Nursing Department, Faculty of Nursing, University of Valladolid, Valladolid, Spain.
Unidad de Hospitalización de Medicina Interna, Hospital Tres Mares, Reinosa, Cantabria, Spain.
Nutr Rev. 2024 Mar 11;82(4):487-502. doi: 10.1093/nutrit/nuad071.
Epilepsy is one of the most prevalent neurological disorders in childhood. Antiepileptic drugs are the preferred treatment. However, 30% of children continue suffering seizures. A ketogenic diet (KD) is one of the emerging alternative treatments.
This review aims to analyze the current evidence regarding the use of a KD for the treatment of refractory epilepsy (RE) in childhood.
A systematic review of reviews was performed, based on MEDLINE (PubMed) as at January 2021.
The data extracted included the first author's last name; the year of publication; the country; the study design; the population; the diagnosis, concept, and description of KD types; and major outcome.
Twenty-one reviews were included, 8 with systematic methodology (2 of them included a meta-analysis) and 13 with unsystematic methodology. The main difference between the 2 types of reviews is the reproducibility of their methodology. Therefore, the results of each type of review were analyzed separately. Each type of review described 4 categories of KD: classic KD, modified Atkins diet (MAD), use of medium-chain triglycerides (MCTs), and low glycemic index treatment (LGIT). In terms of effectiveness, the considered systematic reviews reported reductions in the frequency of seizures greater than 50% in about half of the patients. Reviews without systematic methodology reported that 30%-60% of the children showed a 50% or greater reduction in seizures. The most frequently described adverse effects in the 8 systematic reviews were: vomiting (6/8), constipation (6/8), and diarrhea (6/8); and in the unsystematic reviews: vomiting and nausea (10/13), constipation (10/13), and acidosis (9/13).
KD can be an effective treatment for RE, with a more than 50% reduction in the frequency of seizures and cognitive improvement being achieved in half of the pediatric patients. The effectiveness of the various types of KD is comparable, and the KD can be adapted to the needs of the patient.
PROSPERO registration no. CRD42021244142.
癫痫是儿童中最常见的神经障碍之一。抗癫痫药物是首选的治疗方法。然而，仍有 30%的儿童持续发作癫痫。生酮饮食（KD）是一种新兴的替代治疗方法。
本综述旨在分析目前使用 KD 治疗儿童难治性癫痫（RE）的证据。
基于 MEDLINE（PubMed），截至 2021 年 1 月进行了系统综述。
提取的数据包括第一作者的姓氏；出版年份；国家；研究设计；人群；KD 类型的诊断、概念和描述；以及主要结果。
共纳入 21 篇综述，其中 8 篇具有系统方法学（其中 2 篇包含荟萃分析），13 篇具有非系统方法学。这两种类型综述的主要区别在于其方法学的可重复性。因此，分别分析了每种类型综述的结果。每种类型的综述都描述了 4 种 KD 类型：经典 KD、改良阿特金斯饮食（MAD）、使用中链甘油三酯（MCT）和低血糖指数治疗（LGIT）。在有效性方面，所考虑的系统综述报告称，约一半的患者癫痫发作频率降低了 50%以上。非系统方法学综述报告称，30%-60%的儿童癫痫发作减少了 50%或更多。在 8 篇系统综述中最常描述的不良反应为：呕吐（6/8）、便秘（6/8）和腹泻（6/8）；在非系统综述中为：呕吐和恶心（10/13）、便秘（10/13）和酸中毒（9/13）。
KD 可能是 RE 的有效治疗方法，超过一半的儿科患者癫痫发作频率降低 50%以上，并伴有认知改善。各种类型 KD 的有效性相当，可以根据患者的需求进行调整。
PROSPERO 注册号 CRD42021244142。
