11(5):385-397. doi: 10.1212/CPJ.0000000000001007.
To evaluate current clinical practices and evidence-based literature to establish preliminary recommendations for the management of adults using ketogenic diet therapies (KDTs).
A 12-topic survey was distributed to international experts on KDTs in adults consisting of neurologists and dietitians at medical institutions providing KDTs to adults with epilepsy and other neurologic disorders. Panel survey responses were tabulated by the authors to determine the common and disparate practices between institutions and to compare these practices in adults with KDT recommendations in children and the medical literature. Recommendations are based on a combination of clinical evidence and expert opinion regarding management of KDTs.
Surveys were obtained from 20 medical institutions with >2,000 adult patients treated with KDTs for epilepsy or other neurologic disorders. Common side effects reported are similar to those observed in children, and recommendations for management are comparable with important distinctions, which are emphasized. Institutions differ with regard to recommended biochemical assessment, screening, monitoring, and concern for long-term side effects, and further investigation is warranted to determine the optimal clinical management. Differences also exist between screening and monitoring practices among adult and pediatric providers.
KDTs may be safe and effective in treating adults with drug-resistant epilepsy, and there is emerging evidence supporting the use in other adult neurologic disorders and general medical conditions as well. Therefore, expert recommendations to guide optimal care are critical as well as further evidence-based investigation.
评估当前的临床实践和循证文献，以制定针对成人采用生酮饮食疗法（KDTs）的初步管理建议。
向成人KDTs领域的国际专家发放了一份包含12个主题的调查问卷，这些专家包括在为患有癫痫和其他神经系统疾病的成人提供KDTs的医疗机构中的神经科医生和营养师。作者对小组调查的回复进行了列表整理，以确定各机构之间常见和不同的做法，并将成人的这些做法与儿童KDTs的建议以及医学文献进行比较。建议基于关于KDTs管理的临床证据和专家意见的综合。
从20家医疗机构获得了调查问卷，这些机构用KDTs治疗了2000多名患有癫痫或其他神经系统疾病的成人患者。报告的常见副作用与儿童中观察到的相似，管理建议具有可比性，但也强调了重要的区别。各机构在推荐的生化评估、筛查、监测以及对长期副作用的关注方面存在差异，有必要进行进一步调查以确定最佳临床管理方法。成人和儿科医疗服务提供者在筛查和监测实践方面也存在差异。
KDTs在治疗耐药性癫痫的成人患者中可能是安全有效的，并且有新出现的证据支持其在其他成人神经系统疾病和一般医疗状况中的应用。因此，指导最佳护理的专家建议以及进一步的循证调查至关重要。
