Mandelbaum D E, Burack G D
Department of Pediatrics, Robert Wood Johnson Medical School, University of Medicine and Dentistry of New Jersey, New Brunswick 08901, USA.
Dev Med Child Neurol. 1997 Nov;39(11):731-5. doi: 10.1111/j.1469-8749.1997.tb07374.x.
Antiepileptic drugs have been reported to have a variety of adverse effects on behavior and performance in children with epilepsy. Previous studies investigating these side effects, however, have not controlled for the baseline status of the child (e.g. underlying neurological condition, seizure type, socioeconomic status, family variables), making it difficult to determine whether changes in function are attributable to the use of medication. We investigated the cognitive and behavioral profiles of 43 children, aged from 4 to 16 years, with new onset, idiopathic seizures. Twenty-six of these children participated in a 6-month follow-up study, and 12 in a 12-month follow-up study, investigating the effects of antiepileptic medications on psychological functioning. The children were of average intelligence (mean IQ 108) and had not previously been treated with antiepileptic medication. Children were classified as having either generalized convulsive, generalized non-convulsive (absence), simple partial, or complex partial seizures. Prior to the initiation of treatment, children with partial seizures were found to perform better than children with generalized seizures on measures of cognitive functioning. Children with convulsive seizures obtained significantly higher cognitive scores than those with non-convulsive seizures. Children with generalized non-convulsive seizures had lower cognitive scores than subjects with other types of seizure. No differences were found between groups at baseline prior to the initiation of antiepileptic medications. Analysis of subjects' performance after 6 and 12 months of antiepileptic therapy showed no significant deterioration attributable to medication. The differences in cognitive performance of the four seizure groups at baseline were not apparent at the time of follow-up. These results indicate that intrinsic and environmental variables may play a more significant role in predisposing certain children to cognitive and learning problems than do antiepileptic medications.
据报道，抗癫痫药物对癫痫患儿的行为和表现有多种不良影响。然而，以往调查这些副作用的研究并未对儿童的基线状态（如潜在的神经状况、癫痫发作类型、社会经济地位、家庭变量）进行控制，因此难以确定功能变化是否归因于药物使用。我们调查了43名4至16岁新发特发性癫痫患儿的认知和行为概况。其中26名儿童参与了为期6个月的随访研究，12名儿童参与了为期12个月的随访研究，以调查抗癫痫药物对心理功能的影响。这些儿童智力平均（平均智商108），此前未接受过抗癫痫药物治疗。儿童被分类为全身性惊厥、全身性非惊厥（失神）、单纯部分性或复杂部分性癫痫发作。在开始治疗前，发现部分性癫痫发作的儿童在认知功能测量方面的表现优于全身性癫痫发作的儿童。惊厥性癫痫发作的儿童获得的认知分数明显高于非惊厥性癫痫发作的儿童。全身性非惊厥性癫痫发作的儿童的认知分数低于其他类型癫痫发作的受试者。在开始使用抗癫痫药物之前，各组在基线时未发现差异。对抗癫痫治疗6个月和12个月后受试者的表现进行分析表明，没有明显的因药物导致的恶化。随访时，四个癫痫发作组在基线时认知表现的差异并不明显。这些结果表明，与抗癫痫药物相比，内在和环境变量在使某些儿童易患认知和学习问题方面可能起更重要的作用。
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