摘要
目的 研究脑电图频段功率、放电指数变化与癫痫患儿认知损伤程度的相关性.方法 回顾性选取2023年1月至2024年1月入西安交通大学第一附属医院榆林医院的150例癫痫患儿为病例组,并将同期入院进行体检的150名健康儿童设为对照组.比较两组研究对象的韦氏儿童智力量表第四版(WISC-Ⅳ)中文版评分;且参考WISC-Ⅳ评分将病例组划分为智力正常组(n=44)、智力异常组(n=66)、智力损害组(n=40),比较智力正常组、智力异常组、智力损害组患儿的临床资料(性别、年龄、发病年龄、病程、家族史、癫痫类型、联用抗癫痫药物类型、家庭经济情况、发作频率、发作持续时间、发作形式、照护人员文化水平、首次发作至就诊时间等)、脑电图参数(脑电图频段相对功率、清醒期放电指数、睡眠期放电指数).采用多因素Logistic回归分析对影响癫痫认知损伤的因素进行分析.采用Spearman相关性分析法分析θ频段相对功率、睡眠期放电指数与认知损伤程度的关系.结果 病例组患儿的操作、言语及总智商评分分别为(77.48±6.01)、(83.13±6.08)、(79.06±6.51)分,均明显低于对照组[(103.84±9.06)、(109.67±7.43)、(106.34±8.27)分],差异均有统计学意义(P＜0.05).3组患儿的发病年龄、病程、难治性癫痫、发作频率、发作形式、联用抗癫痫药物类型、照护人员文化水平及首次发作至就诊时间比较,差异均有统计学意义(P＜0.05).智力正常组、智力异常组、智力损害组患儿的脑电图频段相对功率分布、清醒期放电指数分布、睡眠期放电指数分布比较,差异均有统计学意义(P＜0.05).多因素Logistic回归分析显示,智力异常/临界状态独立危险因素有病程、联用抗癫痫药物类型≥3种、发作频率≥4次/月、发作形式≥2种、首次发作至就诊时间＞6个月、θ频段相对功率、睡眠期放电指数＞10％(P＜0.05);智力损害出现的独立危险因素有联用抗癫痫药物类型≥3种、发作频率≥4次/月、θ频段相对功率、睡眠期放电指数＞10％(P＜0.05).Spearman相关性分析显示,θ频段相对功率、睡眠期放电指数与癫痫患儿认知损伤程度呈正相关(r=0.609、0.753,P＜0.05).结论 脑电图θ频段功率、睡眠期放电指数与癫痫患儿认知损伤程度呈正相关,可辅助评估癫痫患儿认知损伤程度.
Abstract
Objective To study the correlation between the changes of electroencephalogram frequency band power and discharge index and the degree of cognitive impairment in children with epilepsy.Methods A total of 150 children with epilepsy who were admitted to Yulin Hos-pital,The First Affiliated Hospital of Xian Jiaotong University from January 2023 to January 2024 were retrospectively selected as the case group,and 150 healthy children who were admitted to the hospital for physical examination during the same period were set as the control group.The scores of Wechsler intelligence scale for children-fourth edition version(WISC-Ⅳ)of chinese were compared between the two groups,and ac-cording to the WISC-Ⅳ score,the case group was divided into the normal intelligence group(n=44),the abnormal intelligence group(n=66),the mental impairment group(n=40).The clinical data(gender,age,age of onset,course of disease,family history,type of epilepsy,type of combined antiepileptic drugs,family economic status,frequency of seizure,duration of seizure,form of seizure,educational level of care-givers,time from first seizure to treatment,etc.)and EEG parameters(EEG frequency band relative power,awake discharge index,sleep dis-charge index)of the normal intelligence group,abnormal intelligence group and mental impairment group were compared.The factors affecting the cognitive impairment of epilepsy were analyzed by multivariate Logistic regression.The relationship between the relative power of the θ,the band discharge index during sleep and the degree of cognitive impairment was analyzed by Spearman correlation analysis.Results The scores of opera-tion,speech and total IQ in the case group were(77.48±6.01),(83.13±6.08)and(79.06±6.51)points,respectively,which were signif-icantly lower than those in the control group[(103.84±9.06),(109.67±7.43)and(106.34±8.27)points],and the differences were sta-tistically significant(P＜0.05).There were statistically significant differences in the age of onset,course of disease,refractory epilepsy,seizure frequency,seizure form,type of combined antiepileptic drugs,education level of caregivers and time from the first seizure to treatment among the three groups(P＜0.05).There were statistically significant differences in the relative power distribution of EEG frequency band,the distribution of discharge index in awake period and the distribution of discharge index in sleep period among the normal intelligence group,the abnormal intelli-gence group and the mental impairment group(P＜0.05).Multivariate Logistic regression analysis showed that the independent risk factors of mental retardation/critical state were course of disease,type of combined antiepileptic drugs≥3,seizure frequency ≥ 4 times/month,seizure form≥2,time from first seizure to visit＞6 months,relative power of θ band,sleep discharge index＞10％(P＜0.05).The independent risk factors of mental impairment were combined antiepileptic drug type ≥3,seizure frequency ≥4 times/month,θ band relative power,sleep dis-charge index＞10％(P＜0.05).Spearman correlation analysis showed that the relative power of θ band and the discharge index during sleep were positively correlated with the degree of cognitive impairment in children with epilepsy(r=0.609,0.753,P＜0.05).Conclusion The power of EEG θ band and the discharge index of sleep are positively correlated with the degree of cognitive impairment in children with epilepsy,which can assist in evaluating the grade of cognitive impairment in children with epilepsy.
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