提升頑固性癲癇病童對生酮飲食之醫療遵從率

Improve the Medical Compliance Rate on Ketogenic Diet among Children with Refractory Epilepsy

生酮飲食可有效改善頑固性癲癇病童發作頻率及減少抗癲癇藥物使用，但需維持精確的飲食控制方能獲得良好成效，照顧者常感備餐不便或認為對病童症狀無改善而中斷，影響治療效果。小組以病歷回溯法調查2015年接受生酮飲食治療的15位病童，對生酮飲食三個月的醫療遵從率低，僅60％，主要原因：一、生酮飲食油脂高，口感不佳以致病童拒吃|二、照顧者不知如何備餐及備餐不便且費時|三、醫護人員對生酮飲食治療認知不足|四、缺乏生酮飲食衛教輔助工具。專案執行期間自2016年12月1日至2017年12月31日，改善方案包括：一、提供客製化生酮飲食膳食計劃|二、導入遊戲化策略|三、舉辦醫護人員教育訓練課程|四、修訂生酮飲食衛教標準化流程及製作衛教工具。經實施後頑固性癲癇病童對生酮飲食三個月之醫療遵從率由改善前平均60％提升至改善後92.3％|病童癲癇發作頻率平均減少51.6％|抗癲癇藥物總用藥使用量由改善前平均100％減少至改善後77.4％，顯示改善方案可有效維持生酮飲食之醫療遵從率，使疾病獲得良好控制，成功減少抗癲癇藥物使用。但因生酮飲食需嚴格且精確控制醣類的攝取，故針對在校就學的兒童，學校團膳備餐無法掌控食材種類，醣類提供無法精確控制，建議由營養師每月過濾營養午餐菜單，刪除不適合食用的菜色，額外添加不足的油量，協助照顧者克服備餐問題，使病童獲得持續性治療，提升病童及其家庭良好生活品質。

The ketogenic diet might effectively reduce the episodes of incurable epileptic seizures and reduce the use of anti-epileptic drugs. However, it is necessary to maintain accurate diet control to achieve good results. The caregivers stop it as feeling the inconvenience to prepare meals or the symptoms are not improved for children. This would affect the effect of treatment. This retrospective study used medical record to understand the compliance of 15 children who received ketogenic diet in 2015. The three-month medical compliance rate for the ketogenic diet was only 60%. The main reasons of noncompliance were (1) the taste of ketogenic diet was not good that kids refusing to eat, (2) the caregiver does not know how to prepare meals and inconvenient and time-consuming for preparing, (3) the medical staff had insufficient knowledge for ketogenic diet, and (4) the lack of standardization procedure for ketogenic diet education. From December 1, 2016 to December 31, 2017, the improvement plan was implemented. It includes (1) providing a customized meal plan for caregivers, (2) introducing children's gamification strategies to understand ketogenic diet, (3) organizing educational training courses for medical staff, (4) setting the standardized procedures of ketogenic diet education program and educational tools. After implementation, the three-month medical compliance rate increased from 60% to 92.3%. Also, the episode of seizures decreased 51.6%. The total dose of antiepileptic drugs decreased from 100% to 77.4%. The results showed the improvement program can effectively maintain the medical compliance of the ketogenic diet, successfully reducing the use of antiepileptic drugs and decreasing the frequency of seizures. It is recommended that for children returning to school, the nutritionist might consult for the lunch menu for patients, decline the dish not suitable for patients, and add extra oil consuming. It will be helpful for caregivers easily overcome the difficulty of preparing meals and make the children continue to be sustained. Well-controlled epilepsy will improve the quality of life of patients and their family members.