Abstract：
BACKGROUND: In 2009, the International Ketogenic Diet Study Group published recommendations for children receiving ketogenic diet (KD) therapy for epilepsy. The document included a table listing epilepsy syndromes and conditions in which the KD has been particularly beneficial, hoping that physicians would refer children for the KD sooner.
OBJECTIVE: To measure the impact of these 2009 recommendations on referral practice, we compared children initiated on the KD at Johns Hopkins Hospital (JHH) 10 years before and after the recommendations.
RESULTS: Overall, children referred to the KD who met indications increased from the pre- to post-recommendation group, 44 % (112/256) to 69 % (175/255) (p < 0.001), with JHH neurologists specifically referring more frequently (10/112, 9 % to 58/175, 33 %) (p < 0.01). Referrals increased for Glut-1 deficiency (0 % to 2.4 %, p = 0.015), Dravet syndrome (0 % to 6.7 %, p < 0.01), Rett syndrome (0.4 % to 3 %, p = 0.018), and formula-fed only status (16 % to 31 %, p < 0.01). The chances of > 50 % seizure reduction for all children referred improved slightly between decades (56 % to 61 %, p = 0.30).
CONCLUSIONS: Following the 2009 recommendations, our study shows there was an increase in referrals for children with indications at our center. Referrals from neurologists at our own institution increased the most. Ketogenic diet efficacy improved slightly over time but did not reach significance.
OBJECTIVE: To measure the impact of these 2009 recommendations on referral practice, we compared children initiated on the KD at Johns Hopkins Hospital (JHH) 10 years before and after the recommendations.
RESULTS: Overall, children referred to the KD who met indications increased from the pre- to post-recommendation group, 44 % (112/256) to 69 % (175/255) (p < 0.001), with JHH neurologists specifically referring more frequently (10/112, 9 % to 58/175, 33 %) (p < 0.01). Referrals increased for Glut-1 deficiency (0 % to 2.4 %, p = 0.015), Dravet syndrome (0 % to 6.7 %, p < 0.01), Rett syndrome (0.4 % to 3 %, p = 0.018), and formula-fed only status (16 % to 31 %, p < 0.01). The chances of > 50 % seizure reduction for all children referred improved slightly between decades (56 % to 61 %, p = 0.30).
CONCLUSIONS: Following the 2009 recommendations, our study shows there was an increase in referrals for children with indications at our center. Referrals from neurologists at our own institution increased the most. Ketogenic diet efficacy improved slightly over time but did not reach significance.
摘要：
背景：2009年，国际生酮饮食研究小组发表了关于儿童接受生酮饮食（KD）治疗癫痫的建议。该文件包括一个表格，列出了癫痫综合症和KD特别有益的疾病，希望医生能更快地转介孩子去KD。
目的：为了衡量这些2009年建议对转诊实践的影响，我们比较了建议前后10年在约翰霍普金斯医院(JHH)接受KD治疗的儿童.
结果：总体而言，从推荐前小组到推荐后小组，提到符合适应症的KD的儿童有所增加，44%(112/256)到69%(175/255)(p<0.001)，JHH神经科医师特别提到的频率更高（10/112，9％至58/175，33％）（p<0.01）。Glut-1缺乏症的转诊增加(0%至2.4%，p=0.015),德拉韦综合征（0%至6.7%，p<0.01),Rett综合征（0.4％至3％，p=0.018),和仅配方食品状态(16%至31%，p<0.01)。在几十年之间，所有转诊儿童的癫痫发作减少>50％的机会略有改善（56％至61％，p=0.30)。
结论：遵循2009年的建议，我们的研究表明,在我们中心有适应症的儿童转诊人数有所增加.我们自己机构的神经学家转诊增加最多。生酮饮食功效随时间略有改善，但未达到显著性。
目的：为了衡量这些2009年建议对转诊实践的影响，我们比较了建议前后10年在约翰霍普金斯医院(JHH)接受KD治疗的儿童.
结果：总体而言，从推荐前小组到推荐后小组，提到符合适应症的KD的儿童有所增加，44%(112/256)到69%(175/255)(p<0.001)，JHH神经科医师特别提到的频率更高（10/112，9％至58/175，33％）（p<0.01）。Glut-1缺乏症的转诊增加(0%至2.4%，p=0.015),德拉韦综合征（0%至6.7%，p<0.01),Rett综合征（0.4％至3％，p=0.018),和仅配方食品状态(16%至31%，p<0.01)。在几十年之间，所有转诊儿童的癫痫发作减少>50％的机会略有改善（56％至61％，p=0.30)。
结论：遵循2009年的建议，我们的研究表明,在我们中心有适应症的儿童转诊人数有所增加.我们自己机构的神经学家转诊增加最多。生酮饮食功效随时间略有改善，但未达到显著性。
