Neuropsychological status at seizure onset in children Risk factors for early cognitive deficits
Neuropsychological status at seizure onset in children Risk factors for early cognitive deficits
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DOI：
10.1212/wnl.0b013e3181b23551
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发表时间：
2009-08-18
期刊：
影响因子：
9.9
通讯作者：
Dunn, D. W.
中科院分区：
文献类型：
--
作者：
Fastenau, P. S.;Johnson, C. S.;Dunn, D. W.
目的：这项大型、前瞻性、以社区为基础的研究描述了首次癫痫发作时的神经心理功能和学业成绩，并确定了认知缺陷的危险因素。方法：我们比较了282名儿童（6-14岁，智商>= 70）与首次承认癫痫发作的147名健康兄弟姐妹在一组良好的-标准化和广泛使用的神经心理学和学术成就测试，并检查与人口统计学和临床变量的关系。在这个智力正常的队列中，27%的只有一次癫痫发作，高达40%的有危险因素的人在发作或接近发作时表现出神经心理学缺陷。与神经心理缺陷相关的风险因素包括多次癫痫发作（即，第二次无故发作;优势比[OR] = 1.96）、使用抗癫痫药物（OR = 2.27）、症状性/不明病因（OR = 2.15）和初始EEG上的癫痫样活动（OR = 1.90）;具有所有4种风险的儿童在首次临床访视时经历神经心理学缺陷的可能性是健康兄弟姐妹的3.00倍。结论：一组智力正常的癫痫发作儿童在发作时表现出神经心理障碍。学业成绩不受影响，这表明在疾病的早期有一个干预窗口，以改善对学校表现的影响。因此，这里确定的风险因素（特别是如果存在多种风险）需要在病情早期迅速转诊进行神经心理学评估。神经病学（R）2009;73：526-534
Objective: This large, prospective, community-based study characterized neuropsychological functioning and academic achievement at the time of the first recognized seizure and identified risk factors for cognitive deficits.Methods: We compared 282 children (ages 6-14 years, IQ >= 70) with a first recognized seizure to 147 healthy siblings on a battery of well-standardized and widely used neuropsychological and academic achievement tests and examined relationships with demographic and clinical variables.Results: In this intellectually normal cohort, 27% with just one seizure and up to 40% of those with risk factors exhibited neuropsychological deficits at or near onset. Risk factors associated with neuropsychological deficits included multiple seizures (i.e., second unprovoked seizure; odds ratio [OR] = 1.96), use of antiepileptic drugs (OR = 2.27), symptomatic/cryptogenic etiology (OR = 2.15), and epileptiform activity on the initial EEG (OR = 1.90); a child with all 4 risks is 3.00 times more likely than healthy siblings to experience neuropsychological deficits by the first clinic visit. Absence epilepsy carried increased odds for neuropsychological impairment (OR = 2.00).Conclusions: A subgroup of intellectually normal children with seizures showed neuropsychological deficits at onset. Academic achievement was unaffected, suggesting that there is a window early in the disorder for intervention to ameliorate the impact on school performance. Therefore, the risk factors identified here (especially if multiple risks are present) warrant swift referral for neuropsychological evaluation early in the course of the condition. Neurology (R) 2009;73:526-534