Limited efficacy of the ketogenic diet in the treatment of highly refractory epileptic spasms.
Limited efficacy of the ketogenic diet in the treatment of highly refractory epileptic spasms.
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生酮饮食在治疗高度难治性癫痫痉挛方面的功效有限。
DOI：
10.1016/j.seizure.2016.01.002
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发表时间：
2016
期刊：
影响因子：
--
通讯作者：
Matsumoto,JoyceH
中科院分区：
文献类型：
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作者：
Hussain,ShaunA;Shin,JiHyun;Shih,EvanJ;Murata,KristinaK;Sewak,Sarika;Kezele,MicheleE;Sankar,Raman;Matsumoto,JoyceH
目的大量研究表明生酮饮食对癫痫痉挛的治疗是有效的，即使是在难治性病例中也是如此。然而，已经有非常有限的证据表明，迅速和完整的（视频脑电图证实）反应。我们着手描述我们的中心的经验与生酮饮食在治疗儿童高度难治性癫痫痉挛，与严格的癫痫发作outcome assessment.Methodchildren治疗与生酮饮食癫痫痉挛之间的2010年4月和2014年6月进行了回顾性鉴定。将基线时和生酮饮食暴露1、3、6和12个月后的癫痫发作负担制表。不良事件也同样determined.ResultsWe确定了一个队列的22例连续患者谁接受生酮饮食治疗，癫痫痉挛发作的中位年龄为5.2（IQR 2.0-9.0）个月，开始饮食开始发病后中位数为26.4（12.5-38.7）个月，并在中位数为7（IQR 5-7）治疗失败。仅2例患者在生酮饮食暴露期间表现出完全缓解，在这两种情况下，缓解更合理地归因于替代疗法。在饮食暴露1个月后，癫痫发作频率的早期适度降低并没有持续。饮食耐受性良好，并继续在6例主观和/或partial respons.ConclusionIn以前的研究报告显着的生酮饮食的疗效，我们的研究结果表明有限的疗效，虽然在一个高度难治性的队列。在难治性和新发人群中进行的前瞻性研究，包括视频EEG确认反应和严格的认知结局评估，对于更清楚地定义生酮饮食在癫痫痉挛治疗中的效用具有重要价值。
PurposeNumerous studies have suggested that the ketogenic diet is effective in the treatment of epileptic spasms, even in refractory cases. However, there has been very limited demonstration of prompt and complete (video-EEG confirmed) response. We set out to describe our center's experience with the ketogenic diet in the treatment of children with highly refractory epileptic spasms, with rigorous seizure outcome assessment.MethodChildren treated with the ketogenic diet for epileptic spasms between April, 2010 and June, 2014 were retrospectively identified. Seizure burden was tabulated at baseline and after 1, 3, 6, and 12-months of ketogenic diet exposure. Adverse events were similarly ascertained.ResultsWe identified a cohort of 22 consecutive patients who received ketogenic diet therapy, with median age of onset of epileptic spasms of 5.2 (IQR 2.0–9.0) months, with diet initiation beginning a median of 26.4 (12.5–38.7) months after onset, and following a median of 7 (IQR 5–7) treatment failures. Only 2 patients exhibited a complete response during ketogenic diet exposure, and response was more reasonably attributed to alternative therapies in both cases. A modest early reduction in seizure frequency was not sustained beyond 1 month of diet exposure. The diet was well tolerated, and continued in 6 patients with subjective and/or partial response.ConclusionIn contrast to prior studies reporting substantial efficacy of the ketogenic diet, our findings suggest limited efficacy, albeit in a highly refractory cohort. Prospective studies in both refractory and new-onset populations, with both video-EEG confirmation of response and rigorous cognitive outcome assessment, would be of great value to more clearly define the utility of the ketogenic diet in the treatment of epileptic spasms.