睡眠期脑电图异常对癫痫患者认知功能影响的随访研究

The impact of sleep interictal epileptiform discharge on cognitive function in epileptic patients: a follow-up study

目的:探讨成年癫痫患者深睡眠期脑电异常与认知功能受损的相关性。方法:随访深睡眠期发作间期痫样放电(interictal epileptic discharge,IED)阳性癫痫患者的动态脑电图(AEEG)及认知功能变化。结果:符合入组条件的受试者50例,其中46例患者完成随访。两年后随访时,深睡眠期复查脑电图仍然阳性的患者有31例,阴性的有15例。深睡眠期初选及两年后随访均IED阳性的患者,两年后随访时的简易精神状态速查量表(MMSE)评分显著降低(P<0. 001),ACE-R评分显著降低(P<0.001),语言流利性显著减退(P=0.009),语言功能显著减退(P<0.001)。结论:深睡眠期IED于入选及两年后随访时均阳性的患者,其认知功能损害显著,在成年患者的研究中首次证实深睡眠期IED与患者的认知功能损害相关。为进一步明确IED对执行功能的影响,尚需积累更大样本量以进一步研究。

Objective: To explore the correlation between interictal epileptiform discharge (IED) in deep sleep episodes of NREM phase and cognitive dysfunction in adult patients with epilepsy. Methods: A two-year follow-up of ambulatory EEG and cognitive evaluation were conducted for patients with IED in initial screening. Results: Forty-six out of 50 cases completed two-year follow-up. At 2 years after enrollment , thirty-one patients are still positive with interictal epileptiform discharge. In those patients, significant deteriorating performance in MMSE (P<0.001), ACE R (P<0.001), language fluency (P = 0. 009) and language (P<0. 001) were found. Conclusion: For those patients with positive interictal epileptiform discharge at enrollment and 2 years after enrollment, cognitive impairment was significant. This is the first evidence proving the correlation between deep-sleep interictal epileptiform discharge and cognitive impairment in adult patients. For further evidence, clinical research with larger sample size is needed.