局灶性痫性放电对脑性瘫痪患儿认知发育的影响

关键词：脑性瘫痪  局灶性痫性放电  Gesell量表  认知发育  癫痫

Keywords:cerebral palsy  interictal epileptiform discharge  Gesell developmental scale  cognitive development  epilepsy

摘要：

      摘要 目的：研究局灶性痫性放电对脑瘫患儿认知发育的影响。 方法：回顾性研究伴痫性放电的脑瘫患儿脑电图结果，分析局灶性放电的分布特征；使用Gesell量表对伴及不伴痫性放电脑瘫患儿认知发育水平进行评估，并对发育商（DQ）进行比较。 结果：71例伴局灶性痫性放电脑瘫患儿的放电部位以脑前部为主，中央区比例最高，为17例（23.94%），其后依次为额区（16例，22.54%）、颞区（12例，16.90%）、顶区（11例，15.49%）、枕区（8例，11.27%）以及前额（7例，9.86%）；左右半球放电比例无明显差异。伴局灶性痫性放电的患儿（总DQ：42.09±16.31，应人能：46.50±20.01、应物能：45.01±17.69、粗大运动能：33.21±16.40、精细运动能：37.91±16.60、言语能：47.81±19.91）与无痫性放电患儿（总DQ：55.91±16.22，应人能：57.42±22.49、应物能：56.70±20.16、粗大运动能：49.65±19.09、精细运动能：54.22±20.33、言语能：61.58±23.22）相比，总DQ值及各能区DQ值均低于无临床下放电患儿，差异具有显著性意义（P＜0.05）。不同脑区放电患儿除中央区放电的粗大运动DQ值低于枕区并有显著性意义外（P＜0.05），其余不同脑区放电患儿在各能区的DQ值差异均无显著性意义（P＞0.05）；左侧半球放电患儿在除应物能外所有能区DQ值（总DQ：35.25±14.58，应人能：39.00±17.95，应物能：39.81±17.12，粗大运动能：24.77±15.13，精细运动能：30.81±15.61，言语能：41.86±18.04）均低于放电位于右侧半球患儿（总DQ：49.53±15.09，应人能：55.47±20.11、应物能：50.52±16.92、粗大运动能：39.15±13.74、精细运动能：45.26±15.21、言语能：57.26±19.50），差异具有显著性意义（P＜0.05）。 结论：局灶性痫性放电对脑瘫患儿认知发育有明显影响，不同脑区放电的影响程度无显著性差异，但左侧半球放电对患儿影响较右侧明显，对脑瘫患儿临床下放电进行干预可能改善认知发育。

Abstract:

      Abstract Objective: To study the effects of focal interictal epileptiform discharges (IEDs) on cognitive development in children with cerebral palsy. Method: In retrospective study of electroencephalogram in cerebral palsy with IEDs, the characteristics of focal epileptiform discharges was analyzed. Gesell developmental scale (GDS) was used to study the cognitive developmental level in cerebral palsy with or without IEDs, the developmental quotiences (DQ) were analyzed. Result: The focal interictal epileptiform discharges in 71 children with cerebral palsy were commonly found near the front of the brain, especially in central region (17, 23.94%), then in frontal region (16, 22.54%), temporal region (12, 16.90%), parietal region (11, 15.49%), occipital region (8, 11.27%) and prefrontal region (7, 9.86%); the ratio of epileptiform discharges between left hemisphere and right hemisphere didn't show significant difference; compared with cerebral palsy without focal IEDs (full scale DQ 55.91±16.22, personal-social behavior DQ 57.42±22.49, adaptive skill DQ 56.70±20.16, gross motor DQ 49.65±19.09, fine motor DQ 54.22±20.33, speech DQ 61.58±23.22), the cerebral palsy with focal IEDs had lower DQ (full scale DQ 42.09±16.31, personal-social behavior DQ 46.50±20.01, adaptive skill DQ 45.01±17.69, gross motor DQ 33.21±16.40, fine motor DQ 37.91±16.60, speech DQ 47.81±19.91), the differences had statistic significance (P＜0.05); among cerebral palsy with IEDs, there was no difference in DQ among diverse discharges region (P＞0.05) except gross motor quotient in central region (cerebral palsy with central discharges had lower gross motor quotient); cerebral palsy with discharges in left hemisphere (full scale DQ 35.25±14.58, personal-social behavior 39.00±17.95, adaptive skill DQ 39.81±17.12, gross motor DQ 24.77±15.13, fine motor DQ 30.81±15.61, speech DQ 41.86±18.04) than in right hemisphere (full scale DQ 49.53±15.09, personal-social behavior DQ 55.47±20.11, adaptive skill DQ 50.52±16.92, gross motor DQ 39.15±13.74, fine motor DQ 45.26±15.21, speech DQ 57.26±19.50) had lower DQ in all of aspects except adaptive skill, the difference had statistic significance (P＜0.05). Conclusion: Focal interictal epileptiform discharges had significant effects on cognitive development in children with cerebral palsy, there was no difference among diverse brain regions, but discharges in left hemisphere had greater impact than in right hemisphere, interventions on IEDs might improve the cognition of CP with IEDs.