Oyegbile-Chidi Temitayo, Harvey Danielle, Eisner Jordan, Dunn David, Jones Jana, Byars Anna, Hermann Bruce, Austin Joan
Department of Neurology, School of Medicine, University of California, Davis, Sacramento, CA, United States.
Department of Public Health Sciences, School of Medicine, University of California, Davis, Sacramento, CA, United States.
Front Neurol. 2022 Jul 26;13:903137. doi: 10.3389/fneur.2022.903137. eCollection 2022.
There is substantial evidence that children with epilepsy experience more sleep, behavior and cognitive challenges than children without epilepsy. However, the literature is limited in describing the relationship between sleep, epilepsy, cognition and behavioral challenges and the interactions amongst these factors over time. This study aims to understand the nature and strength of the relationship between sleep, cognition, mood and behavior in children with new-onset epilepsy as assessed by multiple informants at multiple time periods using multiple different dependent measures.
332 participants (6-16years) were recruited within 6 weeks of their first recognized seizure. The comparison group was comprised of 266 healthy siblings. Participants underwent sleep evaluation by a parent using the Sleep Behavioral Questionnaire (SBQ), cognitive evaluation using a comprehensive neuropsychological test battery, a behavioral evaluation using the Child Behavior Checklist (CBCL from parents and TRF from teachers) and the Children's Depression Inventory (CDI). These evaluations were completed at baseline (B), at 18 months, and at 36 months.
Compared to siblings, children with new-onset epilepsy had more sleep disturbance (SBQ), higher rates of behavioral problems (CBCL and TRF), lower cognitive testing scores, and higher rates of depression; which persisted over the 36-month study. Sleep significantly correlated with behavioral problems, cognitive scores and depression. When divided into categories based of sleep disturbance scores, 39.7% of children with epilepsy experienced "Persistently Abnormal Sleep", while 14.8% experienced "Persistently Normal Sleep". Children with persistently abnormal sleep experienced the highest rates of behavioral problems, depression and cognitive impairment compared to those with persistently normal sleep, regardless of epilepsy syndrome. Younger age of seizure onset, younger age at testing, and lower grade level at baseline were associated with persistently abnormal sleep.
To our knowledge, this is the first demonstration of the nature, strength, reliability, stability and persistence of the relationship between sleep, cognition, and behavioral problems over time in a large cohort of children with newly diagnosed epilepsy, as assessed by multiple informants at different timepoints. The results of this study indicate that children with epilepsy are at a high risk of significant persisting neurobehavioral multimorbidity. Therefore, early screening for these challenges may be essential for optimizing quality of life long-term.
有大量证据表明，与无癫痫的儿童相比，癫痫儿童在睡眠、行为和认知方面面临更多挑战。然而，关于睡眠、癫痫、认知和行为挑战之间的关系以及这些因素随时间的相互作用，现有文献的描述有限。本研究旨在通过多个信息提供者在多个时间段使用多种不同的相关测量方法，了解新发性癫痫儿童睡眠、认知、情绪和行为之间关系的性质和强度。
在首次确诊癫痫发作后的6周内招募了332名参与者（6至16岁）。对照组由266名健康的兄弟姐妹组成。参与者通过家长使用睡眠行为问卷（SBQ）进行睡眠评估，通过综合神经心理测试组合进行认知评估，通过儿童行为检查表（家长版CBCL和教师版TRF）以及儿童抑郁量表（CDI）进行行为评估。这些评估在基线（B）、18个月和36个月时完成。
与兄弟姐妹相比，新发性癫痫儿童有更多的睡眠障碍（SBQ）、更高的行为问题发生率（CBCL和TRF）、更低的认知测试分数以及更高的抑郁发生率；这些情况在为期36个月的研究中持续存在。睡眠与行为问题、认知分数和抑郁显著相关。根据睡眠障碍分数进行分类时，39.7%的癫痫儿童经历“持续异常睡眠”，而14.8%经历“持续正常睡眠”。与持续正常睡眠的儿童相比，无论癫痫综合征如何，持续异常睡眠的儿童行为问题、抑郁和认知障碍的发生率最高。癫痫发作起始年龄较小、测试时年龄较小以及基线时年级较低与持续异常睡眠有关。
据我们所知，这是首次在一大群新诊断癫痫儿童中，通过不同时间点的多个信息提供者评估，证明睡眠、认知和行为问题之间关系的性质、强度、可靠性、稳定性和持续性。本研究结果表明，癫痫儿童存在显著持续的神经行为共病的高风险。因此，早期筛查这些挑战对于长期优化生活质量可能至关重要。
