成年起病的癫痫患者认知损害的影响因素研究

摘要

Objective The effect of six clinical variables on cognition in patients with adult onset epilepsy in China was assessed. Method 50 patients with adult onset epilepsy were enrolled in the study. After subjects were examined by EEG, they were further assessed by the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA). Data were analyzed with SPSS 16.0 software. Results MMSE and MoCA scores were significantly correlated with sharp waves in EEG (P<0.01 and P<0.05, respectively), but neither the seizure frequency nor the epilepsy duration (P>0.05). Although not statistically significant, there was a clear tendency that both MMSE and MoCA scores in patients treated with valproate were lower than those in patients treated with other medicines (lamotrigine, oxcarbazepine, carbamazepine and phenvtoin) (P value was 0.097 and 0.061, respectively). Interestingly, education level only had effect on MoCA score (P<0.05), but not MMSE score (P>0.05). Conclusion Sharp waves in EEG, and probably valproate treatment, are negatively associated with the cognition in patients with adult onset epilepsy. However, seizure frequency, duration of epilepsy, or gender do not influence the cognition in patients with adult onset epilepsy. In addition, high education level in patients with adult onset epilepsy may correlate with better cognition.%目的：评估患者性别、教育水平、发作频率、持续时间、抗癫痫药物和视频脑电图（VEEG）尖波出现对成年起病的癫痫患者认知能力的影响。方法50例成年起病的癫痫患者接受VEEG检查后行简易精神状态量表（MMSE）和蒙特利尔认知评估量表（MoCA）检查获得认知分数，按照上述6种因素分别分组，应用SPSS16.0软件进行差异统计学分析。结果 VEEG尖波出现明显降低癫痫患者两种量表得分（MMSEP<0.01；MoCAP<0.05）,而性别、发作频率和持续时间均不影响两种量表的得分（均P>0.05）。丙戊酸钠治疗组两种量表的得分低于非丙戊酸钠（拉莫三嗪、奥卡西平、卡马西平和苯妥英钠）治疗组（MMSEP=0.097；MoCAP=0.061）。研究还发现，较高教育程度癫痫人群MoCA得分明显高于较低教育水平患者， MoCA量表评分P<0.05,而MMSE量表评分P>0.05，提示MoCA量表对于认知能力影响的评估更加敏感。结论 VEEG尖波出现提示成年发病癫痫患者的认知损害，丙戊酸钠治疗也可能损害癫痫患者的认知水平。另外，教育程度较高的成年发病癫痫患者认知能力较高。而癫痫发作频率、持续时间和患者性别不影响成年发病癫痫患者的认知水平。