生酮饮食疗法对难治性癫痫患者发作频率、血清单胺类神经递质水平的影响

目的探究生酮饮食结合抗癫痫药物对难治性癫痫患者发作频率、血清单胺类神经递质的影响。方法将2016年1月至2018年2月我院神经内科收治的72例难治性癫痫患儿纳入研究,所有患儿均在原有抗癫痫药物基础上进行至少3个月的生酮饮食治疗,于治疗后3、6、12个月时统计癫痫发作频率,复查脑电图评价脑部放电控制情况;于治疗6个月时采用韦氏儿童智力量表对患儿治疗前后的认知功能进行评价,测定事件相关电位P300及血清去甲肾上腺素(NE)、多巴胺(DA)、5-羟色胺(5-HT)水平。结果所有患儿均接受随访,治疗维持3、6、12个月的患者分别为72例、60例、38例。生酮饮食治疗3、6、12个月时临床发作控制有效率分别为40.3%、50%、55.3%,完全控制发作率分别为2.8%、18.3%、21.1%;脑电波减少有效率分别为50%、68.3%、76.3%;与治疗前比较,治疗6个月时患儿言语智商、操作智商、全量表智商得分未见显著性改变(P 0.05);与治疗前比较,治疗6个月时患儿N_2PL显著降低,P3波幅及血清NE、DA、5-HT等神经递质水平显著升高(P 0.05)。结论总体上生酮饮食结合抗癫痫药物治疗难治性癫痫有效,不仅可降低癫痫发作次数,也可一定程度改善患儿认知功能,其机制可能与其对神经递质的调控相关。

Effect of ketogenic diet therapy on seizure frequency and serum levels of monoamine neurotransmitters in patients with intractable epilepsy

Objective To investigate the effect of ketogenic diet therapy combined with antiepileptic drugs on seizure frequency and serum monoamine neurotransmitters in patients with intractable epilepsy. Methods A total of 72 children with intractable epilepsy who were admitted to Department of Neurology in our hospital from January 2016 to February 2018 were enrolled. All children were given at least 3 months of ketogenic diet therapy on the basis of the treatment with antiepileptic drugs. After 3, 6, and 12 months of treatment, seizure frequency was statistically analyzed and electroencephalography (EEG) was used to evaluate brain discharge control. After 6 months of treatment, Wechsler Intelligence Scale for Children was used to evaluate cognitive function, and event-related potential P300 and serum levels of norepinephrine (NE), dopamine (DA), and 5-hydroxytryptamine (5-HT) were measured. Results All children were followed up, and the treatment was maintained 3 months for 72 children, 6 months for 60 children, and 12 months for 38 children. The effective control rates of clinical seizure were 40.3%, 50.0%, and 55.3%, respectively, after 3, 6, and 12 months of ketogenic diet therapy, and the complete seizure control rates were 2.8%, 18.3%, and 21.1%, respectively. The effective rates of brain wave reduction were 50.0%, 68.3%, and 76.3%, respectively. After 6 months of treatment, there were no significant changes in the scores of verbal intelligence quotient, performance intelligence quotient, and full-scale intelligence quotient (P>0.05), and the children had a significant reduction N2PL and significant increases in P3 amplitude and serum levels of the neurotransmitters such as NE, DA, and 5-HT (P<0.05). Conclusions Ketogenic diet combined with antiepileptic drugs is effective in the treatment of intractable epilepsy and can not only reduce seizure frequency but also improve children''s cognitive function, possibly by the regulation of neurotransmitters.