生酮饮食添加治疗儿童难治性癫痫的临床观察
Clinical observation of ketogenic diet adding in children with refractory epilepsy

目的：观察生酮饮食（KD）添加治疗儿童难治性癫痫的临床疗效，对患儿神经行为发育、生长发育的影响及患儿的早期脑电图改变与临床疗效的关系。方法：42例难治性癫痫患儿均采用经典KD添加治疗方案。采用Engel分级评价KD添加治疗3、6、12、18个月的疗效；采用Gesell发育量表评价以上各时点总发育商及各能区发育商改善情况；采用Z评分评估以上各时点患儿的生长发育情况；分析KD治疗1个月患儿清醒期、睡眠期痫样放电指数减少量与KD添加治疗3个月疗效的关系。结果：难治性癫痫患儿KD添加治疗3、6、12、18个月有效率分别为69.0%、54.8%、40.5%、33.3%，完全控制发作率分别为21.4%、26.2%、26.2%、23.8%。患儿适应性、大动作、精细动作能区发育商随治疗时间的增加而逐渐改善（P<0.05）。随访18个月，KD添加治疗对患儿的生长发育无影响（P>0.05）。KD添加治疗1个月，清醒期痫样放电指数减少量与KD添加治疗3个月疗效有相关性（rS=0.337，P=0.029）。结论：KD添加治疗儿童难治性癫痫安全有效，且早期脑电图改变与临床疗效有一定相关性。
Aim: To study the clinical efficiency of ketogenic diet(KD) adding on the children with refractory epilepsy, and the effect on the neurobehavioral development and the growth and development, as well as the correlation between the early electroencephalogram(EEG) changes and clinical efficiency.Methods: Forty？？two pediatric patients with refractory epilepsy who had received KD therapy were recruited. Engel grade was used to evaluate the efficiency at 3, 6, 12 and 18 months after treatment; the Gesell development scale was used to evaluate the improvement of the total development quotient and the energy region quotient at the above time points; Z score was used to evaluate the growth and development of children at the above time points. The relationship between the reduce of the IED index at 1 month after the treatment and the clinical efficiency after 3 months therapy was analyzed.Results: The total effective rate was respectively 69.0%, 54.8%, 40.5%, and 33.3% after 3, 6, 12, and 18 months therapy and the total control rate was 21.4%, 26.2%, 26.2%, and 23.8%, respectively. The differences in adaptive, large movement and fine motor quotients were statistically significant among different time points, and with the increase of the treatment time, the improvement was more obvious(P<0.05).Follow up for 18 months showed that KD treatment had no influence on the growth and development of the children(P>0.05).The reduce of the IED index in awake period at 1 month after the treatment was correlated with the clinical efficiency after 3 month therapy(rS=0.337,P=0.029).Conclusion: KD therapy for children with refractory epilepsy is safe and effective. The early EEG changes might correlate with clinical efficiency