Department of Pediatrics, Faculty of Medicine, Menoufia University, Shebin El-Kom, Egypt.
Department of Bioinformatics and Medical Statistics, Medical Research Institute, Alexandria University, Alexandria, Egypt.
Pediatr Res. 2023 Dec;94(6):1978-1989. doi: 10.1038/s41390-023-02554-w. Epub 2023 Mar 11.
Ketogenic diet (KD) refers to any diet in which food composition induces a ketogenic state of human metabolism.
To assess short- and long-term efficacy, safety, and tolerability of KD [classic KD and modified Atkins diet (MAD)] in childhood drug-resistant epilepsy (DRE) and to investigate the effect of KD on electroencephalographic (EEG) features of children with DRE.
Forty patients diagnosed with DRE according to International League Against Epilepsy were included and randomly assigned into classic KD or MAD groups. KD was initiated after clinical, lipid profile and EEG documentation, and regular follow-up was done for 24 months.
Out of 40 patients with DRE, 30 completed this study. Both classic KD and MAD were effective in seizure control as 60% in classic KD group and 53.33% in MAD group became seizure free, and the remaining showed ≥50% seizure reduction. Lipid profile remained within acceptable levels throughout the study period in both groups. Adverse effects were mild and managed medically with an improvement of growth parameters and EEG during the study period.
KD is an effective and safe non-pharmacologic, non-surgical therapy for the management of DRE with a positive impact on growth and EEG.
Both common types of KD (classic KD and MAD) are effective for DRE, but unfortunately, nonadherence and dropout rates are frequent. High serum lipid profile (cardiovascular AE) is often suspected in children following a high-fat diet, but lipid profile remained in the acceptable level up to 24 months. Therefore, KD constitutes a safe treatment. KD had a positive impact on growth, despite inconsistent results of the KD's effect on growth. In addition to showing strong clinical effectiveness, KD also considerably decreased the frequency of interictal epileptiform discharges and enhanced the EEG background rhythm.
生酮饮食（KD）是指任何一种通过食物组成使人体代谢进入生酮状态的饮食。
评估 KD（经典 KD 和改良阿特金斯饮食（MAD））在儿童耐药性癫痫（DRE）中的短期和长期疗效、安全性和耐受性，并研究 KD 对 DRE 儿童脑电图（EEG）特征的影响。
根据国际抗癫痫联盟的诊断标准，将 40 例 DRE 患儿随机分为经典 KD 组和 MAD 组。在临床、血脂谱和脑电图记录后开始 KD，并进行为期 24 个月的定期随访。
40 例 DRE 患儿中，30 例完成了本研究。经典 KD 和 MAD 均能有效控制癫痫发作，经典 KD 组 60%患儿无癫痫发作，MAD 组 53.33%患儿无癫痫发作，其余患儿癫痫发作减少≥50%。两组患儿血脂谱在整个研究期间均处于可接受水平。不良反应轻微，经医学治疗后，生长参数和脑电图在研究期间均有所改善。
KD 是一种有效且安全的非药物、非手术治疗 DRE 的方法，对生长和 EEG 有积极影响。
两种常见类型的 KD（经典 KD 和 MAD）对 DRE 均有效，但不幸的是，不依从和退出率较高。高血清脂质谱（心血管不良事件）常被怀疑是儿童在高脂饮食后出现的，但脂质谱在 24 个月内仍处于可接受水平。因此，KD 是一种安全的治疗方法。KD 对生长有积极影响，尽管 KD 对生长的影响结果不一致。除了表现出强烈的临床疗效外，KD 还显著降低了癫痫样放电的频率，并增强了 EEG 背景节律。
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