Mineyko Aleksandra, Qi Wei, Carlson Helen L, Bello-Espinosa Luis, Brooks Brian L, Kirton Adam
1Section of Neurology,Departments of Pediatrics and Clinical Neurosciences.
2Department of Pediatrics,University of Calgary;Calgary,Alberta,Canada.
Can J Neurol Sci. 2017 Jul;44(4):358-365. doi: 10.1017/cjn.2017.29.
Patients with arterial perinatal stroke often suffer long-term motor sequelae, difficulties in language, social development, and behaviour as well as epilepsy. Despite homogeneous lesions, long-term behavioural and cognitive outcomes are variable and unpredictable. Sleep-related epileptic encephalopathies can occur after early brain injury and are associated with global developmental delays. We hypothesized that sleep-potentiated epileptiform abnormalities are associated with worse developmental outcomes after perinatal stroke.
Participants were identified from a population-based cohort (Alberta Perinatal Stroke Project). Inclusion criteria were magnetic resonance imaging-confirmed arterial perinatal stroke, age 4 to 18 years, electroencephalogram (EEG) including sleep, and comprehensive neuropsychological evaluation. Sleep-related EEG abnormalities were categorized by an epileptologist blinded to the cognitive outcome. Associations between EEG classification and neuropsychological outcomes were explored (t tests, Bonferroni correction for multiple comparisons).
Of 128 potentially eligible participants, 34 (53% female) had complete EEG (mean age, 8.1 years; range, 0.2-16.4) and neuropsychology testing (mean age, 9.8 years; range 4.4-16.7). Twelve (35%) were classified as having electrical status epilepticus in sleep. Patients with abnormal EEGs were more likely to have statistically worse scores when corrected for multiple comparisons, in receptive language (median, 1st percentile; IQR 1-7th percentile; p<0.05), and externalizing behaviours (median, 82nd percentile; IQR, 79-97th percentile; p<0.05).
Developmental outcome in language and behaviour in children with arterial perinatal stroke is associated with electrical status epilepticus in sleep. Increased screening with sleep EEG is suggested, whereas further studies are necessary to determine if treatment of EEG abnormalities can improve outcome.
围产期动脉性卒中患者常伴有长期运动后遗症、语言、社交发展及行为障碍以及癫痫。尽管病灶相同，但长期行为和认知结果却存在差异且不可预测。睡眠相关性癫痫性脑病可发生于早期脑损伤后，并与整体发育迟缓相关。我们推测睡眠增强的癫痫样异常与围产期卒中后更差的发育结果相关。
从基于人群的队列研究（艾伯塔围产期卒中项目）中确定参与者。纳入标准为磁共振成像确诊的围产期动脉性卒中、年龄4至18岁、包括睡眠期的脑电图（EEG）以及全面的神经心理学评估。由对认知结果不知情的癫痫专家对与睡眠相关的EEG异常进行分类。探讨EEG分类与神经心理学结果之间的关联（t检验，采用Bonferroni校正进行多重比较）。
在128名可能符合条件的参与者中，34名（53%为女性）完成了EEG检查（平均年龄8.1岁；范围0.2 - 16.4岁）和神经心理学测试（平均年龄9.8岁；范围4.4 - 16.7岁）。12名（35%）被分类为睡眠中癫痫持续状态。校正多重比较后，EEG异常的患者在接受性语言（中位数，第1百分位数；四分位间距1 - 7百分位数；p<0.05）和外化行为（中位数，第82百分位数；四分位间距，79 - 97百分位数；p<0.05）方面的得分在统计学上更差。
围产期动脉性卒中患儿的语言和行为发育结果与睡眠中癫痫持续状态相关。建议增加睡眠EEG筛查，而确定EEG异常的治疗是否能改善预后还需要进一步研究。
