Karrasch Mira, Tiitta Petri, Hermann Bruce, Joutsa Juho, Shinnar Shlomo, Rinne Juha, Anttinen Anu, Sillanpää Matti
1Department of Psychology,Åbo Akademi University,Turku,Finland.
2Department of Public Health,University of Turku,Finland.
J Int Neuropsychol Soc. 2017 Apr;23(4):332-340. doi: 10.1017/S1355617716001077. Epub 2017 Jan 10.
Little is known about the very long-term cognitive outcome in patients with childhood-onset epilepsy. The aim of this unique prospective population-based cohort study was to examine cognitive outcomes in aging participants with childhood-onset epilepsy (mean onset age=5.3 years) five decades later (mean age at follow-up=56.5 years).
The sample consisted of 48 participants with childhood-onset epilepsy and 48 age-matched healthy controls aged 48-63 years. Thirty-six epilepsy participants were in remission and 12 continued to have seizures. Cognitive function was examined with 11 neuropsychological tests measuring language and semantic function, episodic memory, and learning, visuomotor function, executive function, and working memory.
The risk of cognitive impairment was very high in participants with continuing seizures; odds ratio (OR)=11.7 (95% confidence interval [CI] (2.8, 49.6), p=.0008). They exhibited worse performances across measures of language and semantic function, and visuomotor function compared to participants with remitted epilepsy and healthy controls. In the participants with remitted epilepsy, the risk of cognitive impairment was somewhat elevated, but not statistically significant; OR=2.6 (95% CI [0.9, 7.5], p=.08).
Our results showed that the distinction of continued versus discontinued seizures was critical for determining long-term cognitive outcome in childhood-onset epilepsy. Few participants in remission exhibited marked cognitive impairment compared to age-matched peers. However, a subgroup of participants with decades long active epilepsy, continuous seizure activity and anti-epileptic drug (AED) medication, showed clinically significant cognitive impairment and are thus in a more precarious position when entering older age. (JINS, 2017, 23, 332-340).
关于儿童期起病癫痫患者的极长期认知结局，我们知之甚少。这项独特的基于人群的前瞻性队列研究的目的是，在五十年后（随访时平均年龄 = 56.5岁），研究儿童期起病癫痫（平均起病年龄 = 5.3岁）的老年参与者的认知结局。
样本包括48名儿童期起病癫痫患者和48名年龄匹配的48 - 63岁健康对照者。36名癫痫患者病情缓解，12名仍有发作。通过11项神经心理学测试对认知功能进行检查，这些测试测量语言和语义功能、情景记忆、学习、视运动功能、执行功能和工作记忆。
仍有发作的参与者出现认知障碍的风险非常高；优势比（OR）= 11.7（95%置信区间[CI]（2.8, 49.），p = 0.0008）。与病情缓解的癫痫患者和健康对照者相比，他们在语言和语义功能以及视运动功能的各项测量中表现更差。在病情缓解的癫痫患者中，认知障碍的风险有所升高，但无统计学意义；OR = 2.6（95% CI [0.9, 7.5]，p = 0.08）。
我们的结果表明，癫痫发作持续与否对于确定儿童期起病癫痫的长期认知结局至关重要。与年龄匹配的同龄人相比，很少有病情缓解的参与者表现出明显的认知障碍。然而，一小部分患有数十年活动性癫痫、持续癫痫发作活动且服用抗癫痫药物（AED）的参与者，表现出临床上显著的认知障碍，因此在步入老年时处于更不稳定的状态。（《神经心理疾病与治疗》，2017年，第23卷，第332 - 340页）
