小儿癫痫脑电图频段功率及放电指数变化与认知损伤分级的相关性分析

Correlation analysis of frequency band power and discharge index of EEG and cognitive impairment grade in children with epilepsy

目的观察小儿癫痫脑电图(EEG)频段功率及放电指数变化,分析其与认知损伤分级的相关性。方法选取2015年2月—2019年1月衡水市人民医院收治的140例癫痫患儿为研究组,另选取同期院内体检的30例健康儿童为对照组。比较两组韦氏儿童智力量表第四版中文版(WISC-IV)评分;根据研究组患儿WISC-IV评分分为智力正常、智力异常/临界状态、智力损害3个等级,比较不同分级癫痫患儿临床特点及EEG参数差异,并应用Logistic多元回归分析法分析不同认知损伤分级的危险因素;采用Spearman相关性分析认知损伤分级与θ频段相对功率及睡眠期放电指数的相关性。结果研究组患儿WISC-IV评分的言语智商、操作智商及总智商评分均低于对照组(P<0.05)。不同认知损伤分级、癫痫患儿病程、发病年龄、首发至就诊时间、照护者文化程度、联合使用抗癫痫药种类、发作形式、发作频率、难治性癫痫、θ频段相对功率、清醒期及睡眠期放电指数比较,差异均有统计学意义(P<0.05)。Logistic回归分析结果显示,病程、首发至就诊时间>6个月、联合使用抗癫痫药≥3种、发作形式≥2种、发作频率≥4次/月、θ频段相对功率、睡眠期放电指数>10%是导致智力异常/临界状态的独立危险因素(P<0.05);联合使用抗癫痫药≥3种、发作频率≥4次/月、θ频段相对功率、睡眠期放电指数>10%是导致智力损害的独立危险因素(P<0.05)。癫痫患儿认知损伤分级与θ频段相对功率及睡眠期放电指数均呈正相关(r=0.610、0.754,P<0.05)。结论小儿癫痫EEGθ频段功率及睡眠期放电指数与认知损伤分级呈正相关,二者可作为小儿癫痫认知损伤分级的重要参考指标。

Objective To observe the changes of frequency band power and discharge index of EEG in children with epilepsy,and to analyze its correlation with cognitive impairment grade.Methods 140 children with epilepsy admitted to the hospital from February 2015 to January 2019 were selected as the study group,and 30 healthy children who received in-hospital physical examination during the same period were selected as the control group.The scores of the fourth edition Chinese version of Webster’s Intelligence Scale for Children(WISC-IV)of the two groups were compared.According to WISC-IV score of the research group,it was divided into three levels:normal intelligence,abnormal/critical state and intellectual impairment.The clinical characteristics and EEG parameters of the children with different grades of epilepsy were compared.Logistic multiple regression analysis was used to analyze the risk factors with different cognitive impairment grades.Spearman correlation was used to analyze the correlation between cognitive impairment grade andθband relative power and sleep discharge index.Results Verbal IQ,operational IQ and total IQ scores in WISC-IV scores of the children in the study group were lower than those in the healthy group(P<0.05).There were statistically significant differences in the course of disease,age of onset,time from first onset to treatment,caregiver's education level,type of antiepileptic drugs used in combination,seizure type,seizure frequency,intractable epilepsy,relative power ofθband,awake and sleep period discharge index of children with epilepsy in different cognitive impairment grades(P<0.05).Logistic regression analysis showed that duration of the disease,time from the first episode to consultation>6 months,combined use of antiepileptic drugs≥3,seizure types≥2,seizure frequency≥4 times/month,relative power ofθband,EEG discharge index during sleep>10%were independent risk factors with leading to abnormal intelligence/critical state(P<0.05).Combined use of anti-epileptic drugs≥3,seizure frequency≥4 times/month,relative power ofθband,and EEG discharge index during sleep>10%were independent risk factors for intellectual impairment(P<0.05).The cognitive impairment grade of the children with epilepsy was positively correlated with relative power ofθband and sleep discharge index(r=0.610,0.754,P<0.05).Conclusion EEGθband power and sleep discharge index in children with epilepsy are positively correlated with cognitive impairment grade,and it both can be used as important reference indicators for identification of cognitive impairment of children with epilepsy.