5岁前癫痫儿童视觉-运动统合发育的前瞻性研究

Prospective study on development of visual-motor integration for children with epilepsy before the age of 5.

【目的】 评估 5岁前确诊为癫痫的儿童在 5～ 7岁时的视觉 运动统合发育状况 ,探讨癫痫发作频率和抗癫痫药物对他们视觉 运动统合能力的影响。 【方法】 以前瞻性研究方式 ,使用视觉 运动统合发育测验 (VMI)对 12 3名 5岁前确诊为癫痫的儿童在 5～ 7岁间每半年进行一次评定 ,结果与正常儿童作 1∶1配对比较 ,同时分析癫痫发作频率和抗癫痫药物与VMI评分的关系。 【结果】 癫痫儿童各时段的VMI评分明显低于正常儿童 ;治疗后无发作者的VMI评分高于发作未控制者 ,而且发作越频繁VMI评分越低 ,无发作者仅 5岁时的VMI评分低于正常儿童 ,发作未控制者则各时段均低于正常儿童 ;服用不同抗癫痫药物者相互间的VMI评分有显著差异 ,其中服苯巴比妥者VMI评分低于服丙戌酸钠或卡马西平者 ,苯巴比妥与其它抗癫痫药物合用者VMI评分最低 ,服药长短与VMI评分亦有明显关系。 【结论】 癫痫儿童学龄前的视觉 -运动统合发育明显滞后 ,与癫痫发作频率和治疗药物有关。为避免他们因此出现严重的认知、学习和行为问题 。

To evaluate the state on development of visuomotor integration of the children at the age of 5 to 7, who were diagnosed as epilepsy before the age of 5 and explore the influence of frequencies of epilepsy attacks and anticonvulsants on their ability of visuomotor integration. The perspective study was used. The whole of 123 children who were diagnosed as epilepsy before the age of 5 were tested with the development test of visual motor integration (VMI) from 5 to 7 years every half a year. Their test results were compared with those of normal children by 1∶1 matched case control study. Meanwhile, the relationship between frequencies of epilepsy attacks and VMI scores, and between anticonvulsants and VMI scores were analyzed. VMI scores of children with epilepsy were significantly lower than those of normal children in all testing time layers. VMI scores of the cases with no epilepsy attacks after treatment were higher than those of the cases whose epilepsy was not controlled, and the lower VMI scores they got, the higher frequencies of epilepsy attacks the cases had. VMI scores of the cases whose epilepsy was controlled were only lower than those of normal children at the age of 5. VMI scores of the cases whose epilepsy was not controlled were lower than those of normal children in all testing time layers. There were significant differences in VMI scores among the cases who took different anticonvulsants. VMI scores of the cases of taking Phenobarbital were lower than those of the cases of taking Valproicacid or Carbamazepine. VMI scores of the cases of taking Phenobarbital together with other anticonvulsants were the lowest. There was significant relationship between the period of taking anticonvulsants and VMI scores. [Conclusions] The development of visuomotor integration is significantly left behind in preschool epileptic children, and there is a high correlation between that and frequencies of epilepsy attacks, and between that and anticonvulsants. The positive intervention should be done to prevent them from serious problems on cognition, learning and behavior as a result of that.