癫痫的饮食干预研究进展_Journal of Epilepsy

Authors：

周燕萍 ¹ ,  王菊莉 ² , 陶德双 ²

1. ;
2. ;

Corresponding author：

王菊莉, Email: wil1989@163.com

Keywords：

癫痫; 饮食疗法; 肠道菌群

DOI：

10.7507/2096-0247.20210069

Video：

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癫痫是一种以具有持久性的致痫倾向为特征的脑部疾病，对于不适合手术的难治性癫痫患者，饮食疗法是一个很好的辅助疗法。饮食疗法包括经典生酮饮食（Ketogenic-diet，KD）、改良阿特金斯氏饮食（Modifified atkins diet，MAD）、低血糖指数饮食（Low glycemic index treatment，LGIT）、中链甘油三酯饮食（Medium-chain triglyceride diet，MCTD）以及益生菌饮食。文章就不同饮食方案对癫痫的疗效证据、不良反应和潜在的病理生理机制作一综述，以期为 KD 治疗癫痫的临床应用提供一定参考。

Citation： 周燕萍, 王菊莉, 陶德双. 癫痫的饮食干预研究进展. Journal of Epilepsy, 2021, 7(5): 422-425. doi: 10.7507/2096-0247.20210069 Copy

1.	Lum GR, Olson CA, Hsiao EY. Emerging roles for the intestinal microbiome in epilepsy. Neurobiology of Disease, 2019, 135: 104576.
2.	Mehdizadeh A, Barzegar M, Negargar S. The current and emerging therapeutic approaches in drug-resistant epilepsy management. Acta Neurol Belg, 2019, 119(2): 155-162.
3.	Sheng J, Liu S, Qin H. Drug-resistant epilepsy and surgery. Curr Neuropharmacol, 2018, 16(1): 17-28.
4.	Ułamek-Kozioł M, Czuczwar SJ, Januszewski S. Ketogenic diet and epilepsy, Nutrients. , 2019, 11(10): 2510.
5.	Rieder R, Wisniewski PJ, Alderman BL. Microbes and mental health: A review. Brain Behav Immun, 2017, 66: 9-17.
6.	Umbrello G, Esposito S. Microbiota and neurologic diseases: potential effects of probiotics. Journal of Translational Medicine, 2016, 14(1): 298.
7.	Rubenstein JE. Use of the ketogenic diet in neonates and infants. Epilepsia, 2008, 49(1): 30-32.
8.	Bergqvist AGC, Schall JI, Gallagher PR. Fasting versus gradual initiation of the ketogenic diet: A prospective, randomized clinical trial of efficacy. Epilepsia, 2005, 46(11): 1810-1819.
9.	Keene DL. A systematic review of the use of the ketogenic diet in childhood epilepsy. Pediatr Neurol, 2006, 35(1): 1-5.
10.	宋婷婷, 黄绍平, 杨琳. 生酮饮食添加治疗婴儿痉挛的临床疗效观察. 中国妇幼健康研究, 2017, 28(2): 163-166.
11.	Bita Poorshiri, Mohammad Barzegar, Sanaz Tahmasebi. The efficacy comparison of classic ketogenic diet and modified Atkins diet in children with refractory epilepsy: a clinical trial. Acta Neurol Belg, 2019, 12(1): 1-5.
12.	Kossoff EH, Krauss GL, McGrogan JR. Efficacy of the Atkins diet as therapy for intractable epilepsy. Neurology, 2003, 61(12): 1789-1791.
13.	Kossoff EH, Zupec-Kania BA, Amark PE. Optimal clinical management of children receiving the ketogenic diet: recommendations of the International Ketogenic Diet Study Group. Epilepsia, 2009, 50: 304-317.
14.	Kossoff EH, Dorward JL. The modifified Atkins diet. Epilepsia, 2008, 49(8): 37-41.
15.	Sharma S, Goel S, Jain P. Evaluation of a simplifified modifified Atkins diet for use by parents with low levels of literacy in children with refractory epilepsy: A randomized controlled trial. Epilepsy Res, 2016, 127: 152-159.
16.	Rezaei S, Abdurahman AA, Saghazadeh A. Short-term and long-term efficacy of classical ketogenic diet and modifified Atkins diet in children and adolescents with epilepsy: a systematic review and meta-analysis. Nutr Neurosci, 2017, 22(5): 317-334.
17.	Park EG, Lee J. Use of the Modified Atkins Diet in Intractable Pediatric Epilepsy. Journal of Epilepsy Research, 2018, 8(1): 2233-2257.
18.	Roehl K, Falco-Walter J, Ouyang B. Modified ketogenic diets in adults with refractory epilepsy: Efficacious improvements in seizure frequency, seizure severity, and quality of life. Epilepsy Behav, 2019, 93: 113-118.
19.	NE Payne, JH Cross, JW Sander. The ketogenic and related diets in adolescents and adults-A review. Epilepsia, 2011, 52(11): 1941-1948.
20.	Heidi H Pfeifer, Elizabeth A Thiele. Low-glycemic-index treatment: A liberalized ketogenic diet for treatment of intractable epilepsy. Neurology, 2005, 65(11): 1810-1812.
21.	Kim SH, Kang HC, Lee EJ. Low glycemic index treatment in patients with drug-resistant epilepsy. Brain Dev, 2017, 39: 687-692.
22.	Muzykewicz DA, Lyczkowski DA, Memon N. Efcacy, safety, and tolerability of the low glycemic index treatment in pediatric epilepsy. Epilepsia, 2009, 50(5): 1118-1126.
23.	Barzegar M, Afghan M, Tarmahi V. Ketogenic diet: overview, types, and possible anti-seizure mechanisms. Nutritional Neuroscience, 2019, (1): 1-10.
24.	Yeou-mei Christiana Liu. Medium-chain triglyceride (MCT) ketogenic therapy. Epilepsia, 2008, 49(Suppl 8): 33-36.
25.	Krisnachai Chomtho, Orapa Suteerojntrakool, Sirinuch Chomtho. Effectiveness of medium chain triglyceride ketogenic diet in Thai children with intractable epilepsy. J Med Assoc Thai, 2016, 99(2): 159-165.
26.	Heidi H Pfeifer, David A Lyczkowski, Elizabeth A Thiele. Low glycemic index treatment: Implementation and new insights into efficacy. Epilepsia, 2008, 49(Suppl 8): 42-45.
27.	Shahabeddin Rezaei, Sara Harsini, Mona Kavoosi. Efficacy of low glycemic index treatment in epileptic patients: a systematic review. Acta Neurol Belg, 2018, 118(3): 339-349.
28.	Verrotti A, Iapadre G, Francesco LD. Diet in the treatment of epilepsy: What We Know So Far. Nutrients, 2020, 12(9): 2645.
29.	Olson CA, Vuong HE, Yano JM. The gut microbiota mediates the anti-seizure effects of the ketogenic diet. Cell, 2018, 173(7): 1728-1741.
30.	Xie G, Zhou Q, Qiu CZ. Ketogenic diet poses a signifificant effffect on imbalanced gut microbiota in infants with refractory epilepsy. World J. Gastroenterol, 2017, 23: 6164-6171.
31.	Peng A, Qiu X, Lai W. Altered composition of the gut microbiome in patients with drug-resistant epilepsy. Epilepsy Research, 2018, 147: 102-107.
32.	王文建, 周潜, 戴文魁. 难治性癫痫婴幼儿肠道菌群的变化. 中国微生态学杂志, 2017, 29(5): 502-505.
33.	郭晨, 张宇, 刘备, 等. 难治性颞叶癫痫患者的肠道菌群分析. 立体定向和功能性神经外科杂志, 2018, (6): 333-336.
34.	Sanders ME. Probiotics: definition, sources, selection, and uses. Clinical Infectious Diseases, 2008, 2: 58-61.
35.	Kwok L, Wang L, Zhang J. A pilot study on the effect of Lactobacillus casei Zhang on intestinal microbiota parameters in Chinese subjects of different age. Benefific Microbes, 2014, 5: 295-304.
36.	Gómez-Eguílaz M, Ramón-Trapero JL, Pérez-Martínez L. The beneficial effect of probiotics as a supplementary treatment in drug-resistant epilepsy: a pilot study. Beneficial Microbes, 2018, 9: 1-8.
37.	Sook YJ, Sook PJ, Young-Soo K. Neonatal seizures and white matter injury: Role of rotavirus infection and probiotics. Brain & Development, 2019, 41(1): 19-28.
38.	Zhang Y, Zhou S, Zhou Y. Altered gut microbiome composition in children with refractory epilepsy after ketogenic diet. Epilepsy Res, 2018, 145: 163-168.
39.	Bagheri S, Heydari A, Alinaghipour A. Effect of probiotic supplementation on seizure activity and cognitive performance in PTZ-induced chemical kindling. Epilepsy Behav, 2019, 95: 43-50.
40.	Paoli A, Mancin L, Bianco A. Ketogenic diet and microbiota: friends or enemies. Genes, 2019, 10(7): 534.
41.	Dhakal R, Bajpai VK, Baek KH. Production of GABA (γ-aminobutyric acid) by micro organisms: a review. Braz J Microbiol, 2012, 43: 1230-1241.
42.	Liu X, Cao S, Zhang X. Modulation of gut microbiota-brain axis by probiotics, prebiotics, and diet. Journal of Agricultural and Food Chemistry, 2015, 63: 7885-7895.
43.	Huiying W, In-Seon L, Christoph B. Effect of probiotics on central nervous system functions in animals and humans: A systematic review. Journal of Neurogastroenterology & Motility, 2016, 22(4): 589-605.
44.	Caro CD, Iannone LF, Citraro R. Can we 'seize' the gut microbiota to treat epilepsy. Neurosci Biobehav Rev, 2019, 107: 750-764.

1. Lum GR, Olson CA, Hsiao EY. Emerging roles for the intestinal microbiome in epilepsy. Neurobiology of Disease, 2019, 135: 104576.
2. Mehdizadeh A, Barzegar M, Negargar S. The current and emerging therapeutic approaches in drug-resistant epilepsy management. Acta Neurol Belg, 2019, 119(2): 155-162.
3. Sheng J, Liu S, Qin H. Drug-resistant epilepsy and surgery. Curr Neuropharmacol, 2018, 16(1): 17-28.
4. Ułamek-Kozioł M, Czuczwar SJ, Januszewski S. Ketogenic diet and epilepsy, Nutrients. , 2019, 11(10): 2510.
5. Rieder R, Wisniewski PJ, Alderman BL. Microbes and mental health: A review. Brain Behav Immun, 2017, 66: 9-17.
6. Umbrello G, Esposito S. Microbiota and neurologic diseases: potential effects of probiotics. Journal of Translational Medicine, 2016, 14(1): 298.
7. Rubenstein JE. Use of the ketogenic diet in neonates and infants. Epilepsia, 2008, 49(1): 30-32.
8. Bergqvist AGC, Schall JI, Gallagher PR. Fasting versus gradual initiation of the ketogenic diet: A prospective, randomized clinical trial of efficacy. Epilepsia, 2005, 46(11): 1810-1819.
9. Keene DL. A systematic review of the use of the ketogenic diet in childhood epilepsy. Pediatr Neurol, 2006, 35(1): 1-5.
10. 宋婷婷, 黄绍平, 杨琳. 生酮饮食添加治疗婴儿痉挛的临床疗效观察. 中国妇幼健康研究, 2017, 28(2): 163-166.
11. Bita Poorshiri, Mohammad Barzegar, Sanaz Tahmasebi. The efficacy comparison of classic ketogenic diet and modified Atkins diet in children with refractory epilepsy: a clinical trial. Acta Neurol Belg, 2019, 12(1): 1-5.
12. Kossoff EH, Krauss GL, McGrogan JR. Efficacy of the Atkins diet as therapy for intractable epilepsy. Neurology, 2003, 61(12): 1789-1791.
13. Kossoff EH, Zupec-Kania BA, Amark PE. Optimal clinical management of children receiving the ketogenic diet: recommendations of the International Ketogenic Diet Study Group. Epilepsia, 2009, 50: 304-317.
14. Kossoff EH, Dorward JL. The modifified Atkins diet. Epilepsia, 2008, 49(8): 37-41.
15. Sharma S, Goel S, Jain P. Evaluation of a simplifified modifified Atkins diet for use by parents with low levels of literacy in children with refractory epilepsy: A randomized controlled trial. Epilepsy Res, 2016, 127: 152-159.
16. Rezaei S, Abdurahman AA, Saghazadeh A. Short-term and long-term efficacy of classical ketogenic diet and modifified Atkins diet in children and adolescents with epilepsy: a systematic review and meta-analysis. Nutr Neurosci, 2017, 22(5): 317-334.
17. Park EG, Lee J. Use of the Modified Atkins Diet in Intractable Pediatric Epilepsy. Journal of Epilepsy Research, 2018, 8(1): 2233-2257.
18. Roehl K, Falco-Walter J, Ouyang B. Modified ketogenic diets in adults with refractory epilepsy: Efficacious improvements in seizure frequency, seizure severity, and quality of life. Epilepsy Behav, 2019, 93: 113-118.
19. NE Payne, JH Cross, JW Sander. The ketogenic and related diets in adolescents and adults-A review. Epilepsia, 2011, 52(11): 1941-1948.
20. Heidi H Pfeifer, Elizabeth A Thiele. Low-glycemic-index treatment: A liberalized ketogenic diet for treatment of intractable epilepsy. Neurology, 2005, 65(11): 1810-1812.
21. Kim SH, Kang HC, Lee EJ. Low glycemic index treatment in patients with drug-resistant epilepsy. Brain Dev, 2017, 39: 687-692.
22. Muzykewicz DA, Lyczkowski DA, Memon N. Efcacy, safety, and tolerability of the low glycemic index treatment in pediatric epilepsy. Epilepsia, 2009, 50(5): 1118-1126.
23. Barzegar M, Afghan M, Tarmahi V. Ketogenic diet: overview, types, and possible anti-seizure mechanisms. Nutritional Neuroscience, 2019, (1): 1-10.
24. Yeou-mei Christiana Liu. Medium-chain triglyceride (MCT) ketogenic therapy. Epilepsia, 2008, 49(Suppl 8): 33-36.
25. Krisnachai Chomtho, Orapa Suteerojntrakool, Sirinuch Chomtho. Effectiveness of medium chain triglyceride ketogenic diet in Thai children with intractable epilepsy. J Med Assoc Thai, 2016, 99(2): 159-165.
26. Heidi H Pfeifer, David A Lyczkowski, Elizabeth A Thiele. Low glycemic index treatment: Implementation and new insights into efficacy. Epilepsia, 2008, 49(Suppl 8): 42-45.
27. Shahabeddin Rezaei, Sara Harsini, Mona Kavoosi. Efficacy of low glycemic index treatment in epileptic patients: a systematic review. Acta Neurol Belg, 2018, 118(3): 339-349.
28. Verrotti A, Iapadre G, Francesco LD. Diet in the treatment of epilepsy: What We Know So Far. Nutrients, 2020, 12(9): 2645.
29. Olson CA, Vuong HE, Yano JM. The gut microbiota mediates the anti-seizure effects of the ketogenic diet. Cell, 2018, 173(7): 1728-1741.
30. Xie G, Zhou Q, Qiu CZ. Ketogenic diet poses a signifificant effffect on imbalanced gut microbiota in infants with refractory epilepsy. World J. Gastroenterol, 2017, 23: 6164-6171.
31. Peng A, Qiu X, Lai W. Altered composition of the gut microbiome in patients with drug-resistant epilepsy. Epilepsy Research, 2018, 147: 102-107.
32. 王文建, 周潜, 戴文魁. 难治性癫痫婴幼儿肠道菌群的变化. 中国微生态学杂志, 2017, 29(5): 502-505.
33. 郭晨, 张宇, 刘备, 等. 难治性颞叶癫痫患者的肠道菌群分析. 立体定向和功能性神经外科杂志, 2018, (6): 333-336.
34. Sanders ME. Probiotics: definition, sources, selection, and uses. Clinical Infectious Diseases, 2008, 2: 58-61.
35. Kwok L, Wang L, Zhang J. A pilot study on the effect of Lactobacillus casei Zhang on intestinal microbiota parameters in Chinese subjects of different age. Benefific Microbes, 2014, 5: 295-304.
36. Gómez-Eguílaz M, Ramón-Trapero JL, Pérez-Martínez L. The beneficial effect of probiotics as a supplementary treatment in drug-resistant epilepsy: a pilot study. Beneficial Microbes, 2018, 9: 1-8.
37. Sook YJ, Sook PJ, Young-Soo K. Neonatal seizures and white matter injury: Role of rotavirus infection and probiotics. Brain & Development, 2019, 41(1): 19-28.
38. Zhang Y, Zhou S, Zhou Y. Altered gut microbiome composition in children with refractory epilepsy after ketogenic diet. Epilepsy Res, 2018, 145: 163-168.
39. Bagheri S, Heydari A, Alinaghipour A. Effect of probiotic supplementation on seizure activity and cognitive performance in PTZ-induced chemical kindling. Epilepsy Behav, 2019, 95: 43-50.
40. Paoli A, Mancin L, Bianco A. Ketogenic diet and microbiota: friends or enemies. Genes, 2019, 10(7): 534.
41. Dhakal R, Bajpai VK, Baek KH. Production of GABA (γ-aminobutyric acid) by micro organisms: a review. Braz J Microbiol, 2012, 43: 1230-1241.
42. Liu X, Cao S, Zhang X. Modulation of gut microbiota-brain axis by probiotics, prebiotics, and diet. Journal of Agricultural and Food Chemistry, 2015, 63: 7885-7895.
43. Huiying W, In-Seon L, Christoph B. Effect of probiotics on central nervous system functions in animals and humans: A systematic review. Journal of Neurogastroenterology & Motility, 2016, 22(4): 589-605.
44. Caro CD, Iannone LF, Citraro R. Can we 'seize' the gut microbiota to treat epilepsy. Neurosci Biobehav Rev, 2019, 107: 750-764.

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