颞叶癫痫患者的认知功能障碍特点及影响因素分析

Characteristics of cognitive dysfunction in patients with temporal lobe epilepsy and its influencing factors

目的探讨耐药性颞叶癫痫(TLE)患者的认知功能障碍特点及影响因素。方法选取2015年12月至2020年5月山东省阳信县中医院脑病科收治的52例耐药性TLE患者作为观察组,同期收集104例非耐药性颞叶癫痫患者作为对照组。所有研究对象均采用蒙特利尔认知评估量表(MoCA)进行认知功能评价,然后再根据MoCA评分是否≥26分,将156例患者分为认知功能障碍组和认知功能正常组,进一步通过逻辑回归分析导致认知功能受损的风险因素。结果观察组病程较对照组偏长,受教育年限偏短,发作频率更高,联合用药比例高。观察组MoCA中视空间与执行能力、命名、注意力、语言流畅、抽象思维、延迟记忆及定向力等评分均低于对照组,差异有统计学意义(P<0.05)。病程与观察组的认知功能损害密切相关,OR(95%CI)为2.799(1.421~5.639),病程越长,越容易出现认知功能损害。发作频率亦与观察组的认知功能损害密切相关,OR(95%CI)为8.333(2.738~11.256),发作频率越高,认知功能损害越重。用药种类多亦与认知功能损害密切相关,OR(95%CI)为4.325(3.401~8.563)。结论病程长、用药种类多及发作频率高可能是耐药性TLE患者认知功能损害的独立危险因素。

Objective To explore the characteristics of cognitive dysfunction of patients with drug-resistant temporal lobe epilepsy(TLE)and its influencing factors.Methods At the Department of Encephalopathy,Traditional Chinese Medical Hospital of Yangxin County in Shandong Province from December 2015 to May 2020,52 patients with drug-resistant TLE were selected as observation group,while 104 patients with non-drug-resistant TLE were collected as control group.All patients were assessed for cognitive function using Montreal cognitive assessment(MoCA).Based on whether each patient's MoCA score was greater than 26,these 156 patients were classified into cognitive dysfunction and normal cognitive function groups.Logistic regression was applied to analyze the risk factors contributing to cognitive impairment.Results When compared with control group,observation group had a longer course of disease,shorter education year,higher seizure frequency and higher proportion of combined medication usage.Observation group had significantly lower MoCA scores in visuospatial and executive ability,naming,attention,language fluency,abstract thinking,delayed memory and orientation than control group(P<0.05).The course of disease was closely associated with cognitive impairment with an OR(95%CI)of 2.799(1.421~5.639).The longer the course of disease,the more prone it was to cognitive impairment.Seizure frequency was also closely associated with cognitive impairment with an OR(95%CI)of 8.333(2.738~11.256).The higher the frequency of seizures,the more severe the cognitive impairment.Multiple types of medication were also closely related to cognitive impairment with an OR(95%CI)of 4.325(3.401~8.563).Conclusion Long course of disease,multiple types of medication and high frequency of seizures may be independent risk factors for cognitive impairment in patients with drug-resistant TLE.