Breuer L E M, Grevers E, Boon P, Bernas A, Bergmans J W M, Besseling R M H, Klooster D C W, de Louw A, Mestrom R M C, Vonck K, Zinger S, Aldenkamp A P
Department of Behavioral Sciences, Epilepsy Centre Kempenhaeghe, Heeze, The Netherlands.
Department of Research and Development, Epilepsy Centre Kempenhaeghe, Heeze, The Netherlands.
Acta Neurol Scand. 2017 Jul;136(1):47-53. doi: 10.1111/ane.12700. Epub 2016 Oct 28.
"Epileptic dementia" is reported in adults with childhood-onset refractory epilepsy. Cognitive deterioration can also occur in a "second-hit model".
We studied the clinical and neuropsychological characteristics of patients with cognitive deterioration (≥1 SD discrepancy between current IQ and premorbid IQ). Memory function, reaction time and processing speed were also evaluated. Analyses were performed to investigate which clinical characteristics correlated with cognitive deterioration.
Twenty-seven patients were included with a mean age of 55.7 years old, an average age at epilepsy onset of 33.9 years and a mean duration of 21.8 years. Over 40% had experienced at least one status epilepticus. About 77.8% had at least one comorbid disease (most of (cardio)vascular origin). Cognitive deterioration scores were significant for both Performance IQ and Full Scale IQ, but not for Verbal IQ. Impairments in fluid functions primarily affected the IQ-scores. Memory was not impaired. Epilepsy factors explained 7% of the variance in deterioration, whereas 38% was explained by relatively low premorbid IQ and educational level, high age at seizure onset and older age.
A subgroup of patients with localization-related epilepsy exhibits cognitive decline characterized by deterioration in PIQ and FSIQ, but with preserved higher order functions (VIQ and memory). Patients typically have epilepsia tarda, comorbid pathology, relatively low educational level and older age. These are factors known to increase the vulnerability of the brain by diminishing cognitive reserve. Cognitive deterioration may develop according to a stepwise "second-hit model", affecting and accelerating the cognitive ageing process.
“癫痫性痴呆”在儿童期起病的难治性癫痫成年患者中有所报道。认知功能衰退也可能发生在“二次打击模型”中。
我们研究了认知功能衰退患者（当前智商与病前智商相差≥1个标准差）的临床和神经心理学特征。还评估了记忆功能、反应时间和处理速度。进行分析以研究哪些临床特征与认知功能衰退相关。
纳入了27例患者，平均年龄55.7岁，癫痫发作的平均年龄为33.9岁，平均病程为21.8年。超过40%的患者经历过至少一次癫痫持续状态。约77.8%的患者至少有一种合并症（大多数为（心血管）源性）。操作智商和全量表智商的认知功能衰退评分具有显著性，但言语智商无显著性。流体功能受损主要影响智商得分。记忆未受损。癫痫因素解释了衰退变异的7%，而38%由相对较低的病前智商和教育水平、癫痫发作时的高龄以及年龄较大所解释。
一组与局灶性癫痫相关的患者表现出认知衰退，其特征为操作智商和全量表智商下降，但高级功能（言语智商和记忆）保留。患者通常患有迟发性癫痫、合并病理状况、教育水平相对较低且年龄较大。这些都是已知的通过减少认知储备而增加大脑易损性的因素。认知功能衰退可能根据逐步的“二次打击模型”发展，影响并加速认知老化过程。
