The ketogenic diet: From molecular mechanisms to clinical effects
The ketogenic diet: From molecular mechanisms to clinical effects
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DOI：
10.1016/j.eplepsyres.2005.10.003
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发表时间：
2006-02-01
影响因子：
2.2
通讯作者：
Perucca, E
中科院分区：
文献类型：
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作者：
Freeman, J;Veggiotti, P;Perucca, E
近年来，儿科神经科医生、神经儿科医生、癫痫医生和普通神经科医生对生酮饮食(KD)用于难治性癫痫的治疗越来越感兴趣，尤其是在儿童和青少年中。本文概述了在最近的一次国际研讨会上讨论的与其使用有关的各种问题的现有知识。较详细地讨论的方面包括：(I)根据生化和神经生理学实验模型的研究结果，该饮食的抗惊厥作用的推定机制；(Ii)关于开始饮食的方式和不同实施方案的共识和争议；(Iii)适应症和禁忌症；(Iv)疗效数据，也与癫痫类型、症状形式和患者年龄有关；(V)不良反应；(Vi)与评估该饮食的临床效果有关的方法学方面，以及对未来研究的展望。总体而言，回顾的数据表明，在了解饮食的作用模式、其有效性和耐受性及其在不同类型癫痫中的潜在作用方面取得了相当大的进展。尽管到目前为止进行的临床研究有重要的方法学局限性，包括患者群体的次优特征和非对照设计，但最近提出了一些创新的、前瞻性的随机研究方案，并正在实施。这些结果有望提供急需的高质量信息，以更好地确定饮食在不同癫痫综合征治疗算法中的作用。
Recent years have witnessed an increased interest from pediatric neurologists, neuropediatricians, epileptologists and general neurologists in the use of the ketogenic diet (KD) for the management of refractory epilepsies, particularly in children and adolescents. This article summarizes current knowledge on various issues related to its use, as discussed at a recent international workshop. Aspects discussed in some detail include (i) the putative mechanisms responsible for the diet's anticonvulsant effects, based on results of biochemical and neurophysiological studies in experimental models; (ii) consensus and controversies on the modalities of initiation of the diet, and different protocols of implementation; (iii) indications and contraindications; (iv) efficacy data, also in relation to seizure type, syndromic form and patients age; (v) adverse effects; (vi) methodological aspects related to assessment of the diet's clinical effects, and perspectives for future research. Overall, the data reviewed indicate that considerable advances have been made in understanding the modes of action of the diet, its efficacy and tolerability profiles and its potential role in different types of epilepsy. Although clinical studies performed to date have important methodological limitations, including suboptimally characterized patients' populations and an uncontrolled design, a number of innovative, prospective randomized study protocols have been recently proposed and are being implemented. The results of these will hopefully provide much needed high-quality information to better define the role of the diet in the treatment algorithms in different epilepsy syndromes.