难治性癫痫儿童致痫灶切除术后认知功能随访

Cognitive Function Follow-up after Epilepsy Surgery in Children with Refractory Epilepsy

目的随访致痫灶切除难治性癫痫患儿术后认知功能并分析其影响因素。方法采用癫痫计算机化认知任务测试的方法(computerized cognitive testing in epilepsy,CCTE)对2016年12月~2020年7月6岁以上接受致痫灶切除的难治性癫痫共29例患儿进行术前及术后9~14个月认知能力评估并加以比较。结果言语工作记忆(正背)、言语工作记忆(倒背)改善者分别占20.7%及17.2%,受损者分别占58.6%及51.8%,差异有统计学意义(P<0.05);其余各项手术前后比较,差异无统计学意义(P>0.05)。术后维斯康星卡片分类认知稳定者较认知改善或认知受损者的起病年龄偏大(P<0.05);在圆点数量估计及简单数字计算两项测验中,术后认知受损组较改善组患儿手术时年龄偏大(P<0.05);术后认知改善或受损与癫痫病程无关(P>0.05);致痫灶位于左侧半球患儿其配对联结学习项目的改善比例高于右侧(P<0.05);致痫灶位于右侧者其配对联结学习受损比例高于左侧(P<0.05);22例局灶皮质发育不良(focal cortex dysplasia,FCD)患儿术后认知较术前无明显变化。结论本研究发现术后言语工作记忆功能较术前多有受损;年龄较大儿童尽早手术有益于数学能力的保留。故对难治性癫痫儿童术后长期随访并评估其认知功能的损获非常重要,以便尽早发现其损害情况并给予干预。

Objective To analyze the cognitive function of children with refractory epilepsy after epilepsy surgery and its influencing factors.Methods The cognitive function of preoperative and postoperative at 9-14 months were evaluated and compared in 29 children with refractory epilepsy who underwent epilepsy surgery from December 2016 to July 2020 by using Computerized Cognitive Testing in Epilepsy(CCTE).Results The changes of Cognitive function after surgery:verbal working memory(forward)and verbal working memory(backward)improved account for 20.7%and 17.2%,respectively,impaired account for 58.6%and 51.8%,and the differences were statistically significant(P<0.05);there were no significant difference in other cognitive functions between before and after surgery(P>0.05).The analysis of influencing factors:the age of onset was older in children with stable Wisconsin Card Sorting Test function than those with improved or impaired cognition(P<0.05);In the two tests of dot number estimation and simple digital calculation the children in the cognitive impairment group were older than the improved group at the time of surgery(P<0.05).Cognitive function improvement or impairment was not related to the course of epilepsy(P>0.05).Children with left hemisphere lesions had a higher proportion of improvement in paired-associate learning than those in the right hemisphere(P<0.05);the proportion of paired-associate learning was higher in children with right hemisphere lesions than those in the left hemisphere(P<0.05).There was no significant change in cognition after operation among the 22 children with focal cortex dysplasia(FCD).Conclusion The verbal working memory function was more impaired after surgery than before surgery,and early surgery in older children is beneficial to the preservation of mathematical ability.Therefore,it is very important to follow up children with refractory epilepsy for the long term and assessment impairment of cognitive in order to detect and intervene as early as possible.