摘要目的:研究伴中央颞区棘波的儿童良性癫痫(BECT)的临床特征、脑电图及认知损害特点。方法:选取2019年1月至2021年6月在宣武医院儿科门诊或住院诊治的105例BECT初治患儿作为试验组,另匹配同年龄同性别健康儿童105例作为对照组。对试验组进行病史采集、脑电图及头颅核磁检查,并采用中国韦氏儿童智力量表第四版(WISC-IV)进行认知功能评估。结果:BECT患儿多于入睡后不久或苏醒前发作,本组患儿局灶性发作45例,局灶性发作继发全面强直阵挛发作(GTCS)60例。脑电图表现为中央颞区中-高幅棘慢或尖慢复合波,可扩散至同侧额顶或对侧,睡眠中放电明显增多。105例患儿中,双侧放电65例,单侧放电40例。神经影像学轻度异常7例,热惊或癫痫家族史阳性20例。两组WISC-IV评分比较,BECT组总智商及言语理解、知觉推理、工作记忆、加工速度指数均显著低于对照组(均P<0.001)。在BECT患儿中,脑电图双侧放电患儿的总智商及言语理解、工作记忆、加工速度指数得分均显著低于单侧放电患儿(P=0.024,P<0.001,P=0.004,P=0.011)。从发作形式(局灶性发作vs GTCS)、发作频率(≤5次/年 vs >5次/年)及发作时长(≤2min vs >2min)分别来看,继发全面强直阵挛发作患儿的言语理解指数明显低于局灶性发作者(P=0.031),发作频率高的患儿言语理解指数明显低于发作频率低者(P<0.001),发作持续时间长的患儿工作记忆指数明显低于发作时间短者(P=0.006),但总智商及其他指数无相应统计学差异(均P>0.05)。结论:BECT患儿具有其特征性临床特点,总智商较正常儿童差,其言语理解、知觉推理、工作记忆及加工速度功能均受损,脑电图双侧放电可能作为认知损害的危险因素,而发作形式、发作频率及发作时长也不同程度影响认知损害。
Abstract：Objective: To study the clinical characteristics,EEG features and cognitive impairment of benign epilepsy in children with central temporal spikes (BECT) . Method: A total of 105 newly diagnosed BECT children were selected as the experimental group, and 105 healthy children were matched as the control group. The clinical course, MRI data and EEG were collected and analyzed in BECT group. Cognitive function was assessed between the two groups using the Wechsler Intelligence Scale for Children--4th edition (WISC-IV). Result: BECT mostly attacked shortly after falling asleep or just before waking up. In this study, 45 BECT children presented with focal seizure (originating from the oropharynx) and the other 60 with secondary generalized tonic-clonic seizure(GTCS). And EEG showed bilateral discharge in 65 patients and unilateral discharge in 40 patients. Among 105 patients ,7 had mild abnormality in MRI and 20 had positive family history of epilepsy or febrile convulsion. The full-scale IQ (FSIQ) and verbal comprehension index (VCI), perceptual reasoning index(PRI), working memory index(WMI), and processing speed index (PSI) were significantly reduced in the BECT group (P<0.001) compared with the control group. In the BECT group, the FSIQ,VCI, WMI and PSI of patients with bilateral discharge was significantly lower than that with unilateral discharge (P=0.024, P<0.001,P=0.004,P=0.011), while there was no significant difference in PRI between the two groups (P>0.05). In terms of seizure form, seizure frequency and seizure duration respectively, the VCI of children with secondary GTCS was significantly lower than that of children with focal seizure (P=0.031); the VCI of children with high seizure frequency was significantly lower than that of children with low seizure frequency (P<0.001); the WMI of the children with long duration of attack was significantly lower than that of the children with short duration of attack (P=0.006); but there was no corresponding significant difference in FISQ and other indexes(all P>0.05). Conclusion: Children with BECT have characteristic clinical features and a lower full-scale IQ than normal children, whose verbal comprehension, perceptual reasoning, working memory and processing speed were impaired. Bilateral discharge in EEG may be a risk factor for cognitive impairment. The form, frequency and duration of seizures also affect cognitive impairment in different degrees.
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2022, Vol. 28 
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