发作间期样放电与癫患者认知功能下降有关

Interictal Epileptiform Discharges Contribute to Cognitive Decline in Patients with Epilepsy

目的探讨发作间期样放电(IEDs)对癫患者认知功能的影响。方法选取6个月内无临床发作的癫患者164例,随访2年(脱落96例,剔除癫发作12例,脑电图改变4例),共计收集52例为研究对象,其中有IEDs癫36例为IED组;无IED癫16例为无IED组。于随访2年前后分别完成24 h动态脑电图及认知功能评定。IED组根据清醒期有无IED分为清醒期IED亚组和清醒期无IED亚组。采用简易精神状态量表(MMSE),ADDENBROOKE'S认知功能检查中文版(ACE-R),短延时词语记忆[AVLT(N4)及连线测试(TMT)]评价各组癫患者的认知功能情况。结果随访前:IED组MMSE、ACE-R,AVLT(N4)及TMT与无IED组比较,均差异无显著性。随访2年后:IED组认知功能评分、ACE-R总分、语言和记忆分值均较无IED组下降,差异有统计学意义(P<0.05);IED组TMT-B延长值与无IED组比较,差异有统计学意义(P<0.05)。清醒期IED组和清醒期无IED组认知功能测试差异无显著性。结论 IEDs是导致癫患者认知功能下降的原因之一,主要表现在语言、记忆、执行功能。未发现清醒期IEDs与癫患者的认知功能相关。

Aim To disclose the potential contribution of interictal epileptiform discharges （IEDs） to the cognitive functions in patients with epilepsy. Methods Overall 164 patients, who had no clinical seizures within 6 months prior to recruitment, were recruited and followed up for 2 years. Ninety-six patients dropped off, 12 patients were excluded for observed seizure during follow-up and 24 h for ambulatory electroencephalography profile. The patients with lED （lED group, 36 patients） and those without lED （non-IED group, 16 patients） underwent AEEG and cognitive evaluation at two time points： at inclusion and 2 years later. The IED group was further divided into two groups depending on whether IEDs happened during awaking period or not. Results No significant difference between the lED group and the non- lED group was found at inclusion in terms of Mini-Mental State Examination （MMSE）, Addenbrooke＇s Cognitive Examination-Revised （ACE-R）, Auditory Verbal Learning Test （AVLT） and Trial Making Test （TMT）. In contrast, the reduced scores of ACE-R, language capacity and memory capacity （P〈0.05）, and the increased TMT scores （P〈0.05） as well, were significantly larger in the lED group than those in the non-IED group. Subgroup analysis was conducted depending on whether IEDs happened during awaking period or not. However, the subgroup analysis came out with no significant difference. Conclusion IEDs contributed to the cognitive decline in patients with epilepsy, mainly in terms of language, memory and executive functions. No correlation was identified between the IEDs that happened during awaking period and the cognitive functions.