Freeman J M, Vining E P, Pillas D J, Pyzik P L, Casey J C, Kelly L M
Division of Pediatric Epilepsy, Departments of Neurology and Pediatrics, the Johns Hopkins Medical Institutions, Baltimore Maryland, USA.
Pediatrics. 1998 Dec;102(6):1358-63. doi: 10.1542/peds.102.6.1358.
The ketogenic diet is a high-fat, low-protein, low-carbohydrate diet developed in the 1920s for the treatment of children with difficult to control seizures. Despite advances in both the pharmacotherapy and the surgery of epilepsy, many children continue to have difficult-to-control seizures. This prospective study sought to determine the ketogenic diet's effectiveness and tolerability in children refractory to today's medications.
One hundred fifty consecutive children, ages 1 to 16 years, virtually all of whom continued to have more than two seizures per week despite adequate therapy with at least two anticonvulsant medications, were prospectively enrolled in this study, treated with the ketogenic diet, and followed for a minimum of 1 year. Seizure frequency was tabulated from patients' daily seizure calendars and seizure reduction calculated as percentage of baseline frequency. Adverse events and reasons for diet discontinuation were recorded.
The children (mean age, 5.3 years), averaged 410 seizures per month before the diet, despite an exposure to a mean of 6.2 antiepileptic medications. Three months after diet initiation, 83% of those starting remained on the diet and 34% had >90% decrease in seizures. At 6 months, 71% still remained on the diet and 32% had a >90% decrease in seizures. At 1 year, 55% remained on the diet and 27% had a >90% decrease in seizure frequency. Most of those discontinuing the diet did so because it was either insufficiently effective or too restrictive. Seven percent stopped because of intercurrent illness.
The ketogenic diet should be considered as alternative therapy for children with difficult-to-control seizures. It is more effective than many of the new anticonvulsant medications and is well tolerated by children and families when it is effective.
生酮饮食是20世纪20年代开发的一种高脂肪、低蛋白、低碳水化合物饮食，用于治疗难以控制癫痫发作的儿童。尽管癫痫的药物治疗和手术都取得了进展，但许多儿童的癫痫发作仍然难以控制。这项前瞻性研究旨在确定生酮饮食对当今药物治疗无效的儿童的有效性和耐受性。
连续纳入150名年龄在1至16岁的儿童，几乎所有儿童尽管使用至少两种抗惊厥药物进行了充分治疗，但每周仍有两次以上癫痫发作。这些儿童被前瞻性纳入本研究，采用生酮饮食治疗，并随访至少1年。根据患者的每日癫痫发作日历记录癫痫发作频率，并将癫痫发作减少量计算为基线频率的百分比。记录不良事件和饮食中断的原因。
这些儿童（平均年龄5.3岁）在饮食前平均每月癫痫发作410次，尽管平均使用了6.2种抗癫痫药物。开始饮食三个月后，83%开始饮食的儿童仍在坚持饮食，34%的儿童癫痫发作减少了90%以上。六个月时，71%的儿童仍在坚持饮食，32%的儿童癫痫发作减少了90%以上。一年时，55%的儿童仍在坚持饮食，27%的儿童癫痫发作频率减少了90%以上。大多数停止饮食的儿童是因为饮食效果不佳或限制过多。7%的儿童因并发疾病而停止饮食。
生酮饮食应被视为难以控制癫痫发作儿童的替代治疗方法。它比许多新型抗惊厥药物更有效，并且在有效的情况下，儿童和家庭对其耐受性良好。
