Efficacy of the classic ketogenic and the modified Atkins diets in refractory childhood epilepsy
Efficacy of the classic ketogenic and the modified Atkins diets in refractory childhood epilepsy
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DOI：
10.1111/epi.13256
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发表时间：
2016-01-01
期刊：
影响因子：
5.6
通讯作者：
Kang, Hoon-Chul
中科院分区：
文献类型：
--
作者：
Kim, Jeong A.;Yoon, Jung-Rim;Kang, Hoon-Chul
目的：我们旨在比较改良阿特金斯饮食（MAD）与经典生酮饮食（KD）治疗儿童难治性癫痫的疗效、安全性和耐受性。方法：从2011年3月至2014年3月，104例1-18岁的难治性癫痫患者被随机分配到每个饮食组（ClinicalTrials.gov，编号NCT 2100501）。癫痫发作日记记录被用来比较癫痫发作频率与基线prediet癫痫发作频率在第三个月和第六个月后，饮食治疗initial.Results：51例患者被分配到KD和53例患者的MAD。在3个月时，KD组基线癫痫发作的平均百分比低于MAD组（KD 38.6%，MAD 47.9%）和6个月KD为33.8%，MAD为44.6%，但差异无统计学意义（3个月的95%置信区间[CI] 24.1-50.8，p = 0.291; 6个月的95% CI 17.8-46.1，p = 0.255）。相反，对于1-2岁的患者，与使用MAD的患者相比，使用KD的患者的癫痫发作结局始终更有利。在这些患者中，饮食治疗开始后3个月的无癫痫发作率显著较高（KD为53%，MAD为20%，p = 0.047）。意义：MAD可作为治疗儿童难治性癫痫的首选方案，但经典KD更适合作为患者的一线饮食疗法
Objective: We aimed to compare the efficacy, safety, and tolerability of a modified Atkins diet (MAD) with the classic ketogenic diet (KD) for the treatment of intractable childhood epilepsy.Methods: From March 2011 to March 2014, 104 patients aged 1-18 years who had refractory epilepsy were randomly assigned to each diet group (ClinicalTrials.gov, number NCT2100501). A seizure diary record was used to compare seizure frequencies with the baseline prediet seizure frequency at the third and sixth months after diet therapy initiation.Results: Fifty-one patients were assigned to the KD and 53 patients to the MAD. The KD group had a lower mean percentage of baseline seizures compared with the MAD group at 3 months (38.6% for KD, 47.9% for MAD) and 6 months (33.8% for KD, 44.6% for MAD), but the differences were not statistically significant (95% confidence interval [CI] 24.1-50.8, p = 0.291 for 3 months; 95% CI 17.8-46.1, p = 0.255 for 6 months). Instead, for patients aged 1-2 years, seizure outcomes were consistently much more favorable in patients consuming the KD compared with those consuming the MAD. The rate of seizure freedom at 3 months after diet therapy initiation was significantly higher (53% for KD, 20% for MAD, p = 0.047) in these patients. The MAD had advantages with respect to better tolerability and fewer serious side effects.Significance: The MAD might be considered as the primary choice for the treatment of intractable epilepsy in children, but the classic KD is more suitable as the first line of diet therapy in patients