基于总脑电图评分的发作间期脑电图分析对癫痫患者认知障碍早期评估的意义  

Research on early assessment significance of analysis of interictal electroencephalogram based on the Grand Total Electroencephalography score for cognitive impairment in epilepsy patients

作　　者：陈洪铧 鞠玲莉 季燕燕 陶丽红 Chen Honghua;Ju Lingli;Ji Yanyan;Tao Lihong(Department of Neurology,the Affiliated Hospital of Yangzhou University,Yangzhou University,Yangzhou 225009,China)

机构地区：[1]扬州大学附属医院神经内科,扬州大学,扬州225009

出　　处：《中华神经科杂志》2025年第1期36-45,共10页Chinese Journal of Neurology

摘　　要：目的探讨癫痫患者认知功能与发作间期脑电图表现的关联,以及总脑电图评分的早期评估意义。方法连续性收集2019年1月至2024年1月扬州大学附属医院神经内科收治的100例原发性癫痫患者,根据2017年国际抗癫痫联盟发布的最新一版癫痫发作分类进行分类。记录所有研究对象的一般资料,包括年龄、性别、文化程度等情况。记录癫痫患者的疾病细节,包括发作持续时间、严重程度、发作先兆、发作后状态、抗癫痫发作药物使用情况。所用的调查量表和问卷包括发作间期总脑电图评分、蒙特利尔认知评估量表(MoCA)、汉密尔顿焦虑量表、汉密尔顿抑郁量表、中文版国立癫痫发作严重程度量表、癫痫持续状态严重程度评分量表(STESS)。将所有研究对象按照MoCA评分的高低分为认知正常组、轻度认知障碍(MCI)组和痴呆组,进行多组间比较和两两比较。两变量的相关性采用Spearman等级相关分析,采用多元线性回归分析筛选对认知障碍有影响作用的变量。绘制受试者工作特征曲线,确定预测癫痫发生认知障碍的临界点。结果根据MoCA评分,100例癫痫患者中认知正常组32例(32%),MCI组49例(49%),痴呆组19例(19%)。3组在年龄[分别为(26.31±10.01)岁、(43.96±16.19)岁、(57.68±16.83)岁,F=29.440,P<0.001]、受教育程度(χ^(2)=28.894,P<0.001)、抗癫痫发作药物使用情况(χ^(2)=11.258,P=0.017)、STESS得分[分别为2.00(1.75,2.25)分、2.00(2.00,3.00)分、3.50(2.75,4.25)分,H=12.646,P=0.002]、STESS得分>2分(χ^(2)=10.075,P=0.006)、背景波频率(H=17.429,P<0.001)、弥漫性慢波(H=42.033,P<0.001)、背景波反应性(H=15.206,P<0.001)、阵发性波(H=25.279,P<0.001)、尖波(H=15.492,P<0.001)以及总脑电图整体评分[分别为1(1,3)分、6(2,8)分、8(7,11)分,H=47.871,P<0.001]方面的差异均有统计学意义。认知(MoCA评分)与总脑电图整体评分(ρ=-0.766,P<0.001)、背景波频率(ρ=-0.520,P<0.001)、Objective To investigate the association between cognitive impairment and manifestation of interictal electroencephalogram(EEG)in epilepsy patients,and the early assessment significance of the Grand Total Electroencephalography(GTE)score.Methods A totall of 100 patients with primary epilepsy admitted to the Department of Neurology of the Affiliated Hospital of Yangzhou University were continuously collected from January 2019 to January 2024,and they were classified according to the latest version of the epilepsy classification by the International League Against Epilepsy in 2017.General information of all research subjects was recorded,including age,gender,educational level,etc.The disease details of epilepsy patients were recorded,including seizure duration,severity,seizure precursors,post seizure status,and use of anti-seizure medications(ASM).The survey scales and questionnaires used included the interictal GTE,Montreal Cognitive Assessment(MoCA),Hamilton Anxiety Scale,Hamilton Depression Scale,National Hospital Seizure Severity Scale(NHS3),Status Epilepticus Severity Score(STESS).All research subjects were classified into normal cognitive(NC)group,mild cognitive impairment(MCI)group,and dementia group according to MoCA score.Comparisons among multiple groups and pairwise comparisons were conducted.The correlation between 2 variables was analyzed using Spearman rank correlation analysis,and multiple linear regression analysis was employed to screen variables that have an impact on cognitive impairment.The receiver operating characteristic curve was plotted to determine the optimal cut-off point for predicting cognitive impairment in epilepsy.Results According to the MoCA score,there were 32(32%)patients in the NC group,49(49%)patients in the MCI group,and 19(19%)patients in the dementia group.There were statistically significant differences in age[(26.31±10.01)years,(43.96±16.19)years,(57.68±16.83)years,respectively;F=29.440,P<0.001],education(χ^(2)=28.894,P<0.001),ASM(χ^(2)=11.258,P<0.017),STESS score[2.

关 键 词：癫痫 认知障碍 总脑电图评分 

分 类 号：R742.1[医药卫生—神经病学与精神病学] R749.1[医药卫生—临床医学]