Maltoni Lucia, Posar Annio, Parmeggiani Antonia
Child Neurology and Psychiatry Unit, Azienda Ospedaliero-Universitaria Policlinico S. Orsola-Malpighi of Bologna and Department of Medical and Surgical Sciences, University of Bologna, Via Massarenti 9, Bologna, Italy.
Child Neurology and Psychiatry Unit, IRCCS Institute of Neurological Sciences of Bologna and Department of Biomedical and Neuromotor Sciences, University of Bologna, Ospedale Bellaria, Padiglione G, Via Altura 3, Bologna, Italy.
Epilepsy Behav. 2016 Jul;60:211-217. doi: 10.1016/j.yebeh.2016.04.006. Epub 2016 May 27.
Continuous spike-waves during sleep (CSWS) are associated with several cognitive, neurological, and psychiatric disorders, which sometimes persist after CSWS disappearance. The purpose of this retrospective study was to investigate the correlation between general (clinical and instrumental) and neuropsychological findings in CSWS, to identify variables that predispose patients to a poorer long-term neuropsychological outcome. Patients with spikes and waves during sleep with a frequency ≥25/min (spikes and waves frequency index - SWFI) were enrolled. There were patients presenting abnormal EEG activity corresponding to the classic CSWS and patients with paroxysmal abnormalities during sleep <85% with SWFI ≥25/min that was defined as excessive spike-waves during sleep (ESWS). Clinical and instrumental features and neuropsychological findings during and after the spike and wave active phase period were considered. A statistical analysis was performed utilizing the Spearman correlation test and multivariate analysis. The study included 61 patients; the mean follow-up (i.e., the period between SWFI ≥25 first recording and last observation) was 7years and 4months. The SWFI correlated inversely with full and performance IQ during CSWS/ESWS. Longer-lasting SWFI ≥25 was related to worse results in verbal IQ and performance IQ after CSWS/ESWS disappearance. Other variables may influence the neuropsychological outcome, like age at SWFI ≥25 first recording, perinatal distress, pathologic neurologic examination, and antiepileptic drug resistance. This confirms that CSWS/ESWS are a complex pathology and that many variables contribute to its outcome. The SWFI value above all during CSWS/ESWS and long-lasting SWFI ≥25 after CSWS/ESWS disappearance are the most significant indexes that appear mostly to determine cognitive evolution. This finding underscores the importance of EEG recordings during sleep in children with a developmental disorder, even if seizures are not reported, as well as the importance of using therapy with an early efficacy.
睡眠期持续棘慢波（CSWS）与多种认知、神经和精神疾病相关，这些疾病有时在CSWS消失后仍会持续存在。这项回顾性研究的目的是调查CSWS患者的一般（临床和仪器检查）与神经心理学检查结果之间的相关性，以确定使患者长期神经心理学预后较差的变量。纳入睡眠期棘慢波频率≥25次/分钟（棘慢波频率指数-SWFI）的患者。其中有呈现与经典CSWS相对应的异常脑电图活动的患者，以及睡眠期阵发性异常<85%且SWFI≥25次/分钟的患者，后者被定义为睡眠期过度棘慢波（ESWS）。考虑了棘慢波活跃期及之后的临床和仪器检查特征以及神经心理学检查结果。采用Spearman相关检验和多变量分析进行统计分析。该研究纳入了61例患者；平均随访时间（即SWFI≥25首次记录与最后一次观察之间的时间段）为7年4个月。在CSWS/ESWS期间，SWFI与全量表智商和操作智商呈负相关。CSWS/ESWS消失后，持续时间更长的SWFI≥25与言语智商和操作智商的较差结果相关。其他变量可能影响神经心理学预后，如SWFI≥25首次记录时的年龄、围产期窘迫、神经系统病理检查以及抗癫痫药物耐药性。这证实了CSWS/ESWS是一种复杂的病理状态，许多变量会影响其预后。最重要的是，CSWS/ESWS期间的SWFI值以及CSWS/ESWS消失后持续较长时间的SWFI≥25是最显著的指标，似乎主要决定认知发展。这一发现强调了即使未报告癫痫发作，对发育障碍儿童进行睡眠期脑电图记录的重要性，以及使用早期有效的治疗方法 的重要性。
