生酮飲食及其他替代性飲食用於癲癇的治療

The Ketogenic Diet and Other Alternative Diets for Treating Epilepsy

廖欣瑩(Hsin-Yin Liao) ； 楊璦瑜(Ai-Yu Yang)

《台灣營養學會雜誌》 43卷1期 (2019/03) Pp. 23-31

https://doi.org/10.6691/NSJ.201903_43(1).0003

摘要

生酮飲食（ketogenic diet, KD）是一種高脂肪、低碳水化合物，模仿飢餓狀態的代謝路徑。KD的治療機轉是藉由酮體生成及葡萄糖限制的作用。酮體及其衍生物藉由神經保護及抑制神經興奮而有抗癲癇的作用。酮體經由抑制糖解作用與葡萄糖競爭產生能量，促進GABA的合成，抑制神經元活動以抗癲癇發作。KD已被證實對於難治性癲癇是有效的非藥物療法。然而典型KD經常因為病人無法耐受，且難以維持飲食限制而停止治療。為了使生酮飲食的適口性更佳，以及改善可能發生的不良反應，發展出其他替代性飲食。包括改良式阿金飲食（modified Atkins diet, MAD）、中鏈三酸甘油酯飲食（medium-chain triglyceride diet, MCTD）、低升糖指數飲食（low-glycemic-index treatment, LGIT）。典型KD已被證實可用於兒童和成人的癲癇治療。MAD或LGIT可作為對典型KD無法耐受的青少年或成人病人的替代選擇。MAD和LGIT可在門診開始執行，典型KD與MCTD則須住院密切監測。KD最常見的副作用為胃腸道症狀，包括嘔吐，腹瀉，便秘等。然而仍有少數個案報告發生嚴重或致命的副作用。KD治療前須評估禁忌症，再依據病人的年齡、個人耐受、家庭支持、癲癇嚴重程度作個別化選擇。並且由營養師和神經科醫生共同監督和照護，以提高治療的有效性和安全性。

關鍵字

生酮飲食 ； 癲癇 ； 中鏈三酸甘油酯飲食 ； 改良式阿金飲食 ； 低升糖指數飲食

並列摘要

The ketogenic diet (KD) is a high-fat, low-carbohydrate diet that mimics the metabolic pathway of starvation. The therapeutic mechanism of the KD depends on ketone body formation and glucose restriction. Ketone bodies and their derivatives exert antiepileptic effects through neuropro-tection and inhibition of nerve stimulation. Ketone bodies compete with glucose to generate energy by inhibiting glycolysis, promoting γ-aminobutyric acid (GABA) synthesis, and inhibiting neuronal activity to prevent epileptic seizures. The KD was proven to be an effective non-drug therapy for refractory epilepsy. However, the typical KD is often discontinued because patients cannot tolerate it, and it is difficult to maintain such stringent dietary restrictions. To make the KD more palatable and reduce possible adverse reactions, other alternative diets, including the modified Atkins diet (MAD), medium-chain triglyceride diet (MCTD), and low-glycemic-index treatment (LGIT), were developed. The typical KD was proven to be useful for epilepsy treatment in children and adults. The MAD or LGIT can be used as alternatives for adolescent or adult patients who cannot tolerate the typical KD. The MAD and LGIT can be initiated in the outpatient clinic, while the typical KD and MCTD require patients to be hospitalized for close monitoring. The most common side effects of the KD are gastrointestinal symptoms, including vomiting, diarrhea, and constipation. However, there have been a few cases of serious or fatal side effects. Before KD treatment, contraindications should be evaluated, and an individualized choice should be made according to the patient's age, personal tolerance, family support, and severity of epilepsy. In addition, nutritionists and neurologists should jointly supervise and manage patients to improve the efficacy and safety of the treatment.

並列關鍵字

ketogenic diet ； epilepsy ； medium-chain triglyceride diet ； modified Atkins diet ； low glycemic index treatment