Safety and tolerability of the ketogenic diet in pediatric epilepsy: Effects of valproate combination therapy
Safety and tolerability of the ketogenic diet in pediatric epilepsy: Effects of valproate combination therapy
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DOI：
10.1111/j.1528-1167.2005.22705.x
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发表时间：
2005-09-01
期刊：
影响因子：
5.6
通讯作者：
Thiele, EA
中科院分区：
文献类型：
--
作者：
Lyczkowski, DA;Pfeifer, HH;Thiele, EA
用途：评价生酮饮食（KGD）和丙戊酸盐（VPA）联合治疗难治性癫痫发作的安全性和耐受性。方法：回顾性分析2002年2月至2004年9月在马萨诸塞州儿童总医院接受KGD治疗的儿童的病历。通过比较基线时和此后3个月间隔时报告的癫痫发作频率来测量疗效。不良事件和终止饮食的原因制表。结果：71例接受KGD启动，24同时使用VPA在启动时。最严重的不良事件是2例急性胰腺炎（2.8%），均发生在未服用VPA的患者中。两组最常见的并发症为酸中毒（39.4%）、恶心呕吐（23.9%）、高血糖（21.1%）、嗜睡（18.3%）、行为改变和易激惹（15.5%）。VPA组和非VPA组的不良事件特征无显著差异。1年时，32名患者仍在饮食中，包括VPA组的11名患者。结论：KGD和VPA联合治疗儿童难治性癫痫是相对安全和有效的。接受KGD和VPA联合治疗的患者的不良事件特征与接受KGD但未接受VPA治疗的患者相似。在考虑难治性癫痫发作的可能治疗方案时，不应因安全性或耐受性问题而排除这两种方式的联合治疗。在某些患者中，这种组合可以提供最佳的癫痫控制。
Purpose: To evaluate safety and tolerability of ketogenic diet (KGD) and valproate (VPA) cotherapy in the treatment of intractable seizures.Methods: The patient records of children who underwent KGD initiation at the Massachusetts General Hospital for Children from February 2002 to September 2004 were retrospectively assessed. Efficacy was measured by comparing reported seizure frequency at baseline and at 3-month intervals thereafter. Adverse events and reasons for terminating the diet were tabulated.Results: Of 71 patients who underwent KGD initiation, 24 were concomitantly using VPA at the time of initiation. The most serious adverse events were two cases of acute pancreatitis (2.8%), both of which occurred in patients not taking VPA. The most common complications in both groups were acidosis (39.4%), nausea and vomiting (23.9%), hypertriglyceridemia (21.1%), lethargy (18.3%), and behavioral changes and irritability (15.5%). No significant difference in adverse-event profiles was found between the VPA group and the non-VPA group. At 1 year, 32 patients remained on the diet, including 11 in the VPA group. Efficacy was nearly identical in these two groups.Conclusions: KGD and VPA combination therapy is relatively safe and effective in refractory pediatric epilepsy. Adverse-event profiles of patients on KGD and VPA cotherapy are similar to those of patients on the KGD without VPA. In considering possible treatment options for intractable seizures, cotherapy with these two modalities should not be excluded for safety or tolerability concerns. In some patients, this combination may provide optimal seizure control.