经颅多普勒超声-视频脑电图评价睡眠中癫痫性电持续状态患儿大脑中动脉血流速度及其意义

Evaluation of middle cerebral artery blood flow velocity in children with electrical status epilepticus during sleep by transcranial Doppler-video electroencephalography and its significance

目的基于经颅多普勒超声(TCD)-视频脑电图(VEEG)评价睡眠中癫痫性电持续状态(ESES)患儿大脑中动脉血流速度,并分析其临床意义。方法回顾性分析河北省张家口市第一医院2019年1月至2021年1月40例ESES患儿(ESES组)的临床资料,采用TCD-VEEG检测深睡期大脑中动脉平均血流速度(MCAmean)和大脑中动脉(MCA)血流波动值,并与同期40例行健康体检儿童(健康对照组)进行比较。采用多元逐步回归分析ESES患儿深睡期MCAmean和MCA血流波动值与临床特征的关系。结果ESES组深睡期MCAmean和MCA血流波动值明显高于健康对照组[(17.87±7.38)%比(2.07±1.11)%和(92.92±21.64)cm/s比(58.11±8.04)cm/s],差异有统计学意义(t=13.389和9.536,P<0.01)。伴中央颞区棘波良性癫痫(16例)、伴中央颞区棘波良性癫痫变异型(13例)和获得性癫痫性失语(11例)患儿深睡期MCAmean和MCA血流波动值比较差异无统计学意义(P>0.05)。多灶性癫痫灶(16例)、双侧不对称癫痫灶(16例)和双侧同步对称癫痫灶(8例)患儿深睡期MCAmean和MCA血流波动值比较差异无统计学意义(P>0.05)。绝对同步波及全导广泛性ESES患儿(16例)深睡期MCA血流波动值明显高于不对称性ESES患儿(24例)[(22.37±2.37)%比(15.37±5.37)%],差异有统计学意义(t=4.890,P<0.01);两者深睡期MCAmean比较差异无统计学意义(P>0.05)。无明显认知损害(14例)、轻微认知损害(13例)和严重认知损害(14例)患儿深睡期MCA血流波动值分别为(14.21±5.20)%、(17.97±7.45)%和(22.10±7.94)%,三者比较差异有统计学意义(F=4.376,P<0.05);三者深睡期MCAmean比较差异无统计学意义(P>0.05)。多元逐步回归分析结果显示,ESES患儿深睡期MCA血液波动值与认知损害程度呈正相关(r=0.391,P<0.05)。结论基于TCD-VEEG检查获得的深睡期MCA血流波动值与ESES患儿认知损害程度呈正相关,或可为临床评估ESES患儿认知损害程度的可靠方式。

Objective To evaluate the middle cerebral artery blood flow velocity in children with electrical status epileptic during sleep(ESES)by transcranial Doppler(TCD)-video electroencephalography(VEEG),and analyze its clinical significance.Methods The clinical data of 40 children with ESES(ESES group)in Zhangjiakou First Hospital of Hebei Province from January 2019 to January 2021 were retrospectively analyzed.The mean flow velocity of middle cerebral artery(MCAmean)and middle cerebral artery(MCA)flow fluctuation value during deep sleep were measured by TCD-VEEG,and the results were compared with 40 healthy children(healthy control group)during the same period.The relationship between MCAmean,MCA flow fluctuation value during deep sleep and clinical characteristics was analyzed by multivariate stepwise regression.Results The MCAmean and MCA flow fluctuation value during deep sleep in ESES group were significantly higher than those in healthy control group:(17.87±7.38)%vs.(2.07±1.11)%and(92.92±21.64)cm/s vs.(58.11±8.04)cm/s,and there were statistical differences(t=13.389 and 9.536,P<0.01).There was no statistical difference in MCAmean and MCA flow fluctuation value during deep sleep in children with benign epilepsy with central temporal spinous wave(16 cases),benign epilepsy variant with central temporal spinous wave(13 cases)and acquired epileptic aphasia(11 cases)(P>0.05).There was no statistical difference in MCAmean and MCA flow fluctuation value during deep sleep in children with multifocal epileptic foci(16 cases),bilateral asymmetric epileptic foci(16 cases)and bilateral synchronous symmetric epileptic foci(8 cases)(P>0.05).The MCA flow fluctuation value during deep sleep in children with absolute synchronization and fully generalized ESES(16 cases)was significantly higher than that in children with asymmetric ESES(24 cases):(22.37±2.37)%vs.(15.37±5.37)%,and there was statistical difference(t=4.890,P<0.01);there was no statistical difference in MCAmean during deep sleep between 2 types of children(P>0.05).The MCA flow fluctuation value during deep sleep in children with non obvious cognitive impairment(14 cases),mild cognitive impairment(13 cases)and severe cognitive impairment(13 cases)was(14.21±5.20)%,(17.97±7.45)%and(22.10±7.94)%,and there was statistical difference(F=4.376,P<0.05);there was no statistical difference in MCAmean during deep sleep in 3 types of children(P>0.05).Multivariate stepwise regression analysis result showed that the MCA flow fluctuation value during deep sleep had positive correlation with the degree of cognitive impairment in children with ESES(r=0.391,P<0.05).Conclusions The fluctuation value of MCA during deep sleep by TCD-VEEG examination is positively correlated with the degree of cognitive impairment in children with ESES,which may be a reliable way for clinical evaluation of the degree of cognitive impairment in children with ESES.