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生酮饮食

Author
Eric HW Kossoff, MD
Section Editor
Douglas R Nordli, Jr, MD
Deputy Editor
Janet L Wilterdink, MD

引言

抗癫痫药(antiepileptic drug, AED)是癫痫发作的主要治疗方法，能有效控制大多数患者的癫痫发作。然而，大约1/3的患者应用药物仍不能避免癫痫发作，需要进行非药物治疗[1]。尽管通常会考虑对这些患者进行癫痫手术，但是许多家庭和患者因为手术会导致无法耐受的运动、语言、记忆损害或因为其他原因，而不愿意考虑或不适合进行癫痫手术。对于这些患者可考虑迷走神经刺激术(vagus nerve stimulation, VNS)和饮食疗法。

本专题将总结治疗癫痫的生酮饮食和其他饮食疗法。本专题也将简要总结生酮饮食用于其他神经疾病的一些初步证据。成人和儿童癫痫患者的癫痫发作和癫痫的其他治疗见其他专题。 (参见“成人癫痫处理概述”和“儿童癫痫发作和癫痫：初始治疗和监测”和“迷走神经刺激疗法治疗癫痫”和“成人癫痫的初始治疗”)

作用机制

已发表的生酮饮食作为癫痫有效治疗的报告可追溯到20世纪20年代初[2]。然而，生酮饮食抑制癫痫发作的作用机制仍不清楚，并且很可能是多因素的[3]。

生酮饮食应用高脂肪、适量蛋白质(1g/kg)、低碳水化合物饮食，引起通常与饥饿状态有关的代谢变化。其通常以一个短时间的禁食期开始，在开始生酮饮食的几小时内血浆酮、胰岛素、葡萄糖、胰高血糖素和游离脂肪酸可发生相当大的变化[3]。

尚不清楚其中哪些代谢变化引起了癫痫发作频率的改善。长链和中链脂肪酸在肝脏中生成酮体(乙酰乙酸、丙酮和β羟丁酸)，当它们穿过血脑屏障时能直接发挥抗癫痫的作用，基于这个理论，这种饮食被称为生酮饮食。接受生酮饮食的患者，通常要监测尿酮水平，偶尔还要监测血清酮水平，以确保饮食处理正确，其监测方法与监测抗癫痫药物水平的方法类似[4]。

                  

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Literature review current through: 2017-07 . | This topic last updated: 2017-07-03.
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