Chen Qian, Jiang Li-li, Zhang Gui-zhen, Wang Yang, Yan Xiu-xian, Yang Jian, Li Er-zhen, Zhou Xin-lin, Xu Ke-ming
Graduate School of Peking Union Medical College, Beijing 100730, China.
Zhonghua Er Ke Za Zhi. 2012 Oct;50(10):771-6.
To study the cognitive function, its correlation with and the impact on quality of life in epileptic children aged 6-13 years in regular school.
Cognitive function of 172 children with various types of epilepsy were measured using a computerized neuropsychological test battery including six items. Their scores across the neuropsychological measures were compared with 172 healthy control subjects from the general population strictly matched for age, sex and the region where education was accepted. The quality of life was measured in 105 cases by the Quality of Life in Epilepsy Inventory (QOLIE-31).
(1) After adjusting for age, gender, and education, children with epilepsy performed significantly worse than healthy control subjects on 5 of 6 cognitive tasks, including Raven's progressive matrices correct number (8.6 vs. 14.0), choice reaction time (620.4 ms vs. 489.5 ms), word-rhyming tasks (2796.9 ms vs. 2324.4 ms), simple substraction correct number (28.6 vs. 35.5)as well as number comparision (1002.4 ms vs. 803.1 ms), P < 0.01. When an impairment index was calculated, 44.2% patients had at least one abnormal score on the test battery, compared with 14.5% of healthy volunteers, there was statistically significant differences between the two groups, P < 0.001. (2) Children with new onset epilepsy before the treatment with anti-epilepstic drugs performed significantly worse than healthy controls on 5 of 6 cognitive tasks, including Raven's progressive matrices correct number (9.1 vs. 13.8), choice reaction time (625.8 ms vs.474.5 ms), word-rhyming tasks(3051.8 ms vs. 2575.4 ms), simple substraction correct number (28.9 vs. 35.3) as well as number comparison (942.4 ms vs. 775.8 ms), P < 0.01. (3) Cognitive performance was not related to the age of onset, type of epilepsy, therapy duration or comorbid emotional and behavior disorders, P > 0.05. (4) 105 cases filled in the QOLIE-31 questionaire, the total score of the quality of life in the group without cognitive impairment and psychical conditions was the highest (60.5 ± 0.9), and the lowest total score was found in group with cognitive impairment and psychical conditions (54.6 ± 1.5), there were highly significant differences between the groups, P < 0.001.
Almost one-half of the children with epilepsy accepting regular education had at least one abnormal score in the battery tests. Newly diagnosed untreated patients with epilepsy are cognitively compromised before the start of antiepileptic drug medication. Cognitive impairment was not related to the epilepsy-related or psychiatric variables. Cognitive impairment and mental disorders require further attention and essential therapy, which is important to the improvement of the quality of life in epileptic children.
研究6 - 13岁在普通学校就读的癫痫儿童的认知功能、其与生活质量的相关性及对生活质量的影响。
使用包含六个项目的计算机化神经心理测试组合对172例不同类型癫痫儿童的认知功能进行测量。将他们在神经心理测量中的得分与172名来自普通人群的健康对照者进行比较，这些对照者在年龄、性别和接受教育的地区方面与癫痫儿童严格匹配。通过癫痫生活质量量表（QOLIE - 31）对105例患者的生活质量进行测量。
（1）在调整年龄、性别和教育因素后，癫痫儿童在6项认知任务中的5项上表现明显差于健康对照者，包括瑞文渐进矩阵正确数（8.6对14.0）、选择反应时间（620.4毫秒对489.5毫秒）、单词押韵任务（2796.9毫秒对2324.4毫秒）、简单减法正确数（28.6对35.5）以及数字比较（1002.4毫秒对803.1毫秒），P < 0.01。计算损伤指数时，44.2%的患者在测试组合中至少有一项异常得分，而健康志愿者为14.5%，两组间差异有统计学意义，P < 0.001。（2）在使用抗癫痫药物治疗前新发病的癫痫儿童在6项认知任务中的5项上表现明显差于健康对照者，包括瑞文渐进矩阵正确数（9.1对13.8）、选择反应时间（625.8毫秒对474.5毫秒）、单词押韵任务（3051.8毫秒对2575.4毫秒）、简单减法正确数（28.9对35.3）以及数字比较（942.4毫秒对775.8毫秒），P < 0.01。（3）认知表现与发病年龄、癫痫类型、治疗持续时间或共患的情绪和行为障碍无关，P > 0.05。（4）105例患者填写了QOLIE - 31问卷，无认知损害和精神状况组的生活质量总分最高（60.5±0.9），而有认知损害和精神状况组的总分最低（54.6±1.5），组间差异有高度统计学意义，P < 0.001。
接受正规教育的癫痫儿童中近一半在成套测试中有至少一项异常得分。新诊断未治疗的癫痫患者在开始抗癫痫药物治疗前存在认知功能损害。认知损害与癫痫相关或精神科变量无关。认知损害和精神障碍需要进一步关注及必要治疗，这对改善癫痫儿童的生活质量很重要。
