伴有中央颞区棘波的儿童良性癫痫患儿智力水平及智力结构

Study of level and structure of intelligence in children with benign epilepsy of childhood with centrotemporal spikes

目的 探讨伴有中央颞区棘波的儿童良件癫痫（BECT）患儿的智力水平及智力结构状况,研究各种因素对BECT患儿智力结构的影响.方法 采用中国修订韦氏儿童智力量表（WISC-R）及多重评估法对47例BECT患儿进行韦氏智力测验,语音意识测验和语素意识测验,并与在性别、年龄、文化程度和家庭背景等方面与之相匹配的30名健康儿童作对照比较,同时分析起病年龄、病程、发作频率、发作类型、放电部位和棘慢波指数等临床因素对BECT患儿智力和智力结构的影响.结果 47例BECT患儿平均总智商为104.20±12.34,较对照组（109.45±15.01）略低,但差异无统计学意义,2组之间的操作智商差异亦无统计学意义,仅语言智商（90.67±18.40）与对照组（98.17±13.18）相比显著降低（t=3.431,P〈0.05）;在语言智商各子项分析中,2组受试者之间＂词汇＂和＂类同＂项目差异存在统计学意义（BECT组：5.97±2.95、4.85±3.02,健康对照组：8.51±3.67、6.95±3.07,t=2.365、2.096,均P〈0.05）;BECT患儿的语音意识得分为12.56±2.34,语素意识得分为22.35±3.25,健康儿童分别为16.78±3.72和24.15±5.28,差异均有统计学意义（t=2.478、2.770,P〈0.05）;语言智商、＂类同＂、＂词汇＂、语音意识及语素意识与非快动眼睡眠（NREM）期棘慢波指数呈负相关（r=-0.305～-0.838,P〈0.05）,与起病年龄、病程和发作频率无相关性.左侧、右侧和双侧病灶者患儿间智商差异无统计学意义.部分性发作及部分性发作继发全身性发作组之间智商差异亦无统计学意义.结论 BECT患儿有正常的智力,但其智力结构存在不平衡现象,语言功能滞后于健康儿童.棘波指数影响BECT患儿的语言功能,而起病年龄、发作类型和放电部位对语言功能影响不大.

Objective To study the level and structure of intelligence in children with benign epilepsy of childhood with centrotemporal spikes（BECT）and investigate factors affecting their intelligence.Methods Congitive skills such as intelligence quotient（IQ）,phonological test and morphological test,were evaluated in 47 children with BECT,and the results were compared to a control group of 30 children matched for gender,age,level of education and family background.The effects of age of onset,disease course,seizure frequency,seizure type,location of spike,and spike and wave index（SWI）on the level and structure of intelligence were also analyzed.Results The total IQ score was slightly lower in children with BECT（104.20±12.34）when compared to the control group of normal children（109.45±15.01）,but the difference was not significant.There was no difference in performance IQ scores between BECT and normal children.BECT children had a lower verbal IQ score（90.67±18.40）when compared to the control group（98.17±13.18,t=3.431.P〈0.05）.Analyses of verbal subtests revealed significant differences between BECT and normal children in vocabulary and similarities（5.97±2.95 vs 8.51±3.67 and 4.85±3.02 vs 6.95±3.07,respectively,t value were 2.365 and 2.096,both P〈0.05）.The differences between BECT and normal children were also significant in phonological test and morphological test （12.56±2.3 vs 16.78±3.72 and 22.35±3.25 vs 24.15±5.28,respectively,t=2.478 and 2.770,both P〈0.05）.SWI was negatively correlated with verbal IQ,vocabulary,similarities,phonological test and morphological test（r=-0.305--0.838,P〈0.05）.Age of onset,disease course and seizure frequency were not correlated with verbal IQ,phonological test and morphological test.The level of intelligence was not different among children with left hemispheric foci,fight hemispheric foci or bilateral foci.The level of intelligence Was similar between children with partial seizures or secondarily generalized seizures.Conclusions Children with BECT have normal level of intelligence,but the structure of intelligence is abnormal with retardation of their language ability.SWI affects the language ability in children with BECT,but age of onset,seizure type and location of spike do not influence their language ability.