Mehta Bharati, Chawla V K, Parakh Manish, Parakh Poonam, Bhandari Bharti, Gurjar Anoop Singh
Associate Professor, Department of Physiology, All India Institute of Medical Sciences , Jodhpur, India .
Professor and Head, Department of Physiology, Jodhpur Medical College & Hospitals , Boranada, Jodhpur, India .
J Clin Diagn Res. 2015 Jul;9(7):CC04-7. doi: 10.7860/JCDR/2015/13920.6168. Epub 2015 Jul 1.
Epilepsy, a chronic condition of recurrent seizures, affects language, but the extent and nature of the language disturbance varies widely according to the type, severity, and cause of the epilepsy. There is paucity of literature on the electroencephalographic abnormalities in children with speech and language impairment. The present study was therefore planned to find the association of epileptiform EEG abnormalities in children with speech and language impairment and if present, their localization and lateralization to the language areas of the brain that are present predominantly in the left hemisphere.
The study was conducted on Paediatric patients having speech and language impairment (n=94, age-2 to 8 years) selected on the basis of detailed history and neurologic examination. Video Electroencephalography (EEG) was performed as per American Clinical Neurophysiology Society guidelines using 16 channel RMS computerized EEG machine for a minimum of 40 minutes to capture both wakefulness and sleep along with activation procedures like hyperventilation (if feasible) and photic stimulation. EEG was reviewed for any abnormal EEG background, benign variants, interictal epileptiform discharges and ictal discharges.
In our cohort, 19.7% boys and 22.2% girls presented with seizures in their infancy and this gender difference was found to be statistically significant (p<0.05). EEG was abnormal in 47.9% children (45 out of 94) with no significant gender difference. Epileptiform EEG was seen in 73.6% of children with history of seizures and 41.3% of children without history of seizures (p<0.05). The EEG abnormities included: abnormal background (64.5%), presence of generalized interictal epileptiform discharges (57.8%), focal epileptiform discharges (20%) exclusively from left hemisphere and multifocal interictal epileptiform discharges (33.3%), each occurring in isolation or associated with other abnormities.
In the current study, it is definite that presence of generalized abnormalities in EEG are seen in higher frequency and focal interictal epileptiform discharges are solely seen in left hemisphere in children with speech and language impairment. Although, there is no distinct pattern of EEG abnormalities in such patients, we recommend a routine EEG in them and also brain imaging to complement the EEG findings.
癫痫是一种反复发作的慢性疾病，会影响语言功能，但语言障碍的程度和性质会因癫痫的类型、严重程度和病因而有很大差异。关于言语和语言障碍儿童脑电图异常的文献较少。因此，本研究旨在探寻言语和语言障碍儿童癫痫样脑电图异常的相关性，若存在这种异常，还要确定其在主要位于左半球的大脑语言区域的定位和侧化情况。
本研究针对经详细病史和神经系统检查筛选出的患有言语和语言障碍的儿科患者（n = 94，年龄2至8岁）开展。按照美国临床神经生理学会指南，使用16通道RMS计算机化脑电图仪进行视频脑电图（EEG）检查，检查时长至少40分钟，以捕捉清醒和睡眠状态，同时进行过度换气（若可行）和光刺激等激活程序。对脑电图进行检查，查看是否存在任何异常脑电图背景、良性变异、发作间期癫痫样放电和发作期放电。
在我们的队列中，19.7%的男孩和22.2%的女孩在婴儿期出现过癫痫发作，这种性别差异具有统计学意义（p < 0.05）。47.9%的儿童（94名中的45名）脑电图异常，无显著性别差异。有癫痫发作史的儿童中73.6%出现癫痫样脑电图，无癫痫发作史的儿童中41.3%出现癫痫样脑电图（p < 0.05）。脑电图异常包括：异常背景（64.5%）、全身性发作间期癫痫样放电（57.8%）、仅来自左半球的局灶性癫痫样放电（20%）和多灶性发作间期癫痫样放电（33.3%），每种异常可单独出现或与其他异常同时出现。
在当前研究中，明确发现言语和语言障碍儿童中脑电图普遍异常的出现频率较高，且局灶性发作间期癫痫样放电仅出现在左半球。尽管此类患者没有明显的脑电图异常模式，但我们建议对他们进行常规脑电图检查以及脑部成像，以补充脑电图检查结果。
