单药治疗的癫患儿认知功能的临床随访研究

A clinical follow-up of cognition in epileptic children medicated with monotherapy

目的 了解影响癫患儿认知功能的因素 ,尤其是抗癫药物 (苯巴比妥、卡马西平、丙戊酸 )对其有无影响。方法 对 38例单药治疗的癫患儿及 15例正常儿童的多项认知功能指标进行 6～ 12个月的随访研究。结果 (1)癫患儿言语智商 (10 6± 11)、短时视觉记忆 (12 3± 4 2 )及对外界信息的反应速度 [单音辨认反应时间 (4 92± 75 )ms、汉字辨认反应时间 (6 15± 99)ms]均落后于正常同龄儿 [分别为 112± 7、14 9± 3 8、(4 43± 5 5 )ms、(5 5 8± 70 )ms,P均 <0 0 5 ]。 (2 )癫患儿的认知功能水平是多因素共同作用的结果 :①年龄是影响癫患儿及正常儿多项认知指标的共同因素 ;②抗癫药种类与短时视觉记忆、言语智商及注意力指标有关 ;血药浓度和服药时间与各认知指标无关 ;③患病时间、临床发作类型、发作持续时间、惊厥持续状态史等因素对短时视觉记忆、注意力、反应速度及手的协调运动等方面产生影响 ,不同因素作用的方面有所不同。 (3)单药治疗已控制发作的癫患儿 ,多数认知指标发育与同龄儿持平 ,仅汉字结构辨认事件相关电位P3潜伏期的缩短速度落后于同龄儿 [前后 2次测验差值 :癫组为 (5 17± 30 95 )ms,对照组为 (- 13 0 4± 1 91)ms,P <0 0 5 ]。结论 癫患儿的认知功能状?

Objective To examine the effect of factors especially the effects of conventional AEDs (phenobarbital, carbamazepine and valproate) on cognitive function of epileptic children Methods A 6 12 month follow up research on aspects in cognitive function of 38 epileptic children with monotherapy and 15 normal children was done Results The epileptic children had poor VIQ, poor short term memory and slow reactive speed as compared to control subjects [verbal IQ 106±11 vs 112±7; short term visual memory 12 3±4 2 vs 14 9±3 8; odd ball reactive time (492±75)ms vs (443±55)ms, Chinese discriminate(615±99)ms vs (558±70)ms, P <0 05] Cognitive functions of epileptic children were affected by multifactors: ①Age was a factor affecting a variety of aspects of cognition in epileptic children and controls ②Type of AEDs was also a factor affecting cognitive functions including short term memory, VIQ and attention However, blood concentration of drug and duration of medication were not affecting factors ③Duration of illness, seizure type, duration of seizure, status epilepticus affected many items including short term memory, concentration , reactive speed and motor speed of hand Different factors affected on different aspects of cognition Children with controlled clinical seizures developed similar cognitive aspects with controls except to that of Chinese architecture discrimination ERP P3 latency (the difference between two tests was(5 17±30 95)ms in epileptic group, and (-13 04±1 91)ms in control group, P <0 05) Conclusion The level of cognition and development of epileptic children were affected by many factors including AEDs Children with controlled clinical seizures by AEDs had similar developing cognitive function with controls