Operto Francesca Felicia, Pastorino Grazia Maria Giovanna, Di Bonaventura Carlo, Scuoppo Chiara, Padovano Chiara, Vivenzio Valentina, Donadio Serena, Coppola Giangennaro
Child and Adolescent Neuropsychiatry Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy.
Child and Adolescent Neuropsychiatry Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy.
Eur J Paediatr Neurol. 2021 May;32:106-114. doi: 10.1016/j.ejpn.2021.04.004. Epub 2021 Apr 17.
Visuospatial abilities are fundamental for good school achievements and good daily functioning. Previous studies showed an impairment of visuospatial skills in pediatric patients with epilepsy; pharmacological treatment, although indispensable for the seizure control, could further affect cognitive functions. The aim of our study was to evaluate the visuospatial skills in children and adolescents with different forms of epilepsy well-controlled by antiseizure monotherapy, both at baseline and after one year follow-up, through a standardized neuropsychological assessment.
We recruited 207 children and adolescents (mean age = 10.35 ± 2.39 years) with epilepsy, well controlled by monotherapy with levetiracetam, valproic acid, ethosuximide, oxcarbazepine or carbamazepine and 45 age/sex-matched controls. All the participants performed the Rey-Osterrieth Complex Figure, a standardized test for visuospatial perception and visuospatial memory assessment, at baseline and after 12 month of drug therapy. Age, sex, executive functions, non-verbal intelligence, age at onset of epilepsy, epilepsy duration, epilepsy type, lobe and side of seizure onset were considered in our analysis. EEG, seizure frequency, and drug dose were also recorded.
At baseline, the epilepsy group performed significantly worse than controls in the Immediate Recall test but not the Direct Copy test, without differences between epilepsy subgroups. Immediate Recall scores were related to age of seizure onset and epilepsy duration and executive functions. The re-assessment after 1 year showed that the Immediate Recall mean scores were not significantly changed in the levetiracetam and oxcarbazepine group, while they significantly worsened in the valproic acid, ethosuximide and carbamazepine groups. The Immediate Recall scores were correlated to age, age at onset of epilepsy, epilepsy duration, and executive functions.
Children with epilepsy may exhibit visuospatial memory impairment compared to their peer, that may be correlated to some features of the epilepsy itself and to the impairment of executive functions. Different antiseizure medications can affect visuospatial memory differently, so it is important monitoring this aspect in pediatric patients.
视觉空间能力对于良好的学业成绩和日常功能至关重要。先前的研究表明，癫痫患儿存在视觉空间技能受损的情况；药物治疗虽然对于控制癫痫发作必不可少，但可能会进一步影响认知功能。我们研究的目的是通过标准化的神经心理学评估，在基线期和一年随访后，评估接受抗癫痫单药治疗且病情得到良好控制的不同类型癫痫患儿和青少年的视觉空间技能。
我们招募了207名癫痫患儿和青少年（平均年龄 = 10.35 ± 2.39岁），他们通过左乙拉西坦、丙戊酸、乙琥胺、奥卡西平或卡马西平单药治疗病情得到良好控制，以及45名年龄/性别匹配的对照者。所有参与者在基线期和药物治疗12个月后都进行了雷-奥斯特里思复杂图形测试，这是一项用于视觉空间感知和视觉空间记忆评估的标准化测试。我们的分析考虑了年龄、性别、执行功能、非言语智力、癫痫发病年龄、癫痫病程、癫痫类型、发作起始的脑叶和侧别。还记录了脑电图、癫痫发作频率和药物剂量。
在基线期，癫痫组在即时回忆测试中的表现明显比对照组差，但在直接临摹测试中没有差异，癫痫亚组之间也没有差异。即时回忆分数与癫痫发病年龄、癫痫病程和执行功能有关。1年后的重新评估显示，左乙拉西坦和奥卡西平组的即时回忆平均分数没有显著变化，而丙戊酸、乙琥胺和卡马西平组的即时回忆平均分数显著恶化。即时回忆分数与年龄、癫痫发病年龄、癫痫病程和执行功能相关。
与同龄人相比，癫痫患儿可能表现出视觉空间记忆受损，这可能与癫痫本身的某些特征以及执行功能受损有关。不同的抗癫痫药物对视觉空间记忆的影响不同，因此在儿科患者中监测这方面很重要。
