Boyer Katrina
Epilepsy Curr. 2019 Mar-Apr;19(2):99-100. doi: 10.1177/1535759719835674.
Neurocognition in Childhood Epilepsy: Impact on Mortality and Complete Seizure Remission 50 Years Later Sillanpää M, Saarinen MM, Karrasch M, Schmidt D, Hermann BP. Epilepsia. 2019;60(1):131-138. doi:10.1111/epi.14606. Epub 2018 Nov 22.
To study associations of the severity of impairment in childhood neurocognition (NC) with long-term mortality and complete seizure remission.
A population-based cohort of 245 subjects with childhood-onset epilepsy was followed up for 50 years (median = 45, range = 2-50). Childhood NC before age 18 years was assessed as a combination of formal intelligence quotient scores and functional criteria (school achievement, working history, and psychoneurological development). Impaired NC was categorized with respect to definitions of intellectual functioning in International Classification of Diseases, Tenth Revision (R41.83, F70-F73). The outcome variables, defined as all-cause mortality and 10-year terminal remission with the 5 past years off medication (10YTR), were analyzed with Cox regression models.
Of the 245 subjects, 119 (49%) had normal childhood NC, whereas 126 (51%) had various degrees of neurocognitive impairment. During the 50-year observation period, 71 (29%) of the subjects died, 13% of those with normal and 44% of those with impaired NC. The hazard of death increased gradually in line with more impaired cognition, reaching significance in moderate, severe, and profound impairment versus normal NC (hazard ratio [Bonferroni corrected 95% confidence interval] = 3.3 [1.2-9.2], 4.2 [1.2-14.2], and 5.5 [2.4-12.3], respectively). The chance for 10YTR was highest among subjects with normal NC (61%), whereas none of those with profound impairment reached 10YTR. In the intermediate categories, the chance was, however, not directly related to the increasing severity of impairment.
The severity of neurocognitive impairment during childhood shows a parallel increase in the risk of death. In comparison with normal NC, subjects with lower childhood NC are less likely to enter seizure remission. However, normal NC does not guarantee complete remission or prevent premature death in some individuals with childhood-onset epilepsy.
儿童癫痫的神经认知：对50年后死亡率和癫痫完全缓解的影响
西兰佩 M、萨里宁 M.M、卡拉斯克 M、施密特 D、赫尔曼 B.P.
《癫痫学》。2019年；60(1):131 - 138。doi:10.1111/epi.14606。2018年11月22日在线发表。
研究儿童神经认知（NC）损害严重程度与长期死亡率及癫痫完全缓解之间的关联。
对一组245例儿童期起病癫痫患者的人群队列进行了50年随访（中位数 = 45，范围 = 2 - 50）。18岁前的儿童NC通过正式智商分数与功能标准（学业成绩、工作经历和心理神经发育）相结合进行评估。根据《国际疾病分类》第十版（R41.83，F70 - F73）中智力功能的定义对NC受损情况进行分类。采用Cox回归模型分析定义为全因死亡率和过去5年停药后的10年终末缓解（10YTR）的结局变量。
在245例受试者中，119例（49%）儿童期NC正常，而126例（51%）有不同程度的神经认知损害。在50年观察期内，71例（29%）受试者死亡，NC正常者中有13%，NC受损者中有44%。随着认知损害程度加重，死亡风险逐渐增加，与正常NC相比，中度、重度和极重度损害时达到显著水平（风险比[Bonferroni校正95%置信区间]分别为 = 3.3[1.2 - 9.2]、4.2[1.2 - 14.2]和5.5[2.4 - 12.3]）。10YTR的机会在NC正常的受试者中最高（61%），而极重度损害者无一人达到10YTR。然而，在中间类别中，机会与损害严重程度的增加并无直接关联。
儿童期神经认知损害的严重程度与死亡风险呈平行增加。与正常NC相比，儿童期NC较低的受试者进入癫痫缓解的可能性较小。然而，正常NC并不能保证某些儿童期起病癫痫患者完全缓解或预防过早死亡。
