经典生酮饮食和改良阿特金斯饮食治疗儿童难治性癫痫的效果比较_Journal of Epilepsy

Authors：

KimJA , YoonJR , LeeEJ , 迟潇洒　译 , 慕洁　审

Corresponding author：

Keywords：

改良阿特金斯饮食; 经典生酮饮食; 难治性癫痫; 儿童

DOI：

10.7507/2096-0247.20180015

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研究旨在比较改良阿特金斯饮食（Modified Atkins diet，MAD）和经典生酮饮食（Ketogenic diet，KD）在治疗儿童难治性癫痫的疗效、安全性和耐受性。研究纳入 2011 年 3 月—2014 年 3 月就诊的 1～18 岁难治性癫痫患者，将其随机分配至一种饮食治疗组（ClinicalTrials.gov，编号 NCT2100501）。痫性发作记录被用于比较饮食治疗后 3、6 个月痫性发作频率与饮食治疗前基线发作频率。研究纳入 KD 组 51 例患者，MAD 组 53 例患者。KD 组平均基线痫性发作百分比在治疗后 3 个月（KD 组 38.6%，MAD 组 47.9%）和 6 个月（KD 组 33.8%，MAD 组 44.6%）均低于 MAD 组，但差异无统计学意义［3 个月，95%CI （24.1，50.8），P=0.291；6 个月，95%CI（17.8，46.1），P=0.255］。然而，在<2 岁患儿中，KD 组痫性发作控制效果优于 MAD 组。这些患者饮食治疗开始的 3 个月内，KD 组癫痫无发作率高于 MAD 组，差异有统计学意义（KD 组 53%，MAD 组 20%，P=0.047）。MAD 组耐受性更好并且副反应更少。MAD 可能是治疗儿童难治性癫痫的首要选择，但经典 KD 更适合<2 岁患者的一线饮食治疗方案。

Citation： KimJA, YoonJR, LeeEJ, 迟潇洒　译, 慕洁　审. 经典生酮饮食和改良阿特金斯饮食治疗儿童难治性癫痫的效果比较. Journal of Epilepsy, 2018, 4(1): 59-65. doi: 10.7507/2096-0247.20180015 Copy

1.	Neal EG, Chaffe H, Schwartz RH, et al. The ketogenic diet for the treatment of childhood epilepsy: a randomized controlled trial. Lancet Neurol, 2008, 7(6): 500-506.
2.	Kang HC, Chung DE, Kim DW, et al. Early- and late-onset complications of the ketogenicdiet for intractable epilepsy. Epilepsia, 2004, 45(9): 1116-1123.
3.	Kossoff EH, Cervenka MC, Henry BJ, et al. A decade of the modified Atkins diet (2003-2013): results, insights, and future directions. Epilepsy Behav, 2013, 29(3): 437-442.
4.	Sharma S, Sankhyan N, Gulati S, et al. Use of the modified Atkins diet for treatment of refractory childhood epilepsy: a randomized controlled trial. Epilepsia, 2013, 54(3): 481-486.
5.	Kossoff EH, Rowley H, Sinha SR, et al. A prospective study of the modified Atkins diet for intractable epilepsy in adults. Epilepsia, 2008, 49(2): 316-319.
6.	Miranda MJ, Mortensen M, Povlsen JH, et al. Danish study of a modified Atkins diet for medically intractable epilepsy in children: can we achieve the same results as with the classical ketogenic diet? Seizure, 2011, 20(2): 151-155.
7.	Tonekaboni SH, Mostaghimi P, Mirmiran P, et al. Efficacy of the Atkins diet as therapy for intractable epilepsy in children. Arch Iran Med, 2010, 13(6): 492-497.
8.	Porta N, Vallée L, Boutry E, et al. Comparison of seizure reduction and serum fatty acid levels after receiving the ketogenic and modified Atkins diet. Seizure, 2009, 18(5): 359-364.
9.	Kim DW, Kang HC, Park JC, et al. Benefits of the nonfastingketogenic diet compared with the initial fasting ketogenic diet. Pediatrics, 2004, 114(6): 1627-1630.
10.	Kossoff EH, McGrogan JR, Bluml RM, et al. A modified Atkins diet is effective for the treatment of intractable pediatric epilepsy. Epilepsia, 2006, 47(2): 421-424.
11.	Kang HC, Kim YJ, Kim DW, et al. Efficacy and safety of the ketogenic diet for intractable childhood epilepsy: Korean multicentric experience. Epilepsia, 2005, 46(2): 272-279.
12.	Neal EG, Chaffe H, Schwartz RH, et al. A randomized trial of classical and medium-chain triglyceride ketogenic diets in the treatment of childhood epilepsy. Epilepsia, 2009, 50(5): 1109-1117.
13.	Kossoff EH, Pyzik PL, McGrogan JR, et al. Efficacy of the ketogenic diet for infantile spasms. Pediatrics, 2002, 109(5): 780-783.
14.	Nordli DR Jr, Kuroda MM, Carroll J, et al. Experience with the ketogenic diet in infants. Pediatrics, 2001, 108(1): 129-133.
15.	Kim YM, Vaidya VV, Khusainov T, et al. Various indications for a modified Atkins diet in intractable childhood epilepsy. Brain Dev, 2012, 34(7): 570-575.
16.	Cross JH, Guerrini R. The epileptic encephalopathies. HandbClinNeurol, 2013, 111: 619-626.
17.	Pellock JM, Hravchovy R, Shinnar S, et al. Infantile Spasms: a U.S. consensus report. Epilepsia, 2010, 51(10): 2175-2189.
18.	Eun SH, Kang HC, Kim DW, et al. Ketogenic diet for treatment of infantile spasms. Brain Dev, 2006, 28: 566-571.
19.	Zupec-Kania B, Neal E, Schultz R, et al. An update on diets in clinical practice. J Child Neurol, 2013, 28(9): 1015-1026.
20.	Kang HC, Lee YJ, Lee JS, et al. Comparison of short-versus long-term ketogenicdiet for intractable infantile spasms. Epilepsia, 2011, 52(4): 781-787.
21.	Hahn TJ, Halstead LR, De Vivo DC. Disordered mineral metabolism produced by ketogenic diet therapy. Calcif Tissue Int, 1979, 28(1): 17-22.
22.	Bergqvist AG, Schall JI, Stallings VA, et al. Progressive bone mineral content loss in children with intractable epilepsy treated with the ketogenic diet. Am J ClinNutr, 2008, 88(6): 1678-1684.
23.	Gilbert DL, Pyzik PL, Freeman JM. The ketogenic diet: seizure control correlates better with serum beta-hydroxybutyrate than with urine ketone levels. J Child Neurol, 2000, 15(12): 787-790.
24.	Kwan P, Brodie MJ. Effectiveness of first antiepileptic drug. Epilepsia, 2001, 42(10): 1255-1260.

1. Neal EG, Chaffe H, Schwartz RH, et al. The ketogenic diet for the treatment of childhood epilepsy: a randomized controlled trial. Lancet Neurol, 2008, 7(6): 500-506.
2. Kang HC, Chung DE, Kim DW, et al. Early- and late-onset complications of the ketogenicdiet for intractable epilepsy. Epilepsia, 2004, 45(9): 1116-1123.
3. Kossoff EH, Cervenka MC, Henry BJ, et al. A decade of the modified Atkins diet (2003-2013): results, insights, and future directions. Epilepsy Behav, 2013, 29(3): 437-442.
4. Sharma S, Sankhyan N, Gulati S, et al. Use of the modified Atkins diet for treatment of refractory childhood epilepsy: a randomized controlled trial. Epilepsia, 2013, 54(3): 481-486.
5. Kossoff EH, Rowley H, Sinha SR, et al. A prospective study of the modified Atkins diet for intractable epilepsy in adults. Epilepsia, 2008, 49(2): 316-319.
6. Miranda MJ, Mortensen M, Povlsen JH, et al. Danish study of a modified Atkins diet for medically intractable epilepsy in children: can we achieve the same results as with the classical ketogenic diet? Seizure, 2011, 20(2): 151-155.
7. Tonekaboni SH, Mostaghimi P, Mirmiran P, et al. Efficacy of the Atkins diet as therapy for intractable epilepsy in children. Arch Iran Med, 2010, 13(6): 492-497.
8. Porta N, Vallée L, Boutry E, et al. Comparison of seizure reduction and serum fatty acid levels after receiving the ketogenic and modified Atkins diet. Seizure, 2009, 18(5): 359-364.
9. Kim DW, Kang HC, Park JC, et al. Benefits of the nonfastingketogenic diet compared with the initial fasting ketogenic diet. Pediatrics, 2004, 114(6): 1627-1630.
10. Kossoff EH, McGrogan JR, Bluml RM, et al. A modified Atkins diet is effective for the treatment of intractable pediatric epilepsy. Epilepsia, 2006, 47(2): 421-424.
11. Kang HC, Kim YJ, Kim DW, et al. Efficacy and safety of the ketogenic diet for intractable childhood epilepsy: Korean multicentric experience. Epilepsia, 2005, 46(2): 272-279.
12. Neal EG, Chaffe H, Schwartz RH, et al. A randomized trial of classical and medium-chain triglyceride ketogenic diets in the treatment of childhood epilepsy. Epilepsia, 2009, 50(5): 1109-1117.
13. Kossoff EH, Pyzik PL, McGrogan JR, et al. Efficacy of the ketogenic diet for infantile spasms. Pediatrics, 2002, 109(5): 780-783.
14. Nordli DR Jr, Kuroda MM, Carroll J, et al. Experience with the ketogenic diet in infants. Pediatrics, 2001, 108(1): 129-133.
15. Kim YM, Vaidya VV, Khusainov T, et al. Various indications for a modified Atkins diet in intractable childhood epilepsy. Brain Dev, 2012, 34(7): 570-575.
16. Cross JH, Guerrini R. The epileptic encephalopathies. HandbClinNeurol, 2013, 111: 619-626.
17. Pellock JM, Hravchovy R, Shinnar S, et al. Infantile Spasms: a U.S. consensus report. Epilepsia, 2010, 51(10): 2175-2189.
18. Eun SH, Kang HC, Kim DW, et al. Ketogenic diet for treatment of infantile spasms. Brain Dev, 2006, 28: 566-571.
19. Zupec-Kania B, Neal E, Schultz R, et al. An update on diets in clinical practice. J Child Neurol, 2013, 28(9): 1015-1026.
20. Kang HC, Lee YJ, Lee JS, et al. Comparison of short-versus long-term ketogenicdiet for intractable infantile spasms. Epilepsia, 2011, 52(4): 781-787.
21. Hahn TJ, Halstead LR, De Vivo DC. Disordered mineral metabolism produced by ketogenic diet therapy. Calcif Tissue Int, 1979, 28(1): 17-22.
22. Bergqvist AG, Schall JI, Stallings VA, et al. Progressive bone mineral content loss in children with intractable epilepsy treated with the ketogenic diet. Am J ClinNutr, 2008, 88(6): 1678-1684.
23. Gilbert DL, Pyzik PL, Freeman JM. The ketogenic diet: seizure control correlates better with serum beta-hydroxybutyrate than with urine ketone levels. J Child Neurol, 2000, 15(12): 787-790.
24. Kwan P, Brodie MJ. Effectiveness of first antiepileptic drug. Epilepsia, 2001, 42(10): 1255-1260.

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经典生酮饮食和改良阿特金斯饮食治疗儿童难治性癫痫的效果比较

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