摘要
目的 探讨生酮饮食(KD)治疗婴幼儿发育性癫痫性脑病(DEE)的疗效。方法 回顾性选取2018年2月至2022年2月在山西省儿童医院神经内科门诊行KD治疗的42例DEE患儿为研究对象。采用经典KD方案,非禁食门诊启动治疗,随访12个月,观察治疗后患儿DEE的发作控制、脑电图改善、认知及行为改善、不良反应等情况,并对结果进行统计分析。结果 在42例患儿中,KD治疗1、3、6、12个月时,癫痫无发作率分别为14.3%、16.7%、19.0%、23.8%,癫痫控制有效率分别为47.6%、76.2%、66.7%、59.5%,治疗后1、3、6、12个月时的癫痫控制有效率比较差异有统计学意义(χ^(2)=17.542,P<0.05);KD治疗3、6、12个月时,患儿脑电图好转率分别为38.1%、47.6%、57.1%,经比较差异有统计学意义(χ^(2)=17.243,P<0.05)。有32例患儿完成了12个月的KD治疗且完善了发育商(DQ)测试,治疗12个月时的适应性、大运动、精细动作、语言、个人-社交能区及总DQ分均明显高于治疗6个月时和治疗前,经比较差异均有统计学意义(F值分别为48.868、41.740、44.862、79.849、61.856、139.187,P<0.05)。KD治疗1、3、6、12个月时的治疗保留率分别为92.9%、90.5%、81.0%、76.2%。有16例患儿发生不同程度的不良反应,包括便秘、腹泻、嗜睡等,不良反应发生率占38.1%,主要发生在KD治疗的前3个月内,经积极对症处理,大多数患儿在不良反应发生1~2周后得到改善。结论 KD对婴幼儿DEE是一种安全、有效控制癫痫发作的治疗方法,随着治疗时间的延长,可不同程度地改善患儿的认知功能,同时脑电图放电频率明显减少。
Objective To investigate the effect of ketogenic diet(KD) in the treatment of developmental epileptic encephalopathy(DEE) in infants.Methods A total of 42 children with DEE who underwent KD treatment in the department of neurology of Children's Hospital of Shanxi from February 2018 to February 2022 were retrospectively selected as the research objects.The classical KD protocol was adopted,non-fasting outpatient treatment was started,and follow-up was conducted for 12 months.The seizure control,the improvement of electroencephalogram,cognitive and behavioral improvement,and the occurrence of adverse reactions of the children were observed,and the results were statistically analyzed.Results The seizure free rate was 14.3%,16.7%,19.0%,23.8%,and the effective rate was 47.6%,76.2%,66.7% and 59.5%,respectively,after 1,3,6,12 months of KD therapy.The effective rate of epilepsy control at 1,3,6,and 12months after treatment was statistically significant(χ^(2)=17.542,P<0.05).The improvement rates of electroencephalogram at 3,6 and 12 months were 38.1%,47.6% and 57.1%,respectively,and the difference was statistically significant(χ^(2)=17.243,P<0.05).There were 32 children who completed 12 months of KD treatment and improved DQ test.The fitness,gross motor,fine motor,language,private-social zone and total DQ at 12 months of treatment were significantly higher than those at 6 months of treatment and before treatment,the differences were statistically significant(F=48.868,41.740,44.862,79.849,61.856 and 139.187,respectively,P<0.05).The retention rates of KD at 1,3,6 and 12 months were 92.9%,90.5%,81.0% and 76.2%,respectively.There were 16 children with varying degrees of adverse reactions,including constipation,diarrhea,lethargy and so on.The incidence of adverse reactions accounted for 38.1%,which mainly occurred in the first 3 months of KD therapy.Most of the children gradually were improved after 1-2 weeks of adverse reactions after active symptomatic treatment.Conclusion KD is a safe and effective treatment to control epileptic seizures in infants with DEE.With the prolongation of treatment time,the cognitive function of children can be improved to varying degrees,and the frequency of electroencephalogram discharge can be significantly reduced.
作者
秦霞霞
樊海珍
韩虹
武运红
周娜
QIN Xiaxia;FAN Haizhen;HAN Hong;WU Yunhong;ZHOU Na(Shanxi Medical University,Shanxi Taiyuan 030000,China;Department of Neurology,Children's Hospital of Shanxi,Shanxi Taiyuan 030000,China)
出处
《中国妇幼健康研究》
2023年第8期34-40,共7页
Chinese Journal of Woman and Child Health Research
基金
中国抗癫痫协会癫痫科研基金—UCB基金项目(CJ-B-2021-19)。
关键词
生酮饮食
发育性癫痫性脑病
认知
疗效
不良反应
ketogenic diet
developmental epileptic encephalopathy
cognitive
efficacy
adverse reactions
