The utility of ketogenic diet therapy in the management of epileptic spasms: A systematic review and meta-analysis

IF 2.3 4区医学 Q3 CLINICAL NEUROLOGY

Epilepsy Research Pub Date : 2026-01-01 Epub Date: 2025-11-15 DOI:10.1016/j.eplepsyres.2025.107694

Gabriella Yakemow , Stephanie Aleluya , Rajesh Ramachandrannair , Kevin C. Jones , Jessie Cunningham , Myanca Rodrigues , Vann Chau , Suvasini Sharma , Puneet Jain , Robyn Whitney

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引用次数: 0

Abstract

Objective

We systematically reviewed the existing literature on the efficacy of the ketogenic diet (KD) in patients with epileptic spasms (ES) and analyzed predictors of seizure outcomes.

Methods

The Preferred Report Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were followed. The primary outcome was the proportion of patients achieving 50–99 % spasm reduction at 3 months following KD initiation. Additional outcomes included the proportion of patients achieving complete spasm freedom at 1, 3, and 6 months. Meta-regression was employed to examine clinical determinants of seizure outcomes.

Results

Twenty-two studies (n = 1077 individuals) were included. There were 607 males (62.2 %) and 369 females (37.8 %) (k = 16 studies). The mean age of KD initiation was 16 months (SD: 5.4, range: 8.4–23 months) (k = 11 studies). Epilepsy etiology was reported in 453 individuals (k = 15 studies), 297 (65.6 %) had a known etiology and 156 (34.4 %) were unknown. Structural (n = 178, 59.9 %) and genetic/metabolic (n = 80, 26.9 %) causes were common. Most received the classic ketogenic diet (n = 975/1077, 90.5 %) and 102 patients (9.5 %) received the modified Atkins diet (MAD). At 3 months, 48 % (95 % CI: 40 %, 57 %) achieved a 50–99 % spasm reduction and 25 % (95 % CI: 17 %, 34 %), achieved spasm freedom. At 6 months, 41 % (95 % CI: 32 %, 50 %) achieved 50–99 % spasm reduction and 25 % (95 % CI: 17 %,35 %), achieved spasm freedom. Meta-regression did not identify predictors of treatment response.

Conclusion

KD may be an effective treatment option for ES. However, predictors of clinical response were not identified, highlighting the need for larger studies to better understand them and long-term outcomes.

查看原文本刊更多论文

生酮饮食疗法在癫痫性痉挛治疗中的应用：一项系统综述和荟萃分析。

目的：我们系统地回顾了有关生酮饮食（KD）对癫痫性痉挛（ES）患者疗效的现有文献，并分析了癫痫发作结局的预测因素。方法：采用系统评价和荟萃分析首选报告项目（PRISMA）指南。主要结局是患者在KD开始后3个月痉挛减少50- 99% %的比例。其他结果包括患者在1、3和6个月时实现完全痉挛自由的比例。meta回归用于检查癫痫发作结局的临床决定因素。结果：纳入22项研究（n = 1077人）。男性607人（62.2 %），女性369人（37.8 %）（k = 16项研究）。KD起始平均年龄为16个月（SD: 5.4，范围：8.4-23 个月）（k = 11项研究）。453人报告了癫痫病因（k = 15项研究），297人（65.6% %）病因已知，156人（34.4% %）病因未知。结构原因（n = 178,59.9 %）和遗传/代谢原因（n = 80,26.9 %）常见。大多数患者接受经典生酮饮食（n = 975/1077,90.5 %），102例患者（9.5 %）接受改良阿特金斯饮食（MAD）。在3个月,48 %(95 % CI: 40 %,57 %)取得了50 - 99 %减少痉挛和25 %(95 % CI: 17 %,34 %),实现痉挛的自由。在6个月,41 %(95 % CI: 32 % 50 %)达到50 - 99 %减少痉挛和25 %(95 % CI: 17 % 35 %),实现痉挛的自由。meta回归没有确定治疗反应的预测因素。结论：KD可能是治疗ES的有效选择。然而，临床反应的预测因素尚未确定，这突出表明需要进行更大规模的研究来更好地了解它们和长期结果。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Epilepsy Research 医学-临床神经学

CiteScore

0.10

自引率

4.50%

发文量

143

审稿时长

62 days

期刊介绍： Epilepsy Research provides for publication of high quality articles in both basic and clinical epilepsy research, with a special emphasis on translational research that ultimately relates to epilepsy as a human condition. The journal is intended to provide a forum for reporting the best and most rigorous epilepsy research from all disciplines ranging from biophysics and molecular biology to epidemiological and psychosocial research. As such the journal will publish original papers relevant to epilepsy from any scientific discipline and also studies of a multidisciplinary nature. Clinical and experimental research papers adopting fresh conceptual approaches to the study of epilepsy and its treatment are encouraged. The overriding criteria for publication are novelty, significant clinical or experimental relevance, and interest to a multidisciplinary audience in the broad arena of epilepsy. Review articles focused on any topic of epilepsy research will also be considered, but only if they present an exceptionally clear synthesis of current knowledge and future directions of a research area, based on a critical assessment of the available data or on hypotheses that are likely to stimulate more critical thinking and further advances in an area of epilepsy research.