临床下痫间样放电对青少年癫癇患者认知功能影响的研究

Clinical study on the effects of epileptiform discharges on cognitive function of adolescents with epilepsy

目的探讨临床下癇样放电对青少年癫癇患者认知功能的影响。方法以全身强直阵挛性发作(GTCS)为临床表现的特发性癫癇患者65例,无临床发作均超过3个月,其中35例动态脑电图或普通脑电图显示有癇样放电,30例患者动态脑电图均正常。65例患者均服用左乙拉西坦治疗,随访6个月,服药前后分别进行基本认知能力测试,分析两组患者6个月前后认知功能的变化。结果 63例完成本实验,两组实验前后IQ均在正常范围且差异不明显。但6个月后有癇样放电组认知功能明显下降(P<0.01),具体表现在数字鉴别(P<0.01)、汉字快速比较(P<0.01)、汉字旋转(P<0.01)、图形再认(P<0.01)等方面,而脑电图正常组认知功能无明显变化(P>0.05)。结论临床下癇样放电可损害患者的认知能力,应受到重视,采取适当的干预措施。

Objective To explore the effects of epileptiform discharges on cognitive function of adoles- cents with epilepsy. Methods The generalized tonic-clonic seizures as the clinical manifestations, 65 patients of idiopathic epilepsy who were free of clinical seizures more than three months included 35 cases of epilepti- form discharges demonstrated by dynamic EEG or routine EEG and 30 normal cases showed by dynamic EEG. All the patients have treated with Levetiracetam （LEV） for 6 months, then had a follow-up for the basic cog- nitive capacity and The results of the tests which completed before the treatment and following it were ana- lyzed. Results Sixty-three patients were examined by intelligent quotient （IQ） tests. There was no statistical difference in scores between the group of epileptiform discharges and the normal group before the treatment. The scores of basic cognitive ability test decreased significantly after 6 months treatment in the group of epilep- tiform disehargesin EEG （P〈0. 01）, including the identification of digit （P〈0. 01 ）, comparison of Chinese expression （P〈0. 01）, rotation of Chinese characters （P〈0. 01）, rerecognization of nonsense figure （P〈 0. 01） and so on. The cognitive function did not impair obviously after the treatment in people whose EEG are normal （P〉0. 05）. Conclusions Effective interventional measures should be taken, because the epileptiform discharge could damage the patients＇ cognitive functions.