Developmental Neurosciences Programme, UCL Institute of Child Health, London, UK.
Developmental Neurosciences Programme, UCL Institute of Child Health, London, UK.
Epilepsy Behav. 2019 Jun;95:18-25. doi: 10.1016/j.yebeh.2019.03.039. Epub 2019 Apr 19.
Long-term intelligence and memory outcomes of children post convulsive status epilepticus (CSE) have not been systematically investigated despite evidence of short-term impairments in CSE. The present study aimed to describe intelligence and memory outcomes in children within 10 years of CSE and identify potential risk factors for adverse outcomes. In this cohort study, children originally identified by the population-based North London Convulsive Status Epilepticus in Childhood Surveillance Study (NLSTEPSS) were prospectively recruited between July 2009 and February 2013 and invited for neuropsychological assessments and magnetic resonance imaging (MRI) scans. Full-scale intelligence quotients (FSIQs) were measured using the Wechsler Abbreviated Scales of Intelligence (WASI), and global memory scores (GMS) was assessed using the Children's Memory Scale (CMS). The cohort was analyzed as a whole and stratified into a prolonged febrile seizures (PFS) and non-PFS group. Their performance was compared with population norms and controls. Regression models were fitted to identify predictors of outcomes. With a mean of 8.9 years post-CSE, 28.5% of eligible participants were unable to undertake testing because of their severe neurodevelopmental deficits. Children with CSE who undertook formal testing (N = 94) were shown to have significantly lower FSIQ (p = 0.001) and GMS (p = 0.025) from controls; the PFS group (N = 34) had lower FSIQs (p = 0.022) but similar memory quotients (p = 0.88) with controls. Intracranial volume (ICV), developmental delay at baseline, and active epilepsy at follow-up were predictive of long-term outcomes in the non-PFS group. The relationship between ICV and outcomes was absent in the PFS group despite its presence in the control and non-PFS groups. Post-CSE, survivors reveal significant intelligence and memory impairments, but prognosis differs by CSE type; memory scores are uncompromised in the PFS group despite evidence of their lower FSIQ whereas both are compromised in the non-PFS group. Correlations between brain volumes and outcomes differ in the PFS, non-PFS, and control groups and require further investigation.
尽管有惊厥性癫痫持续状态(CSE)后短期认知损伤的证据,但儿童 CSE 后长期智力和记忆结果尚未得到系统研究。本研究旨在描述 CSE 后 10 年内儿童的智力和记忆结果,并确定不良结局的潜在危险因素。在这项队列研究中,最初通过人群基础的北伦敦儿童惊厥性癫痫持续状态监测研究(NLSTEPSS)识别的儿童于 2009 年 7 月至 2013 年 2 月期间被前瞻性招募,并邀请他们进行神经心理学评估和磁共振成像(MRI)扫描。使用韦氏简明智力量表(WASI)测量全量表智商(FSIQ),使用儿童记忆量表(CMS)评估总体记忆评分(GMS)。对队列进行了整体分析,并分为发热性癫痫持续状态(PFS)和非 PFS 组。将他们的表现与人群正常值和对照组进行比较。拟合回归模型以确定结局的预测因素。在 CSE 后平均 8.9 年,94 名有资格进行测试的参与者中有 28.5%由于严重的神经发育缺陷而无法进行测试。接受正式测试的 CSE 儿童(N=94)的 FSIQ(p=0.001)和 GMS(p=0.025)明显低于对照组;PFS 组(N=34)的 FSIQ 较低(p=0.022),但与对照组的记忆商数相似(p=0.88)。颅内体积(ICV)、基线时的发育延迟和随访时的活动性癫痫是非 PFS 组长期结局的预测因素。尽管在对照组和非 PFS 组中存在,但在 PFS 组中,ICV 与结局之间的关系不存在。CSE 后,幸存者表现出明显的智力和记忆损伤,但预后因 CSE 类型而异;尽管 PFS 组的 FSIQ 较低,但记忆评分无受损,而非 PFS 组的 FSIQ 和记忆评分均受损。在 PFS、非 PFS 和对照组中,脑容量与结局之间的相关性不同,需要进一步研究。