Mackay Mark T, Molesworth Charlotte, Northam Elisabeth A, Inder Terrie E, Cameron Fergus J
Department of Neurology, Royal Children's Hospital, Melbourne, Victoria, Australia.
Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Parkville, Victoria, Australia.
Pediatr Diabetes. 2016 Jun;17(4):244-8. doi: 10.1111/pedi.12284. Epub 2015 Jun 17.
To document electroencephalogram (EEG) changes and their correlation with clinical parameters in a newly diagnosed pediatric cohort of type 1 diabetes mellitus (T1DM) patients with and without diabetic ketoacidosis (DKA) and to define their medium term utility and significance.
Prospective longitudinal study of children presenting with T1DM. EEGs were performed within 24 h of diagnosis, day 5, and at 6 months post-diagnosis and reviewed by a neurologist blinded to clinical status. Severity of encephalopathy was graded from 1 to 5 using the Aoki and Lombroso encephalopathy scale. Cognitive abilities were assessed using standardized tests of attention, memory, and intelligence.
Eighty eight children were recruited; 34 presented with DKA. Abnormal background slowing was more often observed in the first 24 h in children with DKA (p = 0.01). Encephalopathy scores on day 1 correlated with initial pH, CO2 , HCO3 , base excess, respiratory rate, heart rate, diastolic blood pressure, and IV fluid intake (all parameters p < 0.05). EEG scores at day 1 did not correlate with contemporaneous mental state or cognition in the medium term.
DKA was associated with significant clinical and neurophysiologic signs of brain dysfunction at presentation. While EEG is sensitive to the detection of encephalopathy in newly diagnosed T1DM, it has limited use in identifying children at risk of later cognitive deficits.
记录新诊断的1型糖尿病（T1DM）患儿队列中，伴有和不伴有糖尿病酮症酸中毒（DKA）的患儿的脑电图（EEG）变化及其与临床参数的相关性，并确定其在中期的效用和意义。
对患有T1DM的儿童进行前瞻性纵向研究。在诊断后24小时内、第5天以及诊断后6个月进行脑电图检查，并由对临床状况不知情的神经科医生进行评估。使用青木和隆布罗索脑病量表将脑病严重程度从1到5进行分级。使用注意力、记忆力和智力的标准化测试评估认知能力。
招募了88名儿童；34名患有DKA。DKA患儿在最初24小时内更常观察到背景活动减慢（p = 0.01）。第1天的脑病评分与初始pH值、二氧化碳、碳酸氢根、碱剩余、呼吸频率、心率、舒张压和静脉输液量相关（所有参数p < 0.05）。第1天的脑电图评分与中期的同期精神状态或认知无关。
DKA在发病时与脑功能障碍显著的临床和神经生理学体征相关。虽然脑电图对新诊断的T1DM中的脑病检测敏感，但在识别有后期认知缺陷风险的儿童方面用途有限。
