难治性癫痫病人生酮饮食治疗期间的观察及护理

目的:观察分析生酮饮食结合科学护理方法在对难治性癫痫病人的治疗过程中具有怎样的积极作用.方法:从我院神经内科病例系统中随机抽取23例难治性癫痫病人作为本次实验的总体样本,同时给予其抗癫痫药物治疗、生酮饮食以及全面的护理措施,观察临床疗效.结果:随着治疗时间增加,病人的发作频率和持续时间具短于治疗前,GCS评分优于之前(...     

添加生酮饮食治疗难治性癫痫的长期保留率和不良反应

目的:评价添加生酮饮食(KD)治疗难治性癫痫的长期保留率和不良反应.方法:将28例难治性癫痫病人在1年半内陆续入组.病人住院期间以脂肪/(蛋白质+糖类)重量比=4:1饮食开始,出院继续4:1或适当减低比例.随访3、6和12个月的保留率,统计疗效和不良反应的发生率.结果:3、6和12个月的保留率分别为68％(19/28)、43％(10/23)和28％(5/18).3个月时68％(19/28)病人减少＞50％的发作,43％(12/28)病人减少＞90％的发作,无发作率为11％(3/28).启动期主要不良反应为胃肠道不适、酮症酸中毒、低血糖;维持期主要不良反应为便秘、高脂血症和低蛋白血症,仅有1例因不良反应而退出.结论:添加生酮饮食治疗难治性癫痫病人疗效较高,但保留率不高.不良反应不是治疗失败的主要原因,如何根据中国人的生活习惯来提高操作性是努力的方向.     

生酮饮食在儿童难治性癫痫添加治疗的疗效评价

目的:研究生酮饮食在儿童难治性癫痫加治疗的临床疗效。方法:研究时段2015年3月至2019年1月,以本院难治性癫痫儿童(n=20例)作为研究对象,所有患儿住院期间采用4:1(脂肪:非脂肪)饮食,出院后维持4:1饮食,并根据患者实际情况适当调整剂量,随访观察3个月、6个月、12个月的保留率,并统计临床疗效、各个时间段患儿生长发育情况。结果:难治性癫痫患儿3、6、12个月的临床疗效分别为60.00%、72.22%、81.25%。随着时间的推移,所有患儿的生长发育情况均呈递增趋势,组间数据对比结果显示:P<0.05。结论:生酮饮食添加治疗难治性癫痫患儿临床疗效较高,而且安全性较高,能够显著改善患者的认知情况,促进患儿生长发育,值得临床推荐。     

生酮饮食治疗顽固性癫痫

生酮饮食是指高脂肪、低碳水化合物饮食。临床用于治疗儿童顽固性癫痫，其疗效确切，耐受性好，副作用小，但作用机制尚不清楚。本文对生酮饮食的类型、效能、作用机制等研究现状作简要介绍。     

生酮饮食治疗儿童难治性癫痫的疗效与依从性分析

目的探讨生酮饮食(KD)医治儿童难治性癫痫的临床效果及依从性。方法选取我院2011年7月至2015年8月收治的30例难治性癫痫患儿,对其采用KD方案实行医治,记录其实行KD治疗前和治疗三个月期间患儿的丙戊酸血浓度、体质量及服药剂量,观察控制患儿癫痫发作情况。结果通过三个月的随访,30例患儿中有20例完成观察。其中3例能彻底控制发作,4例发作次数减少≥50%,5例发作情况没有显著变化,其总体有效率是75.00%。患儿的丙戊酸血浓度治疗前后比较差异无统计学意义(P>0.05)。生酮饮食治疗保留率为93.33%。结论生酮饮食(KD)治疗患儿难治性癫痫安全有效,且副作用少,提升了患儿及其家属的依从性,改善了治疗效果。     

第三军医大学新桥医院采用生酮饮食治疗儿童难治性癫痫

熙熙,来喝一杯牛奶!记者从三医大新桥医院儿科门诊看到,患有严重癫痫病的10岁男孩熙熙通过两个月生酮饮食治疗,病情得到控制,从每天发病三五次降到每周一次。据了解,该院是西南地区首家引进生酮饮食治疗儿童难治性癫痫。通     

生酮饮食疗法联合醋酸艾司利卡西平治疗药物难治性癫痫的效果观察

目的探讨生酮饮食疗法对药物难治性癫痫患者癫痫发作情况、免疫功能及神经递质水平的影响。方法选取2019年12月—2020年12月河南省某医院收治的89例药物难治性癫痫患者为研究对象。采用随机数字表法,将患者分为观察组(n=45)与对照组(n=44)。对照组患者采用醋酸艾司利卡西平进行治疗。观察组在对照组基础上增加生酮饮食治疗。比较2组患者治疗效果。比较2组患者治疗前1天、治疗6个月时T淋巴细胞总值(CD3⁺)和T淋巴细胞亚群(CD4⁺、CD8⁺)、免疫球蛋白A(IgA)、免疫球蛋白M(IgM)、免疫球蛋白G(IgG)水平。比较2组患者治疗前1天、治疗6个月时去甲肾上腺素(NE)、多巴胺(DA)、5-羟色胺(5-HT)水平。比较2组患者治疗期间的不良反应发生情况。结果观察组患者治疗有效率为66.67%,高于对照组的45.45%,差异有统计学意义(P<0.05)。治疗6个月时,2组患者IgA、IgG及IgM水平均低于治疗前1天,且观察组低于对照组,差异均有统计学意义(P<0.05)。治疗6个月时,2组患者CD3     

生酮饮食减重靠谱吗

近年来,一种叫"生酮饮食"的饮食模式成了不少人口口相传的特效减重方法,号称吃着大鱼大肉也能减重,国内外各大明星也积极推崇,甚至赋予了这种饮食模式除减重外更多的神奇功效。那么生酮饮食到底是不是真的能有效减重?什么是生酮饮食简单来说,生酮饮食模式就是高脂肪、中至低蛋白、低碳水化合物饮食。该饮食模式是减重领域的时尚新宠,但在神经科医生眼中并不陌生,在20世纪20年代,它是针对用药物难以控制的儿童或成人癫痫的配合饮食配方。     

27例小儿难治性癫痫综合征的外科治疗分析

目的 分析外科手术治疗在小儿难治性癫痫综合征中的使用.方法 随机抽取北京天坛医院2002-2010年期间患小儿难治性癫痫综合征的患者27例,对患者进行外科手术治疗.患者的术前以及术中脑电检查显示为局灶性改变者进行脑叶切除或者多软膜下横纤维切断.对于检测提示一侧半球为主多灶性改变的患者,进行多脑叶切除联合MST.结果 患者在手术后,认知能力,语言能力以及适应能力都有一定程度的提高.并且患者对于手术治疗的效果评分也较高.结论 在对小儿难治性癫痫综合征进行外科手术进行治疗后,有一定的治疗效果.     

生酮饮食对甲状腺疾病影响的研究进展

近年来,生酮饮食作为一种饮食干预疗法受到了广泛关注,其机制是模拟机体的饥饿状态,通过生酮作用诱导机体营养性酮症代谢状态,从而对疾病发挥治疗的作用。然而,限制碳水化合物的摄取可能影响机体甲状腺激素水平,诱导甲状腺功能异常。在这篇综述中,我们介绍了生酮饮食对甲状腺功能的影响及其可能的机制。此外,本综述还探讨了生酮饮食在桥本甲状腺炎、甲状腺结节及甲状腺癌的辅助治疗中可能的作用,为甲状腺疾病患者的饮食方案提供了新思路。然而,生酮饮食对机体的长期影响及其安全性仍存在争议。因此,生酮饮食的实际应用应在严格的医疗及营养监督下进行。     

Effects of Classic Ketogenic Diet in Children with Refractory Epilepsy: A Retrospective Cohort Study in Kingdom of Bahrain

Background: The classic ketogenic diet (cKD) has been used worldwide as an effective therapy for children with drug-resistant epilepsy. However, there have been no studies performed in Middle Eastern countries in order to assess the efficacy, side effects, predictors of cKD response and factors mostly associated with diet adherence. This study aims to assess the efficacy of cKD ratios of 4:1 and 3:1 and their influence on growth and biochemical parameters, particularly lipid profile and liver function tests (LFTs), and the factors most associated with diet adherence in a cohort of children with drug-resistant epilepsy in Bahrain. Methods: Baseline and follow-up data related to patients’ demographic and biochemical variables, epilepsy episodes, diet history and anthropometric measurements were retrieved for a total of 24 children treated with cKD in Bahrain. Results: After 6 months cKD initiation, 58.3% were positive responders with >50% seizure rate reduction, and 33.3% became seizure-free at 12 months. After 6 months of intervention with cKD, the level of triglycerides and albumin had a significant (p < 0.05) average increase over time of +1.47 mmol/L and 4.3 g/L, respectively. Although the median values of total cholesterol and alanine transaminase increased, respectively, following cKD initiation, the difference over time was not statistically significant. The mean z-scores for weight, height, and body mass index (or weight-for-length) did not change significantly at 12 months follow-up. cKD duration was the highest correlated variable with cKD efficacy (r = 0.76), which was followed by age at cKD initiation (r = 0.47). The cKD was discontinued by 14 patients (58.3%) during the first follow-up period (6 months), which was mainly due to inefficacy (n = 8), poor compliance (n = 3), food refusal (n = 1), achieved required efficacy (n = 1) and death (n = 1). Conclusions: cKD is an effective treatment for patients with drug-resistant epilepsy, and positive response to cKD was the main factor that increased adherence to the diet. Although long-term cKD could increase the risk of dyslipidemia and hepatic problems, it appears safe for children. Consequently, close monitoring and emphasis on healthy fats is of high priority.     

Evaluation of E-Health Applications for Paediatric Patients with Refractory Epilepsy and Maintained on Ketogenic Diet

E-health technologies improve healthcare quality and disease management. The aim of this study was to develop a ketogenic diet management app as well as a website about this dietary treatment and to evaluate the benefits of giving caregivers access to various web materials designed for paediatric patients with refractory epilepsy. Forty families participated in the questionnaire survey, from January 2016 to March 2016. All caregivers were exposed to paper-based materials about the ketogenic diet, whereas only 22 received the app, called KetApp, and videos produced by dieticians. Caregivers with free access to web materials were more satisfied than the others with the informative material provided by the centre (p ≤ 0.001, Mann–Whitney test). Indeed, they showed a better attitude towards treatment, and they became more aware of dietary management in comparison to the control group (p ≤ 0.001). Moreover, caregivers provided with web materials were stimulated to pursue the treatment (p = 0.002) and to introduce it to their children and other people (p = 0.001). Additionally, caregivers supplied with web materials were more willing to help other families in choosing the ketogenic diet (p = 0.004). Overall, these findings indicate that web materials are beneficial for caregivers of paediatric patients with refractory epilepsy in our centres. Thus, the use of e-health applications could be a promising tool in the daily aspects of ketogenic diet management, and it is especially of value in the attempt to start or maintain the diet during the ongoing COVID-19 pandemic crisis.     

The Effect of the Ketogenic Diet on Adiponectin,Omentin and Vaspin in Children with Drug-Resistant Epilepsy

Background: Changes in adipokine secretion may be involved in the anti-epileptic effect of a ketogenic diet (KD) in drug-resistant epilepsy (DRE). Objectives: The assessment of the influence of KD on serum adiponectin, omentin-1, and vaspin in children with DRE. Methods: Anthropometric measurements (weight, height, BMI, and waist-to-hip circumference ratio) were performed in 72 children aged 3–9 years, divided into 3 groups: 24 children with DRE treated with KD, 26—treated with valproic acid (VPA), and a control group of 22 children. Biochemical tests included fasting glucose, insulin, beta-hydroxybutyric acid, lipid profile, aminotransferases activities, and blood gasometry. Serum levels of adiponectin, omentin-1 and vaspin were assayed using commercially available ELISA tests. Results: Serum levels of adiponectin and omentin-1 in the KD group were significantly higher and vaspin—lower in comparison to patients receiving VPA and the control group. In all examined children, serum adiponectin and omentin-1 correlated negatively with WHR and serum triglycerides, insulin, fasting glucose, and HOMA-IR. Vaspin levels correlated negatively with serum triglycerides and positively with body weight, BMI, fasting glucose, insulin, and HOMA-IR. Conclusion: One of the potential mechanisms of KD in children with drug-resistant epilepsy may be a modulation of metabolically beneficial and anti-inflammatory adipokine levels.     

综合护理干预模式在小儿癫痫护理中的应用

目的探讨综合护理干预模式在小儿癫痫护理中的应用效果。方法选取我院2016年2月至2018年8月收治的98例癫痫患儿,随机分为对照组和观察组,各49例。对照组行常规护理干预,观察组在对照组基础上采用综合护理干预模式,对比两组的医嘱依从性、患儿生存质量及家长护理满意度评分。结果观察组患儿医嘱依从性为93.88%,明显高于对照组的71.43%(P<0.05)。干预后,观察组患儿生存质量评分、家长护理满意度评分均明显高于对照组(P<0.05)。结论对癫痫患儿采用综合护理干预模式,可有效提高患儿医嘱依从性、生存质量及家长护理满意度,值得临床推广。     

循证护理对癫痫患儿治疗依从性的影响

目的 探讨分析循证护理对于癫痫患儿治疗依从性的影响.方法 选取2013年1月至2014年1月来我院接受治疗的癫痫患儿62例,随机分成观察组和对照组,每组31人,对两组患儿采取相同的常规治疗与护理干预,但对观察组进行常规治疗及护理的基础上实施具有针对性的循证护理干预,观察两组患者在治疗与护理前后的依从性.结果 治疗后观察组的治疗依从性为96.77％,明显高于对照组的74.19％,差异具有统计学意义（P＜0.05）.结论 对癫痫患儿实施具有针对性的循证护理能够提高患者的治疗依从性,对于患者的治疗具有积极有效的意义.     

Graph Theory-Based Electroencephalographic Connectivity and Its Association with Ketogenic Diet Effectiveness in Epileptic Children

Ketogenic diet therapies (KDTs) are widely used treatments for epilepsy, but the factors influencing their responsiveness remain unknown. This study aimed to explore the predictors or associated factors for KDTs effectiveness by evaluating the subtle changes in brain functional connectivity (FC) before and after KDTs. Segments of interictal sleep electroencephalography (EEG) were acquired before and after six months of KDTs. Analyses of FC were based on network-based statistics and graph theory, with a focus on different frequency bands. Seventeen responders and 14 non-responders were enrolled. After six months of KDTs, the responders exhibited a significant functional connectivity strength decrease compared with the non-responders; reductions in global efficiency, clustering coefficient, and nodal strength in the beta frequency band for a consecutive range of weighted proportional thresholds were observed in the responders. The alteration of betweenness centrality was significantly and positively correlated with seizure reduction rate in alpha, beta, and theta frequency bands in weighted adjacency matrices with densities of 90%. We conclude that KDTs tended to modify minor-to-moderate-intensity brain connections; the reduction of global connectivity and the increment of betweenness centrality after six months of KDTs were associated with better KD effectiveness.     

系统性健康教育干预对儿童脑肿瘤手术护理质量的影响

目的观察系统性健康教育干预对儿童脑肿瘤手术护理质量的影响。方法选取2013年8月至2016年5月期间我院收治的接受手术治疗的52例脑肿瘤患儿为研究对象,随机分为治疗组26例(系统性健康教育干预联合常规护理)和对照组26例(常规护理干预),比较两组的干预效果。结果治疗组患儿的恐怖、敌对、焦虑以及抑郁等不良情绪评分均显著低于对照组,差异有统计学意义(P<0.05)。治疗组的护理满意度为96.15%(25/26),显著高于对照组的76.92%(20/26),差异有统计学意义(P<0.05)。治疗组的护理质量评分为(92.4±4.5)分,显著高于对照组的(89.3±3.2)分,差异具有统计学意义(P<0.05)。结论系统性健康教育干预应用于脑肿瘤手术患儿具有显著的效果,可有效提高护理质量以及患儿家属的满意度,缓解患儿的不良情绪,值得临床推广。     

针对性护理干预对肾积水患儿治疗依从性及并发症的影响

目的针对性护理干预对肾积水患儿治疗依从性及并发症的影响。方法选取2016年10月至2018年12月我院收治的肾积水患儿80例,随机分为观察组(40例)和对照组(40例)。对照组采用常规护理,观察组采用针对性护理干预,比较两组患儿的相关指标(引流管拔除时间、输尿管拔除时间、肾盂造瘘管拔除时间、拆线时间、出院时间)、治疗依从性与并发症情况。结果观察组的引流管拔除时间、输尿管拔除时间、肾盂造瘘管拔除时间、拆线时间、出院时间短于对照组(P <0.05)。观察组的总体依从性为97.50%,高于对照组的80.00%(P <0.05)。观察组的并发症发生率为5.00%,低于对照组的22.50%(P <0.05)。结论针对性护理干预对肾积水患儿的效果显著,能有效促进患儿术后身体恢复,提高其治疗依从性,减少并发症发生。