特发性癫痫儿童有无痫性放电与认知功能的研究

Study on cognitive function of idiopathic epilepsy children with or without epileptiform discharge

目的探讨未经治疗的特发性癫痫儿童有无痫性放电对认知功能的影响。方法将确诊的6~12岁特发性癫痫儿童分为有痫性放电组和无痫性放电组各30例,采用中国修订的韦氏儿童智力测验量表（WISC-CR）进行检查,治疗前和治疗至少间隔半年后再进行WISC-CR测验,比较两组对认知功能的影响。结果①痫性放电组和非痫性放电组治疗前语言智商（VIQ）、操作智商（PIQ）及总智商（FIQ）无显著性差异（P〉0.05）;痫性放电组治疗后VIQ、PIQ及FIQ均明显提高,治疗前后比较有显著性差异（P〈0.001）;非痫性放电组治疗后PIQ及FIQ均有提高,治疗前后比较有差异（P〈0.05）,而VIQ差异无统计学意义（P〉0.05）。②两组患儿治疗前智力结构无显著性差异（P〉0.05）;痫性放电组治疗后言语分测验中的分类、算术、领悟、数字广度测验显著提高（P〈0.001）;操作分测验中的填图、图形拼凑、编码测验显著提高（P〈0.001）。非痫性放电组治疗后只有操作分测验中的填图测验有显著提高（P〈0.001）,言语分测验中的分类、领悟和操作分测验中的图形拼凑测验有明显提高（P〈0.05）外,其他项目均无明显改善（P〉0.05）。痫性放电组经过治疗领悟能力的改善明显好于非痫性放电组（P〉0.05）。结论痫性放电组和非痫性放电组认知功能均有损害,痫性放电组较非痫性放电组对认知功能的损害更为广泛,尤其是瞬时记忆、注意力、学习联想能力和抽象概括能力明显差于非痫性放电组,非痫性放电组社会适应能力的恢复较痫性放电组慢,及时、合理的有效治疗可以改善癫痫患儿的部分认知功能。

Objective To explore the effects of epileptiform discharges on cognitive function in the children with idiopathic epilepsy who had never been treated.Methods 30 children with epileptiform discharges were evaluated by WISC-CR and matched for 30 children without epileptiform discharges,they were diagnosed idiopathic epilepsy,aged 6-12.Before treatment and after 6 month＇s therapy they were retested and results were compared.Results ①Before treatment there were no statistical differences of VIQ,PIQ,FIQ between 2 groups（P 〈0.05）.After therapy the scores of VIQ,PIQ,FIQ all showed significantly higher than those before in the group with epileptiform discharges（P 〈0.001）;Excepting VIQ,the scores of PIQ,FIQ of the controls also showed significantly higher than Before（P 〈0.05）.②Both groups were not seen statistical significant of intelligence profile before treatment（P 〈0.05）;After therapy some scores of VIQ or PIQ were significantly higher than those before in the group with epileptiform discharges（P 〈0.001）,they include sorting,arithmetic,insight,digit span,completion of drawing,graph alignment,decipher.Nevertheless in the controls,comparing with the treatment before there were only the scores for completion of drawing of PIQ showed significant difference（P 〈0.001）,the scores for sorting,insight of VIQ and the scores for graph alignmen of PIQ also improved（P 〈0.05）.The ability of insight in the group with epileptiform discharges were obviously better than that of the control group after treatment.Conclusion The idiopathic epileptic children with or without epileptiform discharges all show cognitive impairments.The group with epileptiform discharges show more extensive damage than the controls,especially worse on immediate memory,attention,association learning ability and abstract epitome ability.While the social adaptive capacity of the group without epileptiform discharges recovery relatively slow than the group with epileptiform discharges.It is suggested that timely,reasonable effective treatment can improve part cognitive function of epileptic children.