生酮饮食治疗睡眠中癫痫性电持续状态相关癫痫综合征的疗效及脑电图变化  

The duration of epilepsy in sleep effect of progesterone diet on epilepsy syndrome in sleep and recurrent epilepsy syndrome and EEG changes

作　　者：陈曼 岳璇 刘娜 陈娇 刘晓鸣 CHEN Man;YUE Xuan;LIU Na;CHEN Jiao;LIU Xiaoming(Department of Neurology,Xuzhou Children's Hospital,Xuzhou Medical University,Xuzhou 221000,China)

机构地区：[1]徐州医科大学附属徐州儿童医院神经内科,徐州221000

出　　处：《癫痫杂志》2023年第6期455-460,共6页Journal of Epilepsy

基　　金：江苏省妇幼健康科研项目(F201726)。

摘　　要：目的分析生酮饮食治疗睡眠中癫痫性电持续状态(Electrical status epilepticus during sleep,ESES)相关癫痫综合征的疗效及脑电图变化。方法收集2020年3月—2022年6月徐州市儿童医院门诊及住院收治的58例ESES相关癫痫综合征伴认知损害患儿的临床资料,使用随机数字表法分为观察组(A组)和对照组(B组),每组29例;在不改变原有抗癫痫发作药物治疗的基础上,A组采用生酮饮食治疗,B组采用激素治疗;观察生酮饮食及激素治疗前及治疗后3、6个月ESES相关癫痫综合征患儿的临床疗效、认知及脑电图棘慢波指数(Spike-wave index,SWI)变化。结果A组治疗3个月时临床总有效率、控制率;脑电图总有效率、显效率及韦氏儿童智力量表测得言语商、操作商及总智商均明显低于B组,差异具有统计学意义(P<0.05);但治疗6个月时A组临床总有效率、控制率;脑电图总有效率、显效率及韦氏儿童智力量表测得言语商、操作商及总智商与B组相当,差异无统计学意义(P>0.05)。A组患儿随访期内未出现脑电图SWI及临床症状反复病例;B组患儿在治疗6个月时脑电图SWI反复率55.2%,临床症状反复率37.9%。治疗期间两组患儿均未发生严重不良反应,A组在启动期有约27.6%(8例)的患儿出现胃肠道不适症状,但均较轻、且很快缓解,维持期未发生严重不良反应;但B组中有89.7%(26例)的患儿出现不同程度的体重增长,其中69%(20例)的患儿呈满月脸、水牛背等柯兴容貌。结论生酮饮食可改善ESES相关癫痫综合征患儿的疗效及脑电图变化,改善认知;与激素冲击治疗比较,生酮饮食治疗ESES相关癫痫综合征反复率低,不良反应相对轻且发生率低。Objective To analyze the efficacy of ketogenic diet(KD)in the treatment of epilepsy syndrome associated with Electrical status epilepticus during sleep(ESES)and the changes of electroencephalogram(EEG).Methods The clinical data of 58 children with ESES-related epilepsy syndrome and cognitive impairment admitted to the outpatient and inpatient department of Xuzhou Children’s Hospital from March 2020 to June 2022 were collected.They were divided into observation group(group A)and control group(group B)by random number table method,with 29 cases in each group.On the basis of not changing the original anti-seizure drugs,group A was treated with ketogenic diet,and group B was treated with hormone.The clinical efficacy,cognitive function and Spike-wave index(SWI)of children with ESES-related epilepsy syndrome were observed before and 3 and 6 months after ketogenic diet and hormone treatment.Results The total clinical effective rate and control rate of group A after 3 months of treatment;The total effective rate and significant efficiency of EEG and the verbal quotient,operation quotient and total intelligence quotient of Wechsler Intelligence Scale for children were significantly lower than those of group B,and the differences were statistically significant(P<0.05).However,the total clinical effective rate and control rate of group A after 6 months of treatment;The total effective rate and significant efficiency of electroencephalogram and the verbal quotient,operation quotient and total intelligence quotient measured by Wechsler Intelligence Scale for children were similar to those of group B,and the difference was not statistically significant(P>0.05).There were no cases of EEG SWI and recurrent clinical symptoms in group A during the follow-up period;In group B,the recurrence rate of EEG SWI was 55.2%,and the recurrence rate of clinical symptoms was 37.9%after 6 months of treatment.There were no serious adverse reactions in the two groups during the treatment period.In group A,about 27.6%(8 cases)of the children h

关 键 词：睡眠中癫痫性电持续状态 生酮饮食 癫痫综合征 儿童 

分 类 号：R742.1[医药卫生—神经病学与精神病学]