Departments of Pediatric Neurology, University of Health Sciences Turkey, Dr. Behçet Uz Children's Education and Research Hospital, İzmir.
Departments of Nutrition and Dietetics, University of Health Sciences Turkey, Dr. Behçet Uz Children's Education and Research Hospital, İzmir.
Turk J Pediatr. 2022;64(2):210-220. doi: 10.24953/turkjped.2021.4.
We aimed to investigate the effectiveness of ketogenic diet (KD) in children with various types of refractory epilepsy.
A total of 91 children (49 females) aged 3 to 193 months (median, 52 months) with drug resistant epilepsy who received KD treatment for at least 12 months were enrolled in the study. Seizure frequency, adherence to diet, reason for discontinuation of KD, and adverse effects were recorded. Response was defined as ≥50% improvement in seizure frequency compared to baseline. We also searched for influences of different variables on the outcome.
Intent-to-treat analysis revealed an improvement in seizure frequency for ≥50% in 73.6%, 80.2%, 75.8%, 73.6%, and 70.3% of patients at month-1, -3, -6, -9, and month-12, respectively. Overall, 32 (35.2%) patients remained seizure-free at month-12. There was no significant differences between responders and nonresponders in terms of age at onset of epilepsy, age at onset of KD, gender, or etiology. Mild hyperlipidemia was associated with a higher response rate. At the last follow-up (median: 20 months), 38 (41.8%) patients were still maintained on KD. While 15.4% of patients completed the diet with a success in seizure control, remainder discontinued KD due to lack of efficacy (23.1%), non-adharence to diet (11%), intercurrent infection (4.4%), adverse effects (3.3%), and death (1.1%).
Ketogenic diet treatment appears to be effective in about two-thirds of children with various types of drug-resistant epilepsy, including one-third remaining seizure free. Mild hyperlipidemia seems to be associated with a higher response rate. Discontinuation of KD is mostly due to lack of efficacy or nonadherence, and rarely side effects.
我们旨在研究生酮饮食（KD）在各种类型难治性癫痫儿童中的疗效。
共纳入 91 例（49 例女性）年龄 3 至 193 个月（中位数，52 个月）的耐药性癫痫患儿，接受 KD 治疗至少 12 个月。记录发作频率、饮食依从性、KD 停药原因和不良反应。将≥50%的发作频率改善定义为有效。我们还搜索了不同变量对结果的影响。
意向治疗分析显示，治疗 1、3、6、9 和 12 个月时，分别有 73.6%、80.2%、75.8%、73.6%和 70.3%的患者发作频率改善≥50%。总体而言，12 个月时 32 例（35.2%）患者无发作。在发作起始年龄、KD 起始年龄、性别或病因方面，应答者和无应答者之间无显著差异。轻度血脂异常与更高的应答率相关。末次随访（中位数：20 个月）时，38 例（41.8%）患者仍维持 KD。15.4%的患者完成了饮食治疗，控制了发作，其余患者因疗效不佳（23.1%）、饮食不依从（11%）、并发感染（4.4%）、不良反应（3.3%）和死亡（1.1%）而停止 KD。
KD 治疗似乎对各种类型耐药性癫痫儿童有效，约三分之二的患儿有效，其中三分之一的患儿无发作。轻度血脂异常似乎与更高的应答率相关。KD 的停药主要是由于疗效不佳或不依从，很少因不良反应。
