难治性额叶癫痫患者的认知功能分析

孙朝晖; 周文静; 王思瑜; 林久銮; 张冰清; 刘一鸥; 贺晶; 周新林; 左焕琮

doi:10.3760/cma.j.issn.1001-2346.2016.04.019

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中华神经外科杂志

• 临床论著 •

ENGLISH ABSTRACT

难治性额叶癫痫患者的认知功能分析

作者及单位信息

出版日期： 2016 -04 -28 ·

DOI： 10.3760/cma.j.issn.1001-2346.2016.04.019

Analysis of cognitive function in refractory frontal epilepsy

Authors Info & Affiliations

Sun Zhaohui

Epilepsy Center, Yuquan Hospital, Tsinghua University, Beijing 100040, China

Zhou Wenjing

Wang Siyu

Lin Jiuluan

Zhang Bingqing

Liu Yiou

He Jing

Zhou Xinlin

Zuo Huancong

Published： 2016 -04 -28 ·

DOI： 10.3760/cma.j.issn.1001-2346.2016.04.019

APP内阅读

摘要

目的探讨异常电活动和发作对难治性额叶癫痫患者认知功能的影响。

方法回顾性分析2010年8月至2013年8月于清华大学玉泉医院癫痫中心行手术治疗，且术后Engel分级均为Ⅰ级的42例额叶癫痫患者的临床资料。分析患者的推理能力、语言能力、注意能力及执行能力的特征，并结合异常电活动放电指数、侧别和发作特点，探讨上述因素对不同认知功能的影响。

结果42例患者威斯康辛卡片分类受异常电活动侧别的影响，左侧和双侧或多灶异常电活动患者的得分明显降低(均 P<0.01)。清醒期放电指数和发作频率为语义加工得分的影响因素，放电数量增多(>50%)或继发强直－阵挛发作频繁时(>1次/d)，语义加工得分均降低(均 P<0.05)；异常电活动侧别以及继发强直－阵挛发作为语音加工得分的影响因素，当电活动位于左侧、双侧或多灶时或继发强直－阵挛发作，患者语音加工得分均降低(均 P<0.05)。合并睡眠期频繁放电(>50%)或有继发强直－阵挛发作的患者的三维心理旋转得分均降低(均 P<0.05)。

结论清醒期和睡眠期放电指数、异常电活动侧别、发作频率以及发作类型可不同程度地影响认知功能。

关键词：癫痫，额叶;认知障碍;脑电描记术;放电指数

ABSTRACT

ObjectiveTo investigate the effect of abnormal electrical activity and seizure on cognitive function in patients with refractory frontal lobe epilepsy.

MethodsFrom August 2010 to August 2013, the clinical data of 42 patients with frontal lobe epilepsy (Engel classification grade Ⅰ) treated surgically at the Epilepsy Center, Yuquan Hospital, Tsinghua University were analyzed retrospectively. The reasoning ability, language ability, attention function, and executive function of the patients were analyzed, and the influence of the above factors on different cognitive function was investigated in accordance with abnormal electrical activity discharge index, sides, and seizure characteristics.

ResultsThe Wisconsin Card Sorting Test of 42 patients was affected by the sides of abnormal electrical activity, the scores of the left side, bilateral sides, and multifocal abnormal electrical activities were decreased significantly (all P<0.01). Discharge index and seizure frequency during the waking period were the influencing factors for semantic processing score. When the number of discharges increased (>50%) or the secondary tonic-clonic seizures occurred frequently (>1 time/day), the semantic processing scores were decreased (all P<0.05). The sides of abnormal electrical activity and the secondary tonic-clonic seizures were the influencing factors for the semantic processing scores. When the electrical activity was located on the left side or bilateral sides, and multifoci or secondary tonic-clonic seizures, the speech processing scores of the patients were decreased (all P<0.05). The scores of three-dimensional mental rotation in patients with combined with frequent discharge during sleep (>50%) and secondary tonic-clonic seizures were decreased (all P<0.05).

ConclusionDischarge index, sides of abnormal electrical activity, seizure frequency, and seizure types during waking and sleeping periods affects cognitive function in different degrees.

KEYWORDS： Epilepsy, frontal lobe;Cognition disorders;Electroencephalography;Discharge index

Corresponding author: Zhou Wenjing, Email: mocdef.labiamtohoejesolc

FUNDING:

National Basic Research Program of China(973 Program)(2012CB720704)

COPYRIGHTS:

No content published by the journals of Chinese Medical Association may be reproduced or abridged without authorization. Please do not use or copy the layout and design of the journals without permission.

All articles published represent the opinions of the authors, and do not reflect the official policy of the Chinese Medical Association or the Editorial Board, unless this is clearly specified.

引用本文

孙朝晖,周文静,王思瑜,等. 难治性额叶癫痫患者的认知功能分析[J]. 中华神经外科杂志,2016,32(4)：399-404.

DOI:10.3760/cma.j.issn.1001-2346.2016.04.019

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未经授权，不得转载、摘编本刊文章，不得使用本刊的版式设计。

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额叶癫痫患者常表现为注意力不集中、执行功能低下，如工作记忆、反应抑制、解决复杂问题的能力、流畅性任务等功能缺陷 ^{[
1
,

2
]}。此外，运动功能损伤如心理运动速度、协同能力、运动计划性及双手协调能力下降等现象额叶癫痫患者亦多见 ^{[
3
]}。流畅性任务缺陷与额叶癫痫的定侧有一定关系 ^{[
4
,

5
]}，如言语流畅性差的患者往往定位于优势侧额叶，而设计流畅性差的患者往往为非优势侧额叶癫痫，但目前的结论并不统一。另外，额叶癫痫患者还会出现价值判断、推理、对时序的推断以及社会认知等方面的缺陷。Helmstaedter和Witt ^{[
6
]}发现，额叶癫痫的患者发生行为异常的比率高于颞叶癫痫患者和正常人，有额叶结构异常的患者其行为问题的发生率更高。额叶癫痫患者还会出现记忆损害 ^{[
7
,

8
]}，即在完成需要储存和提取相关的记忆任务时，得分往往更低。如在学习阶段施加干扰，再测试记忆成绩时，额叶癫痫患者表现会更差。额叶癫痫患者在回顾某一事件或信息的时空顺序时也往往存在困难。虽然以往文献对额叶癫痫的认知功能进行了报道，但结果主要集中在对执行功能的影响上，且相关文献较少。鉴于此，本研究回顾性分析了42例行手术治疗且术后Engel分级均为Ⅰ级的难治性额叶癫痫患者的临床资料，分析患者的推理能力、言语能力、注意能力及执行能力等认知功能，并探讨其与清醒期和睡眠期放电指数、放电侧别、发作频率、发作类型的相关性，以期发现异常电活动和发作对难治性额叶癫痫患者的认知功能的影响。

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摘要
参考文献

参考文献

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Patrikelis P , Angelakis E , Gatzonis S . Neurocognitive and behavioral functioning in frontal lobe epilepsy:a review[J]. Epilepsy Behav, 2009,14(1):19-26. DOI: 10.1016/j.yebeh.2008.09.013 .