[1]纪惠茹,武运红,樊海珍,等.长疗程生酮饮食对儿童发育性癫痫性脑病的疗效及认知功能的影响[J].卒中与神经疾病杂志,2024,31(05):470-475,489.[doi:10.3969/j.issn.1007-0478.2024.05.009]
　Ji Huiru*,Wu Yunhong,Fan Haizhen,et al.Study on the clinical efficacy and cognitive function effects of long course ketogenic diet therapy on developmental epileptic encephalopathy in children[J].Stroke and Nervous Diseases,2024,31(05):470-475,489.[doi:10.3969/j.issn.1007-0478.2024.05.009]
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长疗程生酮饮食对儿童发育性癫痫性脑病的疗效及认知功能的影响()
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《卒中与神经疾病》杂志[ISSN:1007-0478/CN:42-1402/R]

卷:
第31卷
期数:
2024年05期
页码:
470-475,489
栏目:
论著
出版日期:
2024-10-20

文章信息/Info

Title:
Study on the clinical efficacy and cognitive function effects of long course ketogenic diet therapy on developmental epileptic encephalopathy in children
文章编号:
1007-0478(2024)05-0470-07
作者:
纪惠茹; 武运红; 樊海珍; 赵娇娇; 郭瑾
030000 太原,山西医科大学(纪惠茹 赵娇娇 郭瑾); 山西省儿童医院神经内科[武运红(通信作者)樊海珍]
Author(s):
Ji Huiru*;  Wu Yunhong;  Fan Haizhen;  et al.
*Shanxi Medical University, Taiyuan 030000
关键词:
发育性癫痫性脑病 生酮饮食 长期疗效 认知功能
Keywords:
Developmental epileptic encephalopathy Ketogenic diet Long-term efficacy Cognitive function
分类号:
R742.1
DOI:
10.3969/j.issn.1007-0478.2024.05.009
文献标志码:
A
摘要:
目的 研究长疗程生酮饮食(KD)添加治疗对发育性癫痫性脑病(DEE)患儿的临床疗效及认知功能的影响。方法 选取2020年1月-2023年12月在山西省儿童医院神经内科进行KD添加治疗的DEE患儿; 比较患儿治疗前与治疗12、24、36、48个月后的月平均癫痫发作频率、痫样放电指数、儿童神经心理发育量表评分等; 分析长疗程KD对DEE患儿的疗效及其认知功能的影响。结果(1)添加KD 12、24、36、48个月后癫痫控制有效率分别为45.24、59.46、83.33、87.50%; 脑电图好转率分别为38.10、56.76、76.67、83.33%(P<0.05),各时间点比较均有明显差异;(2)长疗程KD添加治疗后患儿认知功能明显改善,在大运动、精细动作、适应能力、言语、社交行为5个功能区的评分均得到提升,各时间点比较均有明显差异(P<0.05);(3)在治疗12个月后KD对不同类型综合征患儿的疗效均有明显差异(P<0.05),开始KD的不同年龄组患儿的疗效也均有明显差异(P<0.05)。结论 长疗程KD对患儿癫痫发作控制效果显著,对DEE患儿的脑电图及认知功能均有明显的改善作用,且开始KD的年龄越小,治疗时间越长,其疗效越显著。
Abstract:
ObjectiveThe aim of this paper is to study the clinical efficacy and cognitive function effects of long course ketogenic diet(KD)addition therapy on children with developmental epileptic encephalopathy(DEE).Methods Children with DEE who underwent KD-addition therapy in the Department of Neurology of Shanxi Children's Hospital from January 2020 to December 2023 were selected. The mean monthly seizure frequency, epileptiform discharge index, and neuropsychological developmental scale score before and after treatment at 12, 24, 36, and 48 months were compared and the therapeutic efficacy of the long course of KD on children with DEE and its effect on cognitive function was analyzed.Results(1)After 12, 24, 36 and 48 months of KD addition, the effective rate of epilepsy control was 45.24%, 59.46%, 83.33% and 87.50%, respectively. And the rate of EEG improvement was 38.10%, 56.76%, 76.67% and 83.33%, respectively, with statistically significant differences between the different treatment times upon comparison.(2)The children's cognitive function improved significantly after the long course of KD-added treatment, and their scores in the five functional areas of gross motor, fine motor, adaptive, verbal, and social behavior were improved, with significant differences in comparison at all time points(P<0.05).(3)There was a significant difference in the efficacy of KD in children with different types of syndromes after 12 months of treatment(P<0.05), as well as in children of different age groups who started KD(P<0.05).Conclusion Long course of KD has significant effect on seizure control in children, and has significant improvement on EEG and cognitive function in children with DEE. Moreover, the younger the age at which KD is initiated and the longer the duration of treatment is, the more significant is its efficacy.

参考文献/References:

[1] Uamek-Kozio M,Czuczwar SJ,Januszewski S,et al.Ketogenic diet and epilepsy[J].Nutrients,2019,11(10):2510. [2] Fisher RS,Cross JH,French JA,et al.Operational classification of seizure types by the international league against epilepsy:position paper of the ILAE commission for classification and terminology[J].Epilepsia,2017,58(4):522-530. [3] Scheffer IE,Berkovic S,Capovilla G,et al.ILAE classification of the epilepsies:position paper of the ILAE commission for classification and terminology[J].Epilepsia,2017,58(4):512-521. [4] Wirrell EC,Nabbout R,Scheffer IE,et al.Methodology for classification and definition of epilepsy syndromes with list of syndromes:report of the ILAE task force on nosology and definitions[J].Epilepsia,2022,63(6):1333-1348. [5] 中华医学会儿科学分会神经学组,中国抗癫痫协会,中华儿科杂志编辑委员会.生酮饮食疗法在癫痫及相关神经系统疾病中的应用专家共识[J].中华儿科杂志,2019,57(11):820-825. [6] Wirrell EC,Hood V,Knupp KG,et al.International consensus on diagnosis and management of Dravet syndrome[J].Epilepsia,2022,63(7):1761-1777. [7] 秦霞霞,樊海珍,韩虹,等.生酮饮食治疗婴幼儿发育性癫痫性脑病的效果分析[J].中国妇幼健康研究,2023,34(8):34-40. [8] Engel JJ.Surgery for seizures[J].N Engl J Med,1996,334(10):647-652. [9] Li H,Ouyang M,Zhang PQ,et al.The efficacy and safety of a ketogenic diet for children with refractory epilepsy in China:a retrospective single-center cohort study[J].Transl Pediatr,2020,9(4):561-566. [10] Zhu DN,Wang MM,Wang J,et al.Ketogenic diet effects on neurobehavioral development of children with intractable epilepsy:a prospective study[J].Epilepsy Behav,2016,55:87-91. [11] 中国医师协会神经内科医师分会儿童神经专业委员会.中华医学会儿科学分会神经学组.生酮饮食治疗儿童癫痫性脑病循证指南[J].中华实用儿科临床杂志,2019,34(12):881-888. [12] Caller TA,Ferguson RJ,Roth RM,et al.A cognitive behavioral intervention(HOBSCOTCH)improves quality of Life and attention in epilepsy[J].Epilepsy Behav,2016,57(Pt A):111-117. [13] Shen J,Jiang T,Gao F,et al.And influencing factors of ketogenic diet therapy in children with refractory epilepsy:a retrospective study[J].Neuropediatrics,2023,54(1):37-43. [14] Kossoff EH,Zupec-Kania BA,Auvin S,et al.Optimal clinical management of children receiving dietary therapies for epilepsy: Updated recommendations of the International ketogenic diet study group[J].Epilepsia Open,2018,3(2):175-192. [15] 刘家雯,丁鑫,朱艳伟,等.生酮饮食治疗药物难治性Dravet综合征的疗效和安全性的前瞻性对照研究[J].中华实用儿科临床杂志,2019(15):1160-1165. [16] IJff DM,Postulart D,Lambrechts DAJE,el ta.Cognitive and behavioral impact of the ketogenic diet in children and adolescents with refractory epilepsy:a randomized controlled trial[J].Epilepsy Behav,2016,60:153-157. [17] Svedlund A,Hallböök T,Magnusson P,et al.Prospective study of growth and bone mass in Swedish children treated with the modified Atkins diet[J].Eur J Paediatr Neurol,2019,23(4):629-638. [18] 中国抗癫痫协会生酮饮食专业委员会.葡萄糖转运体1缺陷综合征的诊断与治疗专家共识[J].中华实用儿科临床杂志,2022,37(19):1452-1457. [19] 郁莉斐,张玉琴,段婧,等.葡萄糖转运体1缺陷综合征疾病特征及生酮饮食治疗多中心临床研究[J].中华儿科杂志,2020,58(11):881-886. [20] De Amicis R,Leone A,Lessa C,et al.Long-term effects of a classic ketogenic diet on ghrelin and Leptin concentration: a 12-month prospective study in a cohort of Italian children and adults with GLUT1-deficiency syndrome and drug resistant epilepsy[J].Nutrients,2019,11(期缺失):1716. [21] 韩彤立,徐曼婷,陈春红,等.生酮饮食添加治疗儿童癫痫性痉挛临床和随访研究[J].中国小儿急救医学,2016,23(6):401-404, 408. [22] 杨帆.生酮饮食治疗婴儿痉挛症的研究进展[J].国际儿科学杂志,2023,50(5):335-339. [23] Devi N,Madaan P,Kandoth N,el ta.Efficacy and safety of dietary therapies for childhood drug-resistant epilepsy: a systematic review and network meta-analysis[J].JAMA Pediatr,2023,177(3):258-266. [24] Zhang J,Chen GH,Wang J,et al.Efficacy of the ketogenic diet on ACTH- or corticosteroid-resistant infantile spasm: a multicentre prospective control study[J].Epileptic Disord,2021,23(2):337-345. [25] Yan N,Xin-Hua W,Lin-Mei Z,et al.Prospective study of the efficacy of a ketogenic diet in 20 patients with Dravet syndrome[J].Seizure,2018,60:144-148. [26] Park EG,Lee J,Lee J.The ketogenic diet for super-refractory status epilepticus patients in intensive care units[J].Brain Dev,2019,41(5):420-427. [27] 吴松波,谢旭芳.生酮饮食在儿童难治性癫痫中的应用进展[J].中国神经免疫学和神经病学杂志,2019,26(3):211-216.

备注/Memo

备注/Memo:
基金项目:中国抗癫痫协会癫痫科研基金-UCB 基金项目(CJ-B-2021-19)
更新日期/Last Update: 2024-10-20