不同起病年龄的癫痫性痉挛儿童认知功能的比较  

Comparative analysis of cognitive function of children with epileptic spasm at different onset ages

作　　者：姜虹 王雪莹[2] 孙娜[2] 杨琳[2] JIANG Hong;WANG Xueying;SUN Na;YANG Lin(Department of Pediatrics,Weinan Maternal and Child Health Hospital,Shaanxi Weinan 714000,China;Department of Pediatrics,the Second Affiliated Hospital of Xi'an Jiaotong University,Shaanxi Xi'an 710o04,China)

机构地区：[1]渭南市妇幼保健院儿科,陕西渭南714000 [2]西安交通大学第二附属医院儿科,陕西西安710004

出　　处：《中国妇幼健康研究》2022年第11期13-17,共5页Chinese Journal of Woman and Child Health Research

基　　金：陕西省重点研发计划资助项目(2021SF-283);西安市创新能力强基计划-(3)医学研究资助项目(21YXYJ0119)。

摘　　要：目的分析起始于婴儿期的癫痫性痉挛(IOS)与晚发型癫痫性痉挛(LOS)对儿童认知功能的影响有无差异。方法回顾性收集2018年3月至2021年9月在西安交通大学第二附属医院小儿内科住院的癫痫患儿,选取经临床观察和(或)视频脑电监测(VEEG)证实为癫痫性痉挛(ES)发作、发育商(DQ)测评和社会适应能力测评完善的患儿共66例,按ES发作的起病年龄将患儿分为IOS组(36例)和LOS组(30例)。对两组患儿的测评分值进行分析。结果IOS组ES发作起病的平均年龄为(0.43±0.18)岁,LOS组ES发作起病的平均年龄为(3.66±2.72)岁;IOS组以ES发作为唯一发作类型的有25例,占69.44%,LOS组以ES发作为首次发作类型的有11例,占36.67%。两组患儿中只有1例(1.52%)给予维生素B6单药治疗,其余65例(98.48%)均采用了抗癫痫药联合治疗,其中使用频率较高的药物是托吡酯(71.21%)。根据DQ分值评判:极重度缺陷15例(22.73%),重度缺陷24例(36.36%),中度缺陷11例(16.67%),轻度缺陷9例(13.64%);DQ>75的患儿7例(10.60%)。IOS组和LOS组患儿的DQ(应人能、言语能、应物能、动作能)4个能区及总DQ分值比较,差异均无统计学意义(P>0.05)。IOS组患儿的社会适应能力(独立生活、运动、作业、交往、集体生活及自我管理)6个领域的测评分值均明显落后于LOS组(t值分别为-3.316、-4.150、-4.197、-4.441、-3.690、-3.351,P<0.05)。结论89.39%的ES患儿有不同程度的智能发育落后,需要积极干预,促进其认知功能的改善。ES起病年龄越早,对社会适应能力影响越显著,尤其应重视IOS患儿,更应注重康复训练,改善患儿的认知功能,提高其生活质量。Objective To analyze the difference of cognitive function between infantile-onset spasms(IOS)and last onset epileptic spasms(LOS).Methods Children with epilepsy who were hospitalized in Department of Pediatrics of the Second Affiliated Hospital of Xi′an Jiaotong University from March 2018 to September 2021 were collected.66 children confirmed by clinical observation and(or)video electroencephalography(VEEG)as epileptic seizure(ES),development quotient(DQ)assessment and social adaptability assessment were selected,and divided them into IOS group(36 cases)and LOS group(30 cases)according to the age of onset of ES.The evaluation scores were analyzed.Results The average age of ES onset in IOS group was(0.43±0.18)years,and in LOS group was(3.66±2.72)years;In IOS group,25 cases(69.44%)had ES as the only seizure type,while in LOS group,11 cases(36.67%)had ES as the first seizure type.Only one patient(1.52%)in the two groups was treated with vitamin B6 monotherapy,and the other 65 patients(98.48%)were treated with combined antiepileptic drugs,among which topiramate(71.21%)was used more frequently.According to the DQ scores,there were 15 cases of extremely severe defect(22.73%),24 cases of severe defect(36.36%),11 cases of moderate defect(16.67%),9 cases of mild defect(13.64%)and 7 cases of DQ>75(10.60%).There was no significant difference between the two groups in the four DQ areas(coping,verbal,object,and motor ability)and the total DQ scores(P>0.05).The scores of six areas of children′s social adaptability(independent living,movement,homework,communication,group living and self-management)in IOS group were significantly lower than those in LOS group(t=-3.316,-4.150,-4.197,-4.441,-3.690 and-3.351,respectively,P<0.05).Conclusion 89.39%of the children in this study have different degrees of intellectual development backwardness,which requires active intervention to improve their cognitive function.The earlier the onset age of ES is,the more significant the impact on social adaptability is.Special attention should be

关 键 词：癫痫 癫痫性痉挛 视频脑电监测 认知功能 生活质量 

分 类 号：R179[医药卫生—妇幼卫生保健]