Kimura Nobusuke, Takahashi Yukitoshi, Shigematsu Hideo, Imai Katsumi, Ikeda Hiroko, Ootani Hideyuki, Takayama Rumiko, Mogami Yukiko, Kimura Noriko, Baba Koichi, Matsuda Kazumi, Tottori Takayasu, Usui Naotaka, Kondou Satohiko, Inoue Yushi
National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorder, NHO, Shizuoka, Japan.
National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorder, NHO, Shizuoka, Japan.
Brain Dev. 2019 Jan;41(1):77-84. doi: 10.1016/j.braindev.2018.07.014. Epub 2018 Jul 31.
The purpose of this study was to identify the risk factors of cognitive impairment in pediatric epilepsy patients with focal cortical dysplasia (FCD).
77 patients with histopathologically confirmed FCD were studied. The statistical relationship between cognition levels and clinical factors at presurgical evaluation was analyzed. Cognitive function was evaluated by development quotient or intelligence quotient (DQ-IQ).
Ages at seizure onset were younger than 15 years (mean ± SD; 5.0 ± 4.2 years). Mean disease duration was 14.5 ± 8.5 years. Mean age at pre-surgical DQ-IQ evaluation was 34.8 ± 10.7 years. Mean DQ-IQ was 60.5 ± 20.5, and 41 of 77 (53.2%) patients had mental retardation (DQ-IQ < 70). Younger seizure onset and seizure clustering were significantly associated with lower DQ-IQ (p < 0.001). A multiple regression study identified higher seizure frequency pattern, a history of epileptic spasm and status epilepticus as aggravating factors of DQ-IQ decline (R = 0.63, p < 0.001). On the other hand, the risk was decreased in patients with habitual focal aware seizure and transient seizure-free periods up to 6 months in the course of epilepsy. FCD location (FCD site, extent of radiological lesion and laterality) and histopathology of FCD did not affect DQ-IQ.
Our study suggests that seizure characteristics including higher seizure frequency pattern, a history of epileptic spasm, status epilepticus, seizure clustering and early onset of seizure are risk factors of cognitive impairment in FCD patients.
本研究旨在确定患有局灶性皮质发育不良（FCD）的小儿癫痫患者认知障碍的危险因素。
对77例经组织病理学确诊为FCD的患者进行研究。分析术前评估时认知水平与临床因素之间的统计关系。通过发育商或智商（DQ-IQ）评估认知功能。
癫痫发作起始年龄小于15岁（均值±标准差；5.0±4.2岁）。平均病程为14.5±8.5年。术前DQ-IQ评估的平均年龄为34.8±10.7岁。平均DQ-IQ为60.5±20.5，77例患者中有41例（53.2%）存在智力障碍（DQ-IQ<70）。癫痫发作起始年龄较小和发作成簇与较低的DQ-IQ显著相关（p<0.001）。多元回归研究确定较高的癫痫发作频率模式、癫痫性痉挛病史和癫痫持续状态是DQ-IQ下降的加重因素（R=0.63，p<0.001）。另一方面，在癫痫病程中出现习惯性局灶性觉知发作和长达6个月的无发作间期的患者风险降低。FCD的位置（FCD部位、放射学病变范围和病变侧别）以及FCD的组织病理学不影响DQ-IQ。
我们的研究表明，癫痫发作特征包括较高的癫痫发作频率模式、癫痫性痉挛病史、癫痫持续状态、发作成簇和癫痫发作早发是FCD患者认知障碍的危险因素。
