临床下痫样放电对成人癫痫患者认知功能的影响

Effect of subclinical epileptiform discharges on cognitive function in adult epilepsy

目的 研究临床下痫样放电（subclinical epileptiform discharges,SED）对成人癫痫患者认知功能的影响,以探讨SED引发成人癫痫患者认知功能损害的机制.方法 收集2016年3月至2017年3月就诊于吉林大学中日联谊医院神经内科,且＞3个月无临床发作的成人癫痫患者60例作为SED组,以健康志愿者40名为对照组,详细记录SED组病史.两组均行焦虑自评量表、抑郁自评量表、匹兹堡睡眠质量指数筛查,以排除器质性脑部疾病、代谢性疾病、焦虑、抑郁、睡眠障碍及药物对认知功能的影响.两组均行蒙特利尔认知评估量表（MoCA）检测、长程脑电图监测及基于血氧水平依赖效应的功能磁共振成像检查,并进行对比分析.结果 ①SED对成人癫痫患者认知功能存在不同程度损害,SED组MoCA得分[总分26（22,27）分]与对照组[总分29（28,29）分]相比差异有统计学意义（Z=-6.26,P=0.00）.②SED组中不同放电指数对认知功能的影响程度不同,放电指数＞10％对认知功能损害明显[放电指数1％ - 10％组MoCA总分为26（26,28）分,10％- 50％组为22（19.5,25）分,Z=-4.74,P=0.00].③癫痫患者认知功能与受教育年限（r=0.41,P=0.00）、距离近一次发作时间（r =0.31,P=0.02）呈正相关,与SED（r=-0.57,P=0.17）呈负相关,与病程及首发年龄未见相关.其中SED是本研究中成人癫痫患者认知功能的主要影响因素.④SED组患者静息态脑功能网络连接存在差异,与对照组比较发现连接增强的区域为：右侧颞下回、右侧海马、双侧丘脑;连接减弱区域为：双内侧额上回、双背外侧额上回.结论 SED影响成人癫痫患者认知功能,可能与认知相关区域的脑功能网络连接异常有关.

Objective To investigate the effect of subclinical epileptiform discharges （SED） on the cognition of adult patients with epilepsy,exploring the mechanism of SED that leads to cognitive impairment in adult patients with epilepsy to raise physicians＇ attention about SED.Methods Patients were collected in the Department of Neurology,China-Japan Union Hospital of Jilin University from March 2016 to March 2017.Sixty adult patients with epilepsy without clinical episodes in the last three months were selected as SED group and 40 healthy volunteers as control group.Medical history of the SED group was recorded in detail.All patients were examined by Self-rating Anxiety Scale,Self-rating Depression Scale,Pittsburgh Sleep Quality Index scale in order to exclude organic brain disorders,metabolic diseases,anxiety,depression,sleep disorders and drug-induced cognitive dysfunction.Subjects in the two groups received Montreal Cognitive Assessment （MoCA）,electroencephalogram and blood oxygen level dependent functional magnetic resonance imaging examination.Finally,the results were compared between the two groups.Results ①SED had different effects on cognitive function in adult patients with epilepsy,and the MoCA score （26（22,27）） showed statistically significant difference compared with the control group （29 （28,29）,Z =-6.26,P =0.00）.②Different discharges indexes showed different effects on cognitive function aspects.Cognitive impairment was significant when the discharges indexes were 〉 10% （discharges indexes 1%-10%：MoCA score 26（26,28）,discharges indexes 10%-50%：MoCA score 22（19.5,25）,Z =-4.74,P =0.00）.③The cognitive function of epilepsy patients was positively correlated with the duration of education （r =0.41,P =0.00） and the time interval to recent seizure （r =0.31,P =0.02）,and negatively correlated with SED （r =-0.57,P=0.17）.There was no correlation between cognitive function and duration of disease and onset age.The SED was the main influencing factor of cognitive function in epilepsy.④Compared with healthy people,epilepsy patients with SED showed differences in resting brain function network connection,with strong connective regions at the right inferior temporal gyrus,right hippocampus,bilateral thalamus,with weak connective regions at the double medial upper frontal gyrus,lateral dorsal frontal gyurs.Conclusions SED had an effect on the cognitive function of adult patients with epilepsy.The mechanism of cognitive impairment in adult epilepsy with SED may be related to abnormal brain function in cognitive-related areas.