Aldenkamp Albert Pierre, Beitler Jolanda, Arends Johann, van der Linden Inge, Diepman Leonie
Department of Behavioural Research and Clinical Neuropsychology, Epilepsy Centre Kempenhaeghe, P.O. Box: 61, NL-5590 A.B. Heeze, The Netherlands.
Funct Neurol. 2005 Jan-Mar;20(1):23-8.
In this prospective, open, clinical comparative study we analyzed impairments of cognitive activation occurring during, immediately before and immediately after epochs with epileptiform EEG discharges of 3 seconds or longer, in an attempt to establish whether cognitive slowing occurs in direct association with an epoch with epileptiform EEG discharges and whether cognitive impairments precede or follow such an epoch. All children were assessed with EEG/video (Brainlab) simultaneously with computerized neuropsychological testing (FePsy): a test for cognitive activation (simple visual and auditory reaction time measurement). Thirty-seven epochs with epileptiform EEG discharges without clinical signs of a seizure (subclinical epileptiform EEG discharges) were evaluated. The results showed a statistically significant and clinically relevant slowing (35% compared to the overall reaction time), occurring during the epoch with epileptiform EEG discharges (repeated measurement analysis of variance p = < .05; df = 3; F-value: 3.293). No statistically significant slowing was found for the periods 'post-discharge' or 'pre-discharge'. Type of discharge was important and effects on cognitive activation were found exclusively for generalized discharges. This effect was, however, also seen in the remaining period, outside the 'peri-discharge' periods and thus seemed to represent a more general effect of the type of epilepsy on cognitive activation. Our results show that the acute effect of short epileptiform EEG discharges (duration 4.14 sec; sd 1.38) may be impressive, causing impairment (slowing) of cognitive activation. This effect was limited to generalized discharges. This effect was not observed for focal discharges, even during longer periods with discharges. However, it is reassuring that this impact on cognitive activation is limited to the actual period in which the discharges occur and does not have 'post-discharge' effects. The risk of accumulating effects that may have longer-lasting repercussions on higher-order cognitive functions therefore seems to be negligible.
在这项前瞻性、开放性临床对照研究中，我们分析了在脑电图（EEG）出现持续3秒或更长时间的癫痫样放电期间、之前及之后即刻出现的认知激活障碍，以确定认知减慢是否与癫痫样EEG放电直接相关，以及认知障碍是先于还是后于这样一个时间段出现。所有儿童均接受EEG/视频监测（Brainlab），同时进行计算机化神经心理测试（FePsy）：一项认知激活测试（简单视觉和听觉反应时间测量）。对37次无癫痫发作临床体征的癫痫样EEG放电（亚临床癫痫样EEG放电）进行了评估。结果显示，在癫痫样EEG放电期间出现了具有统计学意义且临床相关的减慢（与总体反应时间相比减慢35%）（重复测量方差分析p = <.05；自由度 = 3；F值：3.293）。在“放电后”或“放电前”时间段未发现具有统计学意义的减慢。放电类型很重要，且仅在全身性放电时发现了对认知激活的影响。然而，在“放电周围”时间段之外的其余时间段也观察到了这种效应，因此这似乎代表了癫痫类型对认知激活的更普遍影响。我们的结果表明，短暂癫痫样EEG放电（持续时间4.14秒；标准差1.38）的急性效应可能很显著，会导致认知激活受损（减慢）。这种效应仅限于全身性放电。局灶性放电即使在较长的放电时间段内也未观察到这种效应。不过，令人放心的是，这种对认知激活的影响仅限于放电发生的实际时间段，且没有“放电后”效应。因此，对高阶认知功能可能产生更持久影响的累积效应风险似乎可以忽略不计。
