生酮饮食对新生儿低血糖导致的耐药性癫痫患儿的疗效和耐受性病例系列。

IF 2.3 3区医学 Q2 BEHAVIORAL SCIENCES

Epilepsy & Behavior Pub Date : 2024-10-30 DOI:10.1016/j.yebeh.2024.110088

Xiangjun Dou , Yan Wu , Lili Liang , Yane Yang , Fengtong Li , Xia Li , Dong Wang

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引用次数: 0

摘要

研究目的本研究旨在探讨生酮饮食（KD）对新生儿低血糖引起的耐药性癫痫（DRE）患儿的有效性和耐受性：我们对2014年5月至2023年3月期间在西安市儿童医院确诊为新生儿低血糖相关DRE并开始生酮饮食的儿科患者数据进行了回顾性分析：本研究共纳入9名患者。癫痫发作的平均年龄为（6.16±3.97）个月，开始饮食治疗的平均年龄为（21.56±10.94）个月，中位饮食持续时间为 9 个月（范围：3-39.6 个月）。所有九名患者（七名男性）每天都有癫痫发作，最常见的发作类型是癫痫痉挛。所有九名患者的脑部磁共振成像（MRI）均显示双侧枕顶叶皮质萎缩，伴有或不伴有胶质增生。在接受研究的患者中，有 22.2% 被归类为明确的 KD 反应者。这些患者在开始接受 KD 治疗一个月后就摆脱了癫痫发作，并保持无发作状态超过 22 个月。一名患者（11.1%）是部分 KD 反应者，在开始接受 KD 治疗三个月内癫痫发作减少了 50%以上，并持续接受饮食治疗一年以上。没有一名患者因为无法忍受大多数轻微的不良反应而停止服用 KD。在最后一次随访中，有六名患者（66.7%）停止了饮食疗法，主要原因是疗效不佳：结论：对于继发于新生儿低血糖症的 DRE 儿童患者来说，KD 是一种安全、可耐受的替代治疗方法。大多数情况下，KD 的疗效甚微；然而，饮食疗法可能对某些患者很有帮助。因此，对于与新生儿低血糖相关的 DRE，考虑使用 KD 治疗是合适的。

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A case series of the efficacy and tolerability of ketogenic diet in children with drug-resistant epilepsy due to neonatal hypoglycemia

Objective

The objective of this study was to investigate the effectiveness and tolerance of the ketogenic diet (KD) in children who have drug-resistant epilepsy (DRE) caused by neonatal hypoglycemia.

Methods

We conducted a retrospective analysis of the data from pediatric patients who were diagnosed with neonatal hypoglycemia-related DRE and initiated a KD at Xi’an Children’s Hospital between May 2014 and March 2023.

Results

Nine patients were enrolled in this study. The mean age of seizure onset was 6.16 ± 3.97 months, with a mean age of dietary therapy initiation at 21.56 ± 10.94 months and a median diet duration of nine months (range: 3–39.6 months). All of the nine patients (seven males) had daily seizures, and the most common seizure type was epileptic spasms. Magnetic resonance imaging (MRI) of the brain in all nine patients revealed bilateral atrophy of the occipital-parietal cortex, with or without gliosis. Of the patients studied, 22.2 % were classified as definite KD responders. These individuals achieved seizure freedom after one month of starting KD treatment and maintained a seizure-free state for over 22 months. One patient (11.1 %) was a partial KD responder who had a > 50 % seizure reduction within three months from KD initiation and continued the diet therapy for more than one year. None of the patients stopped taking KD because they could not tolerate the majority of the adverse effects, which were mild. At the last follow-up, six patients (66.7 %) had stopped their diet therapy with lack of efficacy being the leading cause.

Conclusions

KD is a safe and tolerable alternative treatment in pediatric patients with DRE secondary to neonatal hypoglycaemia. Most of the time, KD has minimal efficacy; however, diet therapy may be quite helpful for some patients. Thus, for DRE associated with neonatal hypoglycemia, KD treatment is appropriate to consider.

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来源期刊

Epilepsy & Behavior 医学-行为科学

CiteScore

5.40

自引率

15.40%

发文量

385

审稿时长

43 days

期刊介绍： Epilepsy & Behavior is the fastest-growing international journal uniquely devoted to the rapid dissemination of the most current information available on the behavioral aspects of seizures and epilepsy. Epilepsy & Behavior presents original peer-reviewed articles based on laboratory and clinical research. Topics are drawn from a variety of fields, including clinical neurology, neurosurgery, neuropsychiatry, neuropsychology, neurophysiology, neuropharmacology, and neuroimaging. From September 2012 Epilepsy & Behavior stopped accepting Case Reports for publication in the journal. From this date authors who submit to Epilepsy & Behavior will be offered a transfer or asked to resubmit their Case Reports to its new sister journal, Epilepsy & Behavior Case Reports.