生酮饮食添加疗法对药物难治性癫痫儿童的疗效与生活质量的影响

目的探讨生酮饮食(KD)添加疗法对药物难治性癫痫儿童的治疗效果与生活质量的影响。方法采用前瞻性对照研究,将临床观察对象分为KD组(30例)与对照组(30例)。收集患儿的临床资料,并于KD添加疗法开始前1个月及治疗后第1、3、6、12个月采用癫痫儿童生活质量量表(QOLCE)-55对患儿进行评测。于KD添加疗法结束当天,参考Engel分级标准,对疗效进行评价。结果 KD添加治疗前1个月及治疗后第1、3个月,KD组及对照组QOLCE各项评分差异无统计学意义(均P>0.05)。KD添加治疗6个月,KD组行为功能评分显著高于对照组(P<0.05),其他评分差异无统计学意义(均P>0.05)。KD添加治疗12个月,KD组躯体功能与行为功能评分显著高于对照组(均P<0.05),其他评分差异无统计学意义(均P>0.05)。与治疗后第1个月比较,对照组及KD组治疗后第3个月躯体功能、情感健康、认知能力、社会功能和行为功能评分显著升高(均P<0.05);与治疗后第3个月比较,对照组治疗后第6个月躯体功能、情感健康、认知能力、社会功能和行为功能评分及KD组治疗后第6个月情感健康及行为功能评分显著升高(均P<0.05);与治疗后第6个月比较,对照组治疗后第12个月躯体功能、认知能力、社会功能和行为功能评分及KD组治疗后第12个月躯体功能、认知能力和行为功能评分显著升高(均P<0.05)。KD组有效率为60.0%,发作缓解率为13.3%;对照组有效率为30.0%,发作缓解率为13.3%。KD添加疗法的疗效优于常规抗癫痫治疗(χ2=6.336,P=0.042)。KD组18例发生不同程度的不良反应,经过积极处理后均改善。结论 KD添加疗法对癫痫儿童具有一定的治疗效果,短期内虽有不良反应的出现,但其后果轻微,且患儿能逐渐耐受。

Efficacy and effectiveness of quality of life of ketogenic dietary therapy in children with refractory epilepsy

Objective To explore the efficacy and effect of quality of life of ketogenic dietary(KD) therapy in children with refractory epilepsy. Methods This study was designed as prospective controlled way. To divide the clinical observation subjects into the KD group(30 cases) and control group(30 cases). The clinical data of the children were collected and were evaluated with the quality of life scale for children with epilepsy(QOLCE)-55 at one month before KD treatment and 1 st, 3 rd, 6 th, and 12 th months after treatment. At the end of KD addiction therapy, the efficacy was evaluated according to Engel’s grading criteria. Results There were no significant differences in QOLCE scores between the KD group and control group at 1 st month before KD treatment and 1 st, 3 rd months after treatment(all P>0.05). After 6 th month of KD treatment, the behavioral function score of the KD group was significantly higher than that of the control group(P<0.05), and the difference in other items was not statistically significant(all P>0.05). After 12 th month of KD treatment, the scores of physical function and behavioral function in the KD group were significantly higher than those of the control group(all P<0.05), and the difference in other items was not statistically significant(all P>0.05). Compared with those in 1 st month after treatment, the scores of physical function, emotional health, cognitive ability, social function and behavioral function in the control group and the KD group were increased significantly at 3 rd month after treatment(all P<0.05). Compared with those in 3 rd month after treatment, the scores of physical function, emotional health, cognitive ability, social function, behavioral function in the control group and the scores of emotional health, behavioral function in the KD group were increased significantly at the 6 th month after treatment(all P<0.05). Compared with those in 6 th month after treatment, the scores of physical function, cognitive ability, social function, behavioral function in the control group and the scores of physical function,cognitive ability,behavioral function in the KD group were increased significantly at the 12 th month after treatment( all P < 0. 05). The effective rate in the KD group was 60. 0%,and the onset remission rate was 13. 3%;the effective rate in the control group was 30. 0%,and the onset remission rate was 13. 3%. The efficacy of KD additive therapy was better than that of conventional antiepileptic therapy( χ2= 6. 336,P = 0. 042). In the KD group,18 cases had different degrees of adverse reactions,which were improved after active treatment. Conclusions KD additive therapy has a certain therapeutic effect on children with epilepsy. Although there are adverse reactions in the short term,the consequences are slight,and the children can gradually tolerate them.