For Personal Use. Only Reproduce with Permission the Lancet Publishing Group. More Fat and Fewer Seizures: Dietary Therapies for Epilepsy
For Personal Use. Only Reproduce with Permission the Lancet Publishing Group. More Fat and Fewer Seizures: Dietary Therapies for Epilepsy
复制标题
DOI：
--
复制
发表时间：
--
期刊：
影响因子：
--
通讯作者：
E. Kossoff
中科院分区：
文献类型：
--
作者：
E. Kossoff
生酮饮食是一种高脂肪、足够蛋白质、低碳水化合物的饮食，自20世纪20年代以来一直用于治疗难治性儿童癫痫。这种饮食模拟了与饥饿相关的生化变化，这种变化会导致酮症。虽然在后来的几十年里由于抗惊厥药物的可用性增加而不太常用，但生酮饮食已重新成为一种治疗选择。仅在十年前，生酮饮食被视为最后的手段;然而，它已成为更常用的学术中心在世界各地，甚至在早期癫痫的过程。阿特金斯饮食是最近使用的一种限制性较低的疗法，它也会造成酮症，并能降低癫痫发作的次数。饮食疗法可能会成为更有价值的治疗癫痫的机制时，其成功的理解。癫痫患者比以往任何时候都有更多的治疗选择。在过去的十年中，可用的抗惊厥药物的数量增加了一倍多，新的药物具有更少的副作用，药物相互作用和更少的致畸性。即使是较老的药物，现在也有液体、咀嚼片和静脉注射制剂，具有缓释形式，每天需要的剂量更少。如果药物不起作用，可以提供手术，在许多情况下导致癫痫发作自由。在手术不是一种选择的情况下，可以植入迷走神经刺激器（VNS）。有了所有这些治疗方法，为什么癫痫患者需要改变饮食来控制癫痫发作？生酮饮食是一种限制性的高脂肪、低蛋白和非常低碳水化合物的饮食，主要针对儿童。膳食必须仔细选择，测量食物的数量，所以在学校或餐馆外吃饭可能很困难。对于一些儿童来说，即使是最小的碳水化合物轻率行为（包括药物甚至全身吸收的防晒霜）也会导致更多的癫痫发作。并非所有癫痫中心都提供饮食治疗，因为它需要经过专门培训的营养师和医疗团队，而且往往报销很少。几十年来，这种饮食被认为是不健康的，潜在的危险，科学上不合理的。那么，为什么医生或家长会想要尝试生酮饮食呢？首先，生酮饮食的副作用可能比抗惊厥药物少，其中许多是可治疗和可逆的。第二，对于患有难治性癫痫的儿童，它的疗效可能高于抗惊厥药，并且有一些引人注目的癫痫发作自由案例引起了媒体的关注。决不是“替代“...
The ketogenic diet is a high-fat, adequate protein, low carbohydrate diet that has been used for the treatment of intractable childhood epilepsy since the 1920s. The diet mimics the biochemical changes associated with starvation, which create ketosis. Although less commonly used in later decades because of the increased availability of anticonvulsants, the ketogenic diet has re-emerged as a therapeutic option. Only a decade ago the ketogenic diet was seen as a last resort; however, it has become more commonly used in academic centres throughout the world even early in the course of epilepsy. The Atkins diet is a recently used, less restrictive, therapy that also creates ketosis and can lower the number of seizures. Dietary therapies may become even more valuable in the therapy of epilepsy when the mechanisms underlying their success are understood. Patients with epilepsy have more therapeutic choices than ever. Over the past decade the number of available anticonvulsants has more than doubled and the newer drugs have fewer side-effects, drug interactions, and less teratogenicity. Even older drugs are now available in liquid, chewable, and intravenous preparations with extended-release forms and fewer doses per day are needed. If drugs do not work, surgery can be offered and leads to seizure freedom in many cases. In cases where surgery is not an option, a vagal nerve stimulator (VNS) can be implanted. With all these therapies available, why would any patient with epilepsy need to change their diet to control seizures? The ketogenic diet is a restrictive high-fat, low-protein, and very low-carbohydrate diet mostly given to children. Meals must be carefully chosen, with amounts of foods measured, so eating outside the home at schools or in restaurants can be difficult. For some children, even the smallest of carbohydrate indiscretions (including medications or even systemically-absorbed sunscreen) can lead to more seizures. Not all epilepsy centres offer dietary therapy as it requires a specially trained dietitian and medical team and is often poorly reimbursed. For decades, this diet was seen as unhealthy, potentially dangerous, and scientifically unsound. Why, therefore, would any physician or parent want to try the ketogenic diet? First, the ketogenic diet has probably fewer side-effects than anticonvulsants, and many of them are treatable and reversible. 3 Second, its efficacy is likely higher than anticonvulsants for children with intractable epilepsy, and there are spectacular cases of seizure freedom that have captured media attention. By no means " alternative " …