Clinical Efficacy And Safety Of Ketogenic Diet In The Treatment Of Infantile Spasm

Objectives:To evaluate the efficacy and safety of ketogenic diet?KD?in the treatment of infantile spasms?IS?,and to explore the related factors affecting the efficacy of KD.Methods:A prospective study was conducted in Union Hospital affiliated to Fujian Medical University and 31 children with IS who received KD treatment were enrolled.The efficacy of KD treatment at 3 months was evaluated according to Engel classification^[1],the efficacy of KD treatment was divided into effective?seizure frequency reduction>50%?and ineffective?seizure frequency reduction<50%?and fully controlled?seizure frequency reduction=100%?.SPSS 23.0 was used for data analyzing.Fisher's exact probability method was used to analyze the correlation between the efficacy of KD treatment and sex,age,age of onset,course of KD treatment,number of antiepileptic drugs used before KD treatment,number of epileptic drugs used during KD treatment,abnormality of brain MR imagines,whether ACTH treatment was conducted before KD treatment and the efficacy of ACTH treatment.And the correlation between the occurrence of adverse reactions during KD treatment and the gender,age and treatment effect of KD in children with IS were also analyzed.The levels of triglycerides?TG?,total cholesterol?TC?,high-density lipoprotein?HDL?and low-density lipoprotein?LDL?were recorded before KD treatment and 3 months after KD treatment.Four clinical indexes were calculated to assess the risk of atherosclerosis:LDL/HDL ratio,arterial stiffness index?AI?,arterial stiffness index?AIP?and lipid comprehensive index?LCI?.The changes of lipid metabolism and atherosclerosis risk index before and after treatment were analyzed by ANOVA for repeated measurement?P=0.05?.Results:?1?A total of 31 children with IS who received KD treatment were enrolled in this study.These children were aged from 78 days to 1558 days?median age is 555 days,mean age is 615 days?.Age of onset was 7 days to 12 months?median is 5 months?.Clinical course was from 1 month to 39 months?median 8months?.20 cases had abnormalities in head MR examination,and 7 cases were abnormal in head MR examination.1 to 7 kinds of anti-epileptic drugs were tried before KD treatment?average 3.55?.1 to 4 kinds of anti-epileptic drugs?average2.32?were used in starting KD treatment.There were 27 children who had been treated with KD for more than 3 months,18 of whom had tried ACTH treatment,and 12 children with effective ACTH treatment.?2?In this study,4 children did not adhere to KD treatment for 3 months.Among those who completed 3 months of KD treatment,the effective rate was 70.4%and the rate of fully controlled was 25.9%.?3?There was no significant correlation between the efficacy of KD treatment and sex,age,age of onset,course of KD treatment,number of antiepileptic drugs used before KD treatment,number of epileptic drugs used during KD treatment,abnormality of brain MR imagines,whether ACTH treatment was conducted before KD treatment and the efficacy of ACTH treatment.?4?51.6%patients had adverse reactions during KD treatment,including metabolic acidosis,hypoglycemia,hypertriglyceridemia,reduced appetite,respiratory tract infection,sleepiness,vomiting,diarrhea and so on.However,all the symptoms were mild and improved rapidly after treatment.?5?There was no significant correlation between the occurrence of adverse reactions during KD treatment and the sex,age and treatment effect of KD in IS patients.?6?After 3 months of KD treatment,the levels of TG,TC and LDL were slightly higher than those before treatment,but there was no significant difference,while the levels of HDL were not significantly changed.Compared with pre KD treatment,LDL/HDL ratio,AI,AIP and LCI increased after KD treatment,but there was no significant difference.Conclusion:?1?KD is an effective treatment for IS.?2?There is no significant correlation between the efficacy of KD treatment and the sex,age,age of onset,course of disease before KD treatment,number of antiepileptic drugs used before KD treatment,number of epileptic drugs used during KD treatment,abnormality of brain MR imagines,whether ACTH treatment was conducted before KD treatment,and the efficacy of ACTH treatment,KD treatment can be considered for those have no contraindication.?3?Transient gastrointestinal dysfunction and metabolic abnormality may occur in IS patients during KD treatment.However,it can be improved quickly after treatment.?4?There was no significant correlation between the occurrence of adverse reactions during KD treatment and sex,age and treatment effect of KD in children with IS.The occurrence of adverse reactions should be closely observed and treated in time.?5?There is no conclusive evidence to suggest that KD treatment increases the risk of atherosclerosis,and a larger sample size and longer follow-up are needed.