情感障碍对癫患者认知障碍影响的事件相关电位研究

Study of the event-related potentials from affective disorder influencing the cognitive impairment of epilepsy patients

目的应用事件相关电位研究和探讨不同抗癫药对癫患者认知功能的影响以及情感障碍对癫患者认知障碍的影响。方法收集湛江中心人民医院神经内科门诊和住院的癫患者320例,正常对照组56例。分别进行韦氏智能测定和情感测定,同时结合抗抑郁剂治疗,并应用事件相关电位P300、N400研究,对比分析癫患者认知功能和情感障碍的特征。结果386例癫患者中,认知水平低于正常者达76.94%。结果显示丙戊酸钠、妥泰、卡马西平单药服药组之间认知水平无差异,但药物联合应用认知功能损害严重。且患者职业、文化程度、病程、发作次数、用药选择以及是否存在脑部继发性疾病等对认知功能影响显著。伴随着认知功能和情感障碍,癫患者P300和N400潜伏期明显延长、波幅降低。百忧解治疗后P300和N400潜伏期和波幅明显改善,且颞顶叶脑区的波幅明显升高。结论抗癫药可造成癫患者认知功能的损害,单药应用较联合用药对癫患者认知功能损害轻。抗抑郁治疗可改善癫患者的认知功能,认知事件相关电位也明显改善。

Objective Applying event-related potentials （ERP）, the study investigates the influence of different antiepileptic drugs upon epileptic patients＇ cognitive function and the impact of affective disorder upon their cognitive impairment. Methotis Three hundred and twenty outpatients and inpatients were collected from Department of Neurology, Zhanjiang Central People＇s Hospital and another 56 cases as control group. The patients were tested by 24-item Hamilton depression Scale （HAMD） and Wechsler adult intelligence scale （WAIS） and prescribed antidepressant. Applying ERP P300 and N400, researchers compared and analyzed features of epileptics＇ cognitive function and affective disorder. Results In 386 cases, 297 of them （76.94%）were lower than normal intelligence level（IQ≤ 90分 ） , 217 cases belonged to（56.22%）mental retardation（IQ≤70 分）. There were significant differences in different drugs taken group on their cognitive function and affective disorder. Result of nonparametric test on multi-independent samples showed that there was no significant differences of cognitive level emerge among single agent groups including carbamazepine （CBZ）,valproate sodium （VPA）, topiramate （TPM） while the combination group brought more cognitive impairment and affeetive disorder. Along with these two symptoms, patients＇ P300 and N400 had a prolonged latency and decreased amplitude. The data were obviously improved after treatment of prozae （fluoxetine） and the e- lectroencephalogram （EEG） of ERP displayed that brain regions of temporal parietal lobe had obviously increased amplitude but the same latency. Conclusion Antiepileptic drugs can cause damages to epileptic patient＇ s cognitive function. Compared to drug combination, single therapy is less harmful to epileptics＇ cognitive function. Epileptics＇ cognitive function can be ameliora- ted by anti-depression therapy, so does the cognitive event related potential.