伴中央颞区棘波的儿童良性癫痫认知功能与电临床特征的相关性研究

doi:10.12372/jcp.2024.22e1748

临床儿科杂志 ›› 2024, Vol. 42 ›› Issue (3): 211-217.doi: 10.12372/jcp.2024.22e1748

伴中央颞区棘波的儿童良性癫痫认知功能与电临床特征的相关性研究

陈世彩¹, 段丽芬², 孙莹², 邵举薇³, 李琼¹, 罗明英¹, 任君君⁴, 张云茜¹()

1.云南大学附属医院神经内科（云南昆明 650021）
2.昆明市儿童医院癫痫中心（云南昆明 650031）
3.云南大学附属医院放射科（云南昆明 650021）
4.云南大学附属医院临床心理科（云南昆明 650021）

收稿日期:2023-01-04 出版日期:2024-03-15 发布日期:2024-03-06
通讯作者: 张云茜电子信箱：zhangyunqian168@163.com
基金资助:
中国抗癫痫协会癫痫科研基金(UCB2019027);中国抗癫痫协会癫痫科研基金(No.CQ-B-2021-04);云南省卫生和计划生育委员会医学学科带头人培养计划项目(D-2017030);昆明市卫生科技人才培养项目暨“十百千”工程培养计划(No. 2021-SW（省）-23);云南省科技厅-昆明医科大学应用基础研究联合专项资金(2019FE001-097);昆明医科大学2022年硕士研究生创新基金(2022S361)

Correlation between cognitive function and electroclinical characteristics of benign childhood epilepsy with centrotemporal spikes

CHEN Shicai¹, DUAN Lifen², SUN Ying², SHAO Juwei³, LI Qiong¹, LUO Mingying¹, REN Junjun⁴, ZHANG Yunqian¹()

1. Department of Neurology, The Affiliated Hospital of Yunnan University, Kunming 650021, Yunnan, China
2. Epilepsy Center, Kunming Children's Hospital, Kunming 650031, Yunnan, China
3. Department of Radiology, The Affiliated Hospital of Yunnan University, Kunming 650021, Yunnan, China
4. Department of Clinical Psychology, The Affiliated Hospital of Yunnan University, Kunming 650021, Yunnan, China

Received:2023-01-04 Online:2024-03-15 Published:2024-03-06

摘要/Abstract

摘要：

目的探讨伴中央颞区棘波的儿童良性癫痫（BECT）患儿认知功能与临床因素、脑电图痫样放电之间的相关性。方法回顾性分析2019年1月至2022年7月行长程视频脑电图监测的BECT患儿的临床资料，另选取同期门诊行健康体检的健康儿童作对照组。对两组儿童进行中国修订-韦氏儿童智力量表测试，对比两组智商情况及分析BECT患儿临床因素和脑电图痫样放电与总智商（FIQ）、言语智商（VIQ）及操作智商（PIQ）之间关系。结果纳入42例经典型BECT患儿，男18例、女24例，平均年龄（9.4±2.0）岁，平均起病年龄（7.4±2.6）岁。对照组45例，男28例、女17例，平均年龄（9.7±2.2）岁。与对照组相比，BECT组的FIQ、VIQ、VIQ子项中的分类和词汇以及PIQ中的木块图得分均较低，差异有统计学意义（P<0.05）。42例BECT患儿中，与≥10岁组相比，<10岁组患儿的FIQ和VIQ较低，差异有统计学意义（P<0.05）；脑电图不同放电侧别组之间VIQ差异有统计学意义（P<0.05），双侧放电组得分较低。BECT患儿起病年龄与FIQ（r=0.39）、VIQ（r=0.57）、VIQ子项中知识（r=0.49）、分类（r=0.35）、词汇（r_s=0.62）、领悟（r=0.43）、数字广度（r=0.37）得分呈显著正相关（均P<0.05），病程与VIQ子项中知识得分（r_s=-0.31）呈显著负相关（P<0.05）。与起病年龄≥10岁组相比，<10岁组VIQ子项中知识、词汇量表得分较低，差异有统计学意义（P<0.05）。左侧组、右侧组和双侧组之间VIQ子项中知识、数字广度量表得分的差异有统计学意义（P<0.05）。结论 BECT患儿平均智力水平处于正常范围，但智力结构存在不平衡现象，以语言功能受损为主，起病年龄早、双侧大脑半球放电、病程长是影响BECT患儿语言功能、导致认知功能下降的主要因素。

关键词: 伴中央颞区棘波的儿童良性癫痫, 认知功能, 电临床特征

Abstract:

Objective To investigate the association of cognitive function and clinical factors with electroencephalogram epileptiform discharges in benign childhood epilepsy with centrotemporal spikes (BECT). Methods The clinical data of children with BECT monitored by long-term video electroencephalogram from January 2019 to July 2022 were retrospectively analyzed, and the healthy children who underwent physical examination in outpatient department during the same period were selected as control group. Chinese Revised Wechsler Intelligence Scale for Children (C-WISC) test was conducted in both groups of children. The intelligence quotient of the two groups was compared, and the relationship between clinical factors, electroencephalogram epileptiform discharges and total intelligence quotient (FIQ), verbal intelligence quotient (VIQ) and performance intelligence quotient (PIQ) in children with BECT were analyzed. Results A total of 42 patients (18 boys and 24 girls) with typical BECT were included, with an average age of (9.4±2.0) years and an average onset age of (7.4±2.6) years. The control group consisted of 45 healthy children, including 28 boys and 17 girls, with an average age of (9.7±2.2) years. FIQ, VIQ, scores of classification and vocabulary in VIQ sub-items, as well as wood block map in PIQ sub-items in BECT group were lower compared with the control group, with statistical significance (P<0.05). FIQ and VIQ in <10-year-old group were lower than those in ≥10-year-old group among 42 children with BECT, and the differences was statistically significant (P<0.05). There was a statistically significant difference in VIQ among different discharge side groups (P<0.05), and the score of bilateral discharge group was lower. The onset age of children with BECT was significantly positively correlated with FIQ (r=0.39), VIQ (r=0.57) and scores of knowledge (r=0.49), classification (r=0.35), vocabulary (r_s=0.62), comprehension (r=0.43) and digit span (r=0.37) in VIQ sub-items. The course of disease was significantly negatively correlated with the scores of knowledge (r_s=-0.31) in VIQ sub-items (P<0.05). Compared with the group with onset age ≥10 years old, the scores of knowledge and vocabulary in VIQ sub-items in the group with onset age <10 years old were lower, and the difference was statistically significant (P<0.05). There were statistically significant differences in the scores of knowledge and digit span in VIQ sub-items among left, right and bilateral groups (P<0.05). Conclusions The average intelligence level of BECT children is in the normal range, but there is an imbalance in the intellectual structure, mainly manifested as impaired language function. Early onset age, bilateral cerebral hemispheres discharges and long course of disease are the main factors that affect the language function and lead to the decline of cognitive function in children with BECT.

Key words: benign childhood epilepsy with centrotemporal spikes, cognitive function, electroclinical characteristics

陈世彩, 段丽芬, 孙莹, 邵举薇, 李琼, 罗明英, 任君君, 张云茜. 伴中央颞区棘波的儿童良性癫痫认知功能与电临床特征的相关性研究[J]. 临床儿科杂志, 2024, 42(3): 211-217.

CHEN Shicai, DUAN Lifen, SUN Ying, SHAO Juwei, LI Qiong, LUO Mingying, REN Junjun, ZHANG Yunqian. Correlation between cognitive function and electroclinical characteristics of benign childhood epilepsy with centrotemporal spikes[J]. Journal of Clinical Pediatrics, 2024, 42(3): 211-217.

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参考文献 20

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项目	对照组(n=45)	BECT组(n=42)	统计量	P
男性[n(%)]	28(62.2)	18(42.9)	χ²=3.27	0.071
年龄($\bar{x}\pm s$)/岁	9.7±2.2	9.4±2.0	t=0.39	0.699
FIQ[M(P₂₅~P₇₅)]/分	112.0(107.0~118.0)	105.00(97.0~112.0)	Z=2.71	0.007
VIQ($\bar{x}\pm s$)/分	115.1±11.9	106.2±18.4	t=2.68	0.009
PIQ[M(P₂₅~P₇₅)]/分	107.0(95.0~116.0)	101.50(89.0~113.0)	Z=1.61	0.107
VIQ子项/分
知识($\bar{x}\pm s$)	10.7±3.0	10.1±3.5	t=0.85	0.398
分类[M(P₂₅~P₇₅)]	14.0(13.0~15.0)	13.0(10.0~15.0)	Z=2.40	0.016
算术[M(P₂₅~P₇₅)]	11.0(9.0~13.00)	10.0(9.0~13.0)	Z=1.02	0.307
词汇[M(P₂₅~P₇₅)]	13.0(12.0~16.00)	11.5(7.00, 15.0)	Z=2.83	0.005
领悟($\bar{x}\pm s$)	11.7±3.3	10.8±4.1	t=1.14	0.257
数字广度[M(P₂₅~P₇₅)]	11.0(9.0~12.0)	10.0(8.0~14.0)	Z=0.13	0.898
PIQ子项/分
填图[M(P₂₅~P₇₅)]	9.0(7.0~11.00)	7.5(7.0~11.0)	Z=1.54	0.123
图片排列[M(P₂₅~P₇₅)]	10.0(9.0~11.00)	9.0(7.0~11.0)	Z=1.15	0.250
木块图($\bar{x}\pm s$)	12.9±2.9	10.7±3.4	t=3.35	0.001
图形拼凑($\bar{x}\pm s$)	12.6±3.7	11.6±3.5	t=1.33	0.186
编码($\bar{x}\pm s$)	10.7±3.0	10.7±2.8	t=0.04	0.968

项目	组别	例数	FIQ	VIQ	PIQ
起病年龄	<10岁	33	102.3±18.5	103.4±19.6	100.4±16.9
起病年龄	≥10岁	9	111.6±6.6	116.2±7.9	103.6±10.1
	t值		2.38	2.98	0.53
	P		0.023	0.005	0.599
病程	<1年	23	106.0±10.6	107.43±14.55	102.9±10.8
病程	≥1年	19	102.2±22.7	104.63±22.576	98.9±20.1
	t值		0.66	0.47	0.79
	P		0.514	0.629	0.440
发作类型	局灶性	17	108.8±14.0	110.4±15.3	104.7±13.8
发作类型	继发全面性	25	101.2±18.5	103.3±20.1	98.6±16.5
	t值		1.43	1.24	1.25
	P		0.160	0.222	0.220
发作次数	<5次	27	106.7±10.8	109.0±12.9	102.5±11.4
发作次数	≥5次	15	99.9±24.5	101.1±25.4	98.5±21.5
	t值		1.03	1.12	0.67
	P		0.319	0.278	0.512
放电侧别	左侧	14	110.8±10.9	116.4±10.5	101.8±12.2
	右侧	11	102.9±16.5	103.1±15.4	102.3±18.4
	双侧	17	99.8±20.5	99.8±22.2	99.8±16.9
	F值		1.71	3.77	0.10
	P		0.194	0.032	0.903
放电指数	<50%	28	103.4±15.2	104.6±16.4	101.1±14.3
放电指数	≥50%	14	106.0±20.9	109.29±22.3	101.1±18.6
	t值		0.46	0.77	0.01
	P		0.646	0.445	0.995
放电时程	<1年	29	104.9±14.0	106.5±16.5	101.8±12.8
放电时程	≥1年	13	102.9±23.1	105.4±22.9	99.5±21.1
	t值		0.28	0.18	0.36
	P		0.783	0.856	0.726

项目	起病年龄	病程	发作次数	放电指数	放电时程
FIQ	0.39¹⁾	-0.02	-0.15	0.06	-0.01
VIQ	0.57¹⁾	-0.01	-0.15	0.20	0.00
PIQ	0.10	-0.10	-0.07	-0.03	-0.06
VIQ子项
知识	0.49¹⁾	-0.31¹⁾	-0.20	-0.04	-0.21
分类	0.35¹⁾	0.09	-0.06	0.15	0.10
算术	0.23	0.10	-0.25	0.22	0.06
词汇	0.62¹⁾	0.01	-0.08	0.14	0.03
领悟	0.43¹⁾	0.03	-0.05	0.12	0.08
数字广度	0.37¹⁾	-0.05	-0.26	-0.05	0.07
PIQ子项
填图	0.01	-0.03	-0.10	-0.08	0.05
图片排列	-0.03	0.01	-0.27	-0.06	-0.09
木块图	0.14	-0.09	0.09	0.10	-0.05
图形拼凑	0.08	-0.19	-0.15	-0.15	-0.18
编码	0.13	-0.11	-0.01	0.04	-0.01

项目	<10岁(n=33)	≥10岁(n=9)	t值	P
VIQ子项
知识	9.4±3.4	12.8±2.8	2.73	0.009
分类	12.1±4.0	12.9±1.3	1.03	0.312
算术	10.6±3.6	11.0±3.5	0.34	0.735
词汇	10.5±4.0	13.8±2.8	2.82	0.011
领悟	10.4±4.2	12.2±3.5	1.19	0.242
数字广度	10.2±4.1	13.1±4.3	1.86	0.070
PIQ子项
填图	8.7±3.2	7.9±2.3	0.75	0.460
图片排列	9.6±3.1	9.6±3.3	0.01	0.993
木块图	10.4±3.5	11.6±2.9	0.88	0.382
图形拼凑	11.3±3.7	12.9±2.0	1.72	0.097
编码	10.7±2.8	10.9±2.7	0.21	0.833

项目	左侧(n=14)	右侧(n=11)	双侧(n=17)	F值	P
VIQ子项
知识	12.1±3.8	8.4±3.3	9.7±2.8	4.22	0.022
分类	13.7±3.0	12.1±3.6	11.1±3.7	2.18	0.126
算术	11.9±3.7	11.2±2.7	9.3±3.6	2.38	0.106
词汇	12.8±3.7	10.3±4.0	10.5±4.1	1.70	0.195
领悟	12.4±3.1	10.8±2.0	9.5±5.4	1.98	0.151
数字广度	12.7±4.3	11.3±2.5	9.1±4.5	3.29	0.048
PIQ子项
填图	8.1±2.3	8.2±2.9	9.1±3.5	0.51	0.603
图片排列	8.9±2.7	10.8±3.8	9.3±2.9	1.34	0.273
木块图	11.0±3.0	10.9±3.5	10.2±3.8	0.22	0.801
图形拼凑	12.9±2.6	11.0±3.8	11.0±3.8	1.35	0.272
编码	10.7±2.4	11.0±2.9	10.5±3.1	0.09	0.911

伴中央颞区棘波的儿童良性癫痫认知功能与电临床特征的相关性研究

Correlation between cognitive function and electroclinical characteristics of benign childhood epilepsy with centrotemporal spikes

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