Ketogenic diets: new advances for metabolism-based therapies.
Ketogenic diets: new advances for metabolism-based therapies.
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DOI：
10.1097/wco.0b013e3283515e4a
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发表时间：
2012-04
影响因子：
4.8
通讯作者：
Hartman AL
中科院分区：
文献类型：
--
作者：
Kossoff EH;Hartman AL
尽管有多种抗惊厥药物可供使用且处于不同的开发阶段，但全世界仍有数千名患有癫痫症的儿童和成人仍然难以接受治疗，也不适合进行癫痫手术。这些患者中的许多人现在将转向饮食疗法，例如生酮饮食、中链甘油三酯（MCT）饮食、改良阿特金斯饮食和低血糖指数治疗。在过去的几年中，神经科医生正在寻找使用这些饮食疗法的新适应症，甚至可能作为一线疗法，包括婴儿痉挛症、肌阵挛性癫痫（Doose 综合征）、Dravet 综合征和癫痫持续状态（包括 FIRES 综合征）。成年人也是当今接受治疗增长最快的人群之一；一组以前通常不提供这些治疗的患者。 2009年，发表了两项生酮饮食对照试验以及癫痫饮食治疗国际专家共识声明。现在，生酮饮食也越来越多地被研究用于治疗癫痫以外的神经系统疾病，包括阿尔茨海默病和癌症。基础科学研究的见解有助于阐明基于代谢的治疗在抗惊厥和可能的神经保护作用方面可能有所帮助的机制。癫痫的饮食疗法在世界范围内继续流行，并扩大用于成人和癫痫以外的疾病。
Despite myriad anticonvulsants available and in various stages of development, there are thousands of children and adults with epilepsy worldwide still refractory to treatment and not candidates for epilepsy surgery. Many of these patients will now turn to dietary therapies such as the ketogenic diet, medium-chain triglyceride (MCT) diet, modified Atkins diet, and low glycemic index treatment. In the past several years, neurologists are finding new indications to use these dietary treatments, perhaps even as first-line therapy, including infantile spasms, myoclonic-astatic epilepsy (Doose syndrome), Dravet syndrome, and status epilepticus (including FIRES syndrome). Adults are also one of the most rapidly growing populations being treated nowadays; a group of patients previously not typically offered these treatments. In 2009, two controlled trials of the ketogenic diet were published as well as an International Expert Consensus Statement on dietary treatment of epilepsy. Ketogenic diets are also now being increasingly studied for neurologic conditions other than epilepsy, including Alzheimer disease and cancer. Insights from basic science research have helped elucidate the mechanisms by which metabolism-based therapy may be helpful, both in terms of an anticonvulsant and possibly neuroprotective effect. Dietary therapy for epilepsy continues to grow in popularity worldwide, with expanding use for adults and conditions other than epilepsy.