生酮饮食对婴儿癫痫痉挛综合征的疗效和安全性：一项荟萃分析

IF 2.8 3区医学 Q2 CLINICAL NEUROLOGY

Seizure-European Journal of Epilepsy Pub Date : 2025-08-25 DOI:10.1016/j.seizure.2025.08.029

CaoXue Zuo , KangJie Xu , Kun Ni , YuXin Xiang , Yang Wang , Zhisheng Liu , Dan Sun

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引用次数: 0

摘要

目的系统评价生酮饮食（KD）治疗小儿癫痫痉挛综合征（IESS）的疗效和安全性。方法对电子数据库进行全面检索，以确定使用KD治疗IESS的预后研究。从符合条件的研究中提取数据，并使用随机效应模型进行meta分析。结果荟萃分析显示，在kd开始后3、6和12个月痉挛发作减少≥50%的儿童比例分别为63% （95% CI: 0.52-0.73）、66% （95% CI: 0.56-0.76）和60% （95% CI: 0.43-0.77）。在3个月、6个月和12个月时，分别有21% （95% CI: 0.11-0.32）、21% （95% CI: 0.12-0.30）和19% （95% CI: 0.08-0.31）的患者出现无癫痫发作。KD治疗还显著改善了脑电图（EEG）异常（OR: 54%, P < 0.01），并有助于增强运动、认知和语言发育（OR: 56%, P < 0.01）。常见的不良事件包括胃肠道问题（427/1313,32%）和内部环境紊乱（428/1313,32%），尽管大多数是轻微和可控的。证据主要是低确定性的，具有显著的发表偏倚。结论生酮饮食对抗癫痫药物无反应的IESS患儿是一种安全有效的治疗方法。

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The efficacy and safety of the ketogenic diet in infantile epileptic spasm syndrome: a meta-analysis

Objective

To systematically evaluate the efficacy and safety of the ketogenic diet (KD) in treating infantile epileptic spasm syndrome (IESS).

Methods

A comprehensive search of electronic databases was conducted to identify prognostic studies on the use of KD for IESS. Data from eligible studies were extracted and meta-analyzed using a random-effects model.

Results

The meta-analysis indicated that the proportion of children experiencing a ≥ 50% reduction in spasticity episodes at 3, 6, and 12 months post-KD initiation was 63% (95% CI: 0.52–0.73), 66% (95% CI: 0.56–0.76), and 60% (95% CI: 0.43–0.77), respectively. Seizure-free periods occurred in 21% (95% CI: 0.11–0.32), 21% (95% CI: 0.12–0.30), and 19% (95% CI: 0.08–0.31) of patients at 3, 6, and 12 months, respectively. KD treatment also significantly improved electroencephalogram (EEG) abnormalities (OR: 54%, P < 0.01) and contributed to the enhancement of motor, cognitive, and language development (OR: 56%, P < 0.01). Common adverse events included gastrointestinal issues (427/1313, 32%) and disturbances in the internal environment (428/1313, 32%), though most were mild and manageable. Evidence is predominantly low-certainty with significant publication bias.

Conclusion

The ketogenic diet is an effective and safe treatment option for children with IESS who are unresponsive to antiepileptic drugs.

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来源期刊

Seizure-European Journal of Epilepsy 医学-临床神经学

CiteScore

5.60

自引率

6.70%

发文量

231

审稿时长

34 days

期刊介绍： Seizure - European Journal of Epilepsy is an international journal owned by Epilepsy Action (the largest member led epilepsy organisation in the UK). It provides a forum for papers on all topics related to epilepsy and seizure disorders.