Billard C, Hassairi I, Delteil F
Centre de référence sur les troubles des apprentissages, hôpital Bicêtre, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre, France.
Arch Pediatr. 2010 Apr;17(4):350-8. doi: 10.1016/j.arcped.2010.01.012. Epub 2010 Feb 26.
Electroencephalographic recording (electroencephalogram [EEG]) is frequent in specific language impairment (SLI), whereas the relations between epileptiform activity (EA) and language disorders remain uncertain and the therapeutic approach undetermined. The aim of this prospective study was to clarify EEG indications and interpretation in SLI.
We present a prospective study of cognitive (speech-language measures, psychological assessments) and electroencephalographic data on 24 children (20 males, 4 females; mean age: 4 years 5 months; range: 3 years to 4 years 8 months) with a diagnosis of SLI, defined as a pathologic score on at least 2 speech-language measures and IQ performance of at least 80 points, within epileptic seizures. All participants had an EEG after partial deprivation of sleep at night. When nonsporadic EA was found, 24-h EEG was performed. Antiepileptic treatment was prescribed depending on the frequency of discharges and the SLI profile. The follow-up lasted 2 years.
All patients reached stage II sleep during their EEG. Seven children had abnormal electroencephalography results, including 5 children with EA. Two patients with mixed SLI prevailing on expression presented a left centrotemporal spike focus on EEG becoming subcontinuous during sleep. In the first case, the language progressed without antiepileptic treatment. The 2nd case was treated with ethosuximide; the EEG normalized on subsequent recordings, but the language disorder remained severe. The lexical and syntactic understanding and syntactic production scores were not different for children presented EA (5 cases) or without (19 cases) (Wilcoxon's test). Finally, the progression of the various linguistic skills was similar whether or not the children had EA (p<0.1).
Abnormal electroencephalographic activity is more frequent in SLI than in normal children. It can be seen in all types of SLI but preferentially in the mixed forms. The longitudinal systematic evaluation of all the children with or without EA has never been reported in the literature, which confirms that there is no parallel between EEG progression and language development, contrary to Landau-Kleffner's syndrome. Systematic EEG recording is not recommended in SLI. It is indicated in cases of fluctuation or stagnation of language development or if there is a family history of cognitive disorders or epilepsy. Antiepileptic treatment is justified in cases with fluctuation or stagnation in language development after 6 months of progression associated with frequent EA. However, when the EA is particularly diffuse and dense, an additional moderate aggravating effect on language development cannot be eliminated. The method most likely to clarify this question is to compare a child's baseline phase followed by a treatment phase, with the same double follow-up.
脑电图记录（脑电图[EEG]）在特定语言障碍（SLI）中很常见，而癫痫样活动（EA）与语言障碍之间的关系仍不明确，治疗方法也未确定。这项前瞻性研究的目的是阐明SLI中脑电图的指征和解读。
我们对24名被诊断为SLI的儿童（20名男性，4名女性；平均年龄：4岁5个月；范围：3岁至4岁8个月）进行了一项前瞻性研究，这些儿童的SLI定义为至少两项言语语言测量指标的病理评分以及癫痫发作时智商表现至少80分。所有参与者在夜间部分睡眠剥夺后进行了脑电图检查。当发现非散发性EA时，进行24小时脑电图检查。根据放电频率和SLI情况开抗癫痫治疗药物。随访持续2年。
所有患者在脑电图检查期间都进入了II期睡眠。7名儿童脑电图结果异常，其中5名儿童有EA。两名以表达为主的混合性SLI患者脑电图显示左中央颞部棘波灶，睡眠期间变得不连续。在第一例中，未进行抗癫痫治疗语言仍有进步。第二例用乙琥胺治疗；后续记录脑电图恢复正常，但语言障碍仍然严重。有EA（5例）和无EA（19例）的儿童在词汇和句法理解以及句法生成得分上没有差异（Wilcoxon检验）。最后，无论儿童有无EA，各种语言技能的进展相似（p<0.1）。
SLI中异常脑电图活动比正常儿童更常见。在所有类型的SLI中都可出现，但在混合形式中更常见。文献中从未报道过对所有有或无EA的儿童进行纵向系统评估，这证实了与Landau-Kleffner综合征相反，脑电图进展与语言发展之间没有平行关系。不建议在SLI中进行系统性脑电图记录。在语言发展波动或停滞、或有认知障碍或癫痫家族史的情况下进行脑电图检查。在与频繁EA相关的进展6个月后语言发展波动或停滞的情况下，抗癫痫治疗是合理的。然而，当EA特别弥漫和密集时，不能排除对语言发展有额外的中度加重作用。最有可能阐明这个问题的方法是比较儿童的基线期和治疗期，并进行相同的双重随访。
