Camfield Carol, Camfield Peter
Department of Pediatrics, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia, Canada.
Department of Pediatrics, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia, Canada.
Semin Pediatr Neurol. 2017 Nov;24(4):243-250. doi: 10.1016/j.spen.2017.10.006. Epub 2017 Oct 6.
Cognitive problems ranging from mild specific learning problems to profound intellectual disability (ID) are very common in children with epilepsy. For most affected patients there is good evidence that the cognitive problems are present at the onset of seizures and do not deteriorate over time. There is no evidence that a few seizures lead to cognitive deterioration. An exception may occur in children with epileptic encephalopathies, although this contention is not always easy to prove. ID is a strong predictor of intractable epilepsy, and the greater the degree of the ID the greater the risk of medication resistant epilepsy. It is not known if specific learning disorders are associated with more severe epilepsy. Rolandic epilepsy is unusual because possibly one-third of patients have transient cognitive and behavioral difficulties during the active phase but later have normal adult social outcome. More longitudinal studies with baseline and repeated cognitive assessments are needed to fully understand the relationship of cognitive problems to childhood onset epilepsy.
认知问题范围从轻度特定学习问题到严重智力残疾（ID），在癫痫儿童中非常常见。对于大多数受影响的患者，有充分证据表明认知问题在癫痫发作开始时就已存在，且不会随时间恶化。没有证据表明少数几次癫痫发作会导致认知能力下降。癫痫性脑病儿童可能是个例外，不过这一观点并不总是容易证实。智力残疾是难治性癫痫的有力预测指标，智力残疾程度越高，药物抵抗性癫痫的风险就越大。目前尚不清楚特定学习障碍是否与更严重的癫痫有关。罗兰多癫痫较为特殊，因为可能有三分之一的患者在发作活跃期会出现短暂的认知和行为困难，但成年后社会结局正常。需要更多进行基线和重复认知评估的纵向研究，以全面了解认知问题与儿童期癫痫的关系。
