Li Hua, Wang Yao, Guo Jing, Zhang Peiqi, Xu Zheng, Peng Kai, Dong Xiaoli, Zhao Liming
Department of Neurology, Guangdong Sanjiu Brain Hospital, Guangzhou, 510510, China.
Acta Epileptol. 2024 Mar 6;6(1):9. doi: 10.1186/s42494-024-00150-x.
Medium-chain triglyceride ketogenic diet (MCTKD) is previously less commonly used in China. This study was aimed to assess the efficacy and safety of the modified MCTKD in the treatment of drug-resistant epilepsy in Chinese patients.
Patients with drug-resistant epilepsy were enrolled to receive treatment with modified MCTKD in Guangdong Sanjiu Brain Hospital during December 2020 and September 2022. The modified MCTKD contained fat that provided 50-70% of the total energy, as well as proteins and carbohydrates that provided 20-30% and 20% of energy, respectively. The fat component was composed of 20-30% medium-chain triglycerides (MCTs) and 30-40% long-chain triglycerides. The efficacy and safety of the diet were assessed at 1, 3 and 6 months.
A total of 123 patients aged 2.5 to 65 years, were included in this study. The response rates at 1, 3 and 6 months were 49.6%, 43.1%, and 30.9%, respectively. The seizure freedom rates at 1, 3 and 6 months were 12.2%, 10.6%, and 6.5%, respectively. The retention rates at 1, 3 and 6 months were 98.4%, 65.0% and 33.3% respectively. Side effects occurred in 21.14% of patients, which were predominantly gastrointestinal symptoms such as abdominal pain, diarrhea, vomiting, and constipation, and most of them resolved after dietary adjustments. A total of 82 patients (66.7%) discontinued the treatment with the reason of refusing to eat (8.1%), poor efficacy (35.0%), poor compliance (4.9%), and inability to follow-up (9.8%). Only 4 patients (3.3%) withdrew the diet due to side effects.
The modified MCTKD with MCTs providing 20-30% of energy has a good safety in patients with drug-resistant epilepsy, but its effectiveness needs to be enhanced. Further modifications of MCTKD with an optimal energy ratio are required to achieve a better efficacy and safety.
中链甘油三酯生酮饮食（MCTKD）在中国此前较少使用。本研究旨在评估改良MCTKD治疗中国耐药癫痫患者的疗效和安全性。
2020年12月至2022年9月期间，在广东三九脑科医院招募耐药癫痫患者接受改良MCTKD治疗。改良MCTKD所含脂肪提供总能量的50 - 70%，蛋白质和碳水化合物分别提供20 - 30%和20%的能量。脂肪成分由20 - 30%的中链甘油三酯（MCTs）和30 - 40%的长链甘油三酯组成。在1、3和6个月时评估饮食的疗效和安全性。
本研究共纳入123例年龄在2.5至65岁之间的患者。1、3和6个月时的缓解率分别为49.6%、43.1%和30.9%。1、3和6个月时的无发作率分别为12.2%、10.6%和6.5%。1、3和6个月时的保留率分别为98.4%、65.0%和33.3%。21.14%的患者出现副作用，主要为胃肠道症状，如腹痛、腹泻、呕吐和便秘，大多数在饮食调整后缓解。共有82例患者（66.7%）因拒绝进食（8.1%）、疗效不佳（35.0%）、依从性差（4.9%）和无法随访（9.8%）而停止治疗。仅4例患者（3.3%）因副作用退出饮食治疗。
能量占比为20 - 30%的改良MCTKD对耐药癫痫患者具有良好的安全性，但其有效性有待提高。需要对MCTKD进行进一步改良，以获得更佳的疗效和安全性。
