Georgetown University Medical Center, Washington, D.C., United States of America.
Epilepsy Behav. 2019 Oct;99:106332. doi: 10.1016/j.yebeh.2019.05.028. Epub 2019 Aug 6.
Children with epilepsy can experience significant cognitive dysfunction that can lead to academic underachievement. Traditionally believed to be primarily due to the effects of factors such as the chronicity of epilepsy, medication effects, or the location of the primary epileptogenic lesion;, recent evidence has indicated that disruption of cognition-specific distributed neural networks may play a significant role as well. Specifically, over the last decade, researchers have begun to characterize the mechanisms underlying disrupted cognitive substrates by evaluating neural network abnormalities observed during specific cognitive tasks, using task-based functional magnetic resonance imaging (fMRI). This targeted review assesses the current literature investigating the relationship between neural network abnormalities and cognitive deficits in pediatric epilepsy. The findings indicate that there are indeed neural network abnormalities associated with deficits in executive function, language, processing speed, and memory. Overall, cognitive dysfunction in pediatric epilepsy is associated with a decrease in neural network activation/deactivation as well as increased recruitment of brain regions not typically related to the specific cognitive task under investigation. The research to date has focused primarily on children with focal epilepsy syndromes with small sample sizes and differing research protocols. More extensive research in children with a wider representation of epilepsy syndromes (including generalized epilepsy syndromes) is necessary to fully understand these relationships and begin to identify underlying cognitive phenotypes that may account for the variability observed across children with epilepsy. Furthermore, more uniformity in fMRI protocols and neuropsychological tasks would be ideal to advance this literature.
患有癫痫的儿童可能会出现明显的认知功能障碍，从而导致学业成绩不佳。传统上认为这主要是由于癫痫的慢性、药物效应或原发性致痫病变的位置等因素所致；但最近的证据表明，认知特异性分布式神经网络的破坏也可能起重要作用。具体而言，在过去十年中，研究人员开始通过评估在特定认知任务期间观察到的神经网络异常，使用基于任务的功能磁共振成像（fMRI）来描述认知障碍的潜在机制。本针对性综述评估了目前研究儿童癫痫中神经网络异常与认知缺陷之间关系的文献。研究结果表明，确实存在与执行功能、语言、处理速度和记忆缺陷相关的神经网络异常。总体而言，儿科癫痫中的认知功能障碍与神经网络激活/失活减少以及与特定认知任务不相关的脑区的过度募集有关。迄今为止的研究主要集中在具有小样本量和不同研究方案的局灶性癫痫综合征的儿童。需要对具有更广泛癫痫综合征（包括全身性癫痫综合征）代表性的儿童进行更广泛的研究，以充分了解这些关系并开始识别可能解释癫痫儿童之间观察到的变异性的潜在认知表型。此外，理想情况下，fMRI 方案和神经心理学任务的更加统一将有助于推进这一文献。
