The Clinical Study Of Ketogenic Diet In Children With Infant Spasm

Background Ketogenic diet (KD) is a special diet of high fat, low carbohydrate and moderate amount of protein.KD can imitate the starvation of human that the carbohydrate is in short supply and fat burns for energy. Fatty acid can not traverse blood-brain barrier,but ketone body as intermediate product of fatty caid can transfer to the brain to supply energy. Meanwhile,the excitability of intracerebral neuron is modulated and it leads to an antiepileptic effect,but the pathogenesis is not very clear.Infant spasm(IS) is an epilepsy syndrome which features infant-onset and frequent seizures. Treatment effectiveness of classical antiepileptic drugs(AEDs) is not satisfied.The recurrence rate is more than50%even with the treatment of adrenocorticotrophic hormone(ACTH)which is well recommended home and abroad.In recent years,more and more therapeutic methods,including KD are tried in the treatment of IS.Purposes In this paper, treatment effectiveness,side effects,and probable effect factors of effectiveness are studied and analyzed in the purpose of providing reference for treating IS with KD clinically.Methods41Children with IS who were treated with KD between June,2012and March,2014in our hospital were selected. In reference of the classic KD of the Johns Hopkins hospital, we formulated our own classic KD that suited our hospital and treated the patients with it. Data from these children had follow-up of at least one month after initiation of the KD. We evaluate the efficacy according to the Engel classification. Response was defined as more than50%seizure reduction,which can be classificated as level1,level2or level3. Seizure reduction less than50%is regarded as ineffective.In this paper,we also analyze the probable effect factors including gender, age at epilepsy onset, course of disease,KD initial ratio, AEDs before KD, etiology,seizure type and EEG.The side effects and influence of KD on the development of nervous system are evaluated.Results In the41cases studied, there were20males and21females. Their mean onset age of KD was25.48months±■17.43(0-48). Mean duration of KD was5.58months±3.63(1-18). Mean amount of AEDs before KD is4.6±1.86(2-9).Following-up1,3,6,9,12and more than12months,25(60.9%),18(50.0%),14(51.9%),4(80.0%),2(66.7%) and2(100.0%) of the patients were responders. The cognition and mental development were gradually improved in25cases.In the treatment of KD,29patients (70.7%)had side effects.14cases(34.1%)had vomiting,16cases(39.2%) had diarrhea,7cases(17.1%) had constipation,3cases (7.3%) had pneumonia,2cases(4.9%) had hypoglycemia,1cases (2.4%) had hypoalbuminemia and lcase(2.4%) had kidney stones.Conclusion KD is an effective therapy in IS and it takes effect quite quickly.The effective rate of KD is much higher than adding a third AEDs in controlling seizures. It can not only reduce the epilepsy seizure, but also can significantly improve patients’ EEG and promote the development of patients’ nervous system and improve their cognition. KD is a comparative safe therapy.The side effects occur frequently,but most of them are less serious and can be tolerated.