Dlouha Olga, Prihodova Iva, Skibova Jelena, Nevsimalova Sona
Department of Phoniatrics, 1st Faculty of Medicine, Charles University and General Hospital, 12000 Prague, Czech Republic.
Department of Neurology and Clinical Sciences, 1st Faculty of Medicine, Charles University and General Hospital, 12000 Prague, Czech Republic.
Brain Sci. 2020 Nov 26;10(12):910. doi: 10.3390/brainsci10120910.
Developmental language disorder (DLD) is frequently associated with other developmental diseases and may lead to a handicap through adolescence or adulthood. The aim of our retrospective study was to characterize DLD subgroups, their etiological factors and clinical comorbidities, and the role of epileptiform discharges in wake and sleep recordings. Fifty-five children (42 male, mean age 6.2 ± 1.4 years, range 4-9 years) were included in the present study and underwent phoniatric, psychologic, neurologic, as well as wake and nocturnal electroencephalography (EEG) or polysomnography (PSG) examinations. A receptive form of DLD was determined in 34 children (63.0%), and an expressive form was found in 20 children (37.0%). Poor cooperation in one child did not permit exact classification. DLD children with the receptive form had significantly lower mean phonemic hearing (79.1% ± 10.9) in comparison with those with the expressive form (89.7% ± 6.2, < 0.001). A high amount of perinatal risk factors was found in both groups (50.9%) as well as comorbid developmental diseases. Developmental motor coordination disorder was diagnosed in 33 children (61.1%), and attention deficit or hyperactivity disorder was diagnosed in 39 children (70.9%). Almost one half of DLD children (49.1%) showed abnormalities on the wake EEG; epileptiform discharges were found in 20 children (36.4%). Nocturnal EEG and PSG recordings showed enhanced epileptiform discharges, and they were found in 30 children (55.6%, = 0.01). The wake EEG showed focal discharges predominantly in the temporal or temporo-parieto-occipital regions bilaterally, while in the sleep recordings, focal activity was shifted to the fronto-temporo-central areas ( < 0.001). Almost all epileptiform discharges appeared in non-rapid eye movement (NREM) sleep. A close connection was found between DLD and perinatal risk factors, as well as neurodevelopmental disorders. Epileptiform discharges showed an enhancement in nocturnal sleep, and the distribution of focal discharges changed.
发育性语言障碍(DLD)常与其他发育性疾病相关,可能导致青少年期或成年期出现功能障碍。我们这项回顾性研究的目的是对DLD亚组、其病因及临床合并症进行特征描述,并研究癫痫样放电在清醒和睡眠记录中的作用。本研究纳入了55名儿童(42名男性,平均年龄6.2±1.4岁,范围4 - 9岁),他们接受了语音、心理、神经学检查,以及清醒和夜间脑电图(EEG)或多导睡眠图(PSG)检查。34名儿童(63.0%)被确定为接受型DLD,20名儿童(37.0%)为表达型DLD。一名儿童因配合不佳无法进行准确分类。接受型DLD儿童的平均音素听力(79.1%±10.9)显著低于表达型DLD儿童(89.7%±6.2,P<0.001)。两组中均发现大量围产期危险因素以及合并的发育性疾病。33名儿童(61.1%)被诊断为发育性运动协调障碍,39名儿童(70.9%)被诊断为注意力缺陷或多动障碍。近一半的DLD儿童(49.1%)清醒EEG显示异常;20名儿童(36.4%)发现有癫痫样放电。夜间EEG和PSG记录显示癫痫样放电增强,30名儿童(55.6%,P = 0.01)出现这种情况。清醒EEG显示局灶性放电主要双侧出现在颞叶或颞顶枕区,而在睡眠记录中,局灶性活动转移至额颞中央区(P<0.001)。几乎所有癫痫样放电都出现在非快速眼动(NREM)睡眠期。发现DLD与围产期危险因素以及神经发育障碍之间存在密切联系。癫痫样放电在夜间睡眠时增强,局灶性放电的分布发生了变化。