Vining E P, Freeman J M, Ballaban-Gil K, Camfield C S, Camfield P R, Holmes G L, Shinnar S, Shuman R, Trevathan E, Wheless J W
The Johns Hopkins Medical Institutions, Baltimore, MD 21287-7247, USA.
Arch Neurol. 1998 Nov;55(11):1433-7. doi: 10.1001/archneur.55.11.1433.
To determine the efficacy of the ketogenic diet in multiple centers.
A prospective study of the change in frequency of seizures in 51 children with intractable seizures who were treated with the ketogenic diet.
Patients were enrolled from the clinical practices of 7 sites. The diet was initiated in-hospital and the patients were followed up for at least 6 months.
Fifty-one children, aged 1 to 8 years, with more than 10 seizures per week, whose electroencephalogram showed generalized epileptiform abnormalities or multifocal spikes, and who had failed results when taking at least 2 appropriate anti-epileptic drugs.
The children were hospitalized, fasted, and a 4:1 ketogenic diet was initiated and maintained.
Frequency of seizures was documented from parental calendars and efficacy was compared with prediet baseline after 3, 6, and 12 months. The children were categorized as free of seizures, greater than 90% reduction, 50% to 90% reduction, or lower than 50% reduction in frequency of seizures.
Eighty-eight percent of all children initiating the diet remained on it at 3 months, 69% remained on it at 6 months, and 47% remained on it at 1 year. Three months after initiating the diet, frequency of seizures was decreased to greater than 50% in 54%. At 6 months, 28 (55%) of the 51 initiating the diet had at least a 50% decrease from baseline, and at 1 year, 40% of those starting the diet had a greater than 50% decrease in seizures. Five patients (10%) were free of seizures at 1 year. Age, sex, principal seizure type, and electroencephalogram were not statistically related to outcome.
The ketogenic diet is effective in substantially decreasing difficult-to-control seizures and can successfully be administered in a wide variety of settings.
确定生酮饮食在多个中心的疗效。
一项对51例接受生酮饮食治疗的难治性癫痫患儿癫痫发作频率变化的前瞻性研究。
患者来自7个地点的临床实践。饮食在医院开始，患者随访至少6个月。
51名年龄在1至8岁之间的儿童，每周癫痫发作超过10次，脑电图显示广泛性癫痫样异常或多灶性棘波，且在服用至少2种合适的抗癫痫药物时效果不佳。
患儿住院、禁食，开始并维持4:1的生酮饮食。
根据家长记录的日历记录癫痫发作频率，并在3、6和12个月后将疗效与饮食前基线进行比较。患儿被分为无癫痫发作、发作频率降低超过90%、降低50%至90%或降低低于50%。
所有开始饮食的患儿中，88%在3个月时仍在坚持，69%在6个月时仍在坚持，47%在1年时仍在坚持。开始饮食3个月后，54%的患儿癫痫发作频率降低超过50%。6个月时，开始饮食的51名患儿中有28名（55%）较基线至少降低了50%，1年时，开始饮食的患儿中有40%癫痫发作降低超过50%。5名患者（10%）在1年时无癫痫发作。年龄、性别、主要癫痫发作类型和脑电图与结局无统计学关联。
生酮饮食在显著减少难治性癫痫发作方面有效，且能在多种环境中成功实施。
