TY - JOUR T1 - 1-36个月儿童癫痫的药物和饮食治疗JF -神经学JO -神经学SP - e16 LP - e27 DO - 10.1212/WNL.0000000000201026半岛投注体育官网VL - 100 IS - 1 AU - Jonathan R. Treadwell AU - Sudha Kilaru Kessler AU - Mingche Wu AU - Nicholas S. Abend AU - Shavonne L. Massey AU - Amy Y. Tsou Y1 - 2023/01/03 UR - http://n.半岛投注体育官网neurology.org/content/100/1/e16.abstract N2 -背景和目标早期癫痫很常见，往往使人衰弱，但除了婴儿痉挛之外，没有循证管理指南。我们对1-36个月无婴儿痉挛的癫痫患儿的药物和饮食治疗的有效性和危害进行了系统综述。方法检索EMBASE、MEDLINE、PubMed和Cochrane图书馆1999年1月1日至2021年8月19日发表的研究。使用预先指定的标准，我们确定了报告1-36个月儿童癫痫接受药物或饮食治疗数据的研究。我们不要求研究报告病原学特异性数据。我们排除了新生儿、婴儿痉挛和癫痫持续状态的研究。我们纳入了29种药物治疗中的1种和/或5种饮食治疗中的1种的研究，报告了≥12周的有效性结果。我们回顾了全文，以找到1-36个月儿童的任何亚组分析。23项研究符合纳入标准(6项随机研究，2项非随机比较研究，15项预研究/后研究)。所有结论均被评为证据强度低。 Levetiracetam leads to seizure freedom in some infants (32% and 66% in studies reporting seizure freedom), but data on 6 other medications were insufficient to permit conclusions about effectiveness (topiramate, lamotrigine, phenytoin, vigabatrin, rufinamide, and stiripentol). Three medications (levetiracetam, topiramate, and lamotrigine) were rarely discontinued because of adverse effects, and severe events were rare. For diets, the ketogenic diet leads to seizure freedom in some infants (rates 12%–37%), and both the ketogenic diet and modified Atkins diet reduce average seizure frequency, but reductions are greater with the ketogenic diet (1 RCT reported a 71% frequency reduction at 6 months for ketogenic diet vs only a 28% reduction for the modified Atkins diet). Dietary harms were not well-reported.Discussion Little high-quality evidence exists on pharmacologic and dietary treatments for early life epilepsies. Future research should isolate how treatments contribute to outcomes, conduct etiology-specific analyses, and report patient-centered outcomes such as hospitalization, neurodevelopment, functional performance, sleep quality, and patient and caregiver quality of life.Trial Registration Information This systematic review was registered in PROSPERO (CRD42021220352) on March 5, 2021.AHRQ=Agency for Healthcare Research and Quality; ASM=antiseizure medication; ILAE=International League Against Epilepsy; MAD=modified Atkins diet; RCTs=randomized controlled trials; SOE=strength of evidence; SR=systematic review ER -