EEG criteria predictive of complicated evolution in idiopathic rolandic epilepsy
EEG criteria predictive of complicated evolution in idiopathic rolandic epilepsy
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DOI：
10.1212/wnl.57.6.1071
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发表时间：
2001-09-25
期刊：
影响因子：
9.9
通讯作者：
Marescaux, C
中科院分区：
文献类型：
--
作者：
Massa, R;de Saint-Martin, A;Marescaux, C
背景：虽然所谓的伴有中央-颞叶棘波的良性癫痫(BECTS)在癫痫缓解方面预后良好，但在其过程中有时会出现行为问题和认知功能障碍。为了寻找可以早期发现易发生此类并发症的患者的临床或脑电标记物，作者在一组未选定的BECTS患者中进行了一项前瞻性研究。方法：对35例BECTS患儿从发作障碍开始至完全恢复，每隔6~12个月复查一次学术、家族、神经学、神经心理学、觉醒与睡眠脑电检查。结果：在35例患者中，有25例(72%)的行为和智能功能没有受损。在35名患者中，有10名(28%)出现了教育表现和家庭适应不良。这些社交问题与冲动、学习困难、注意力障碍以及轻微(7/35例，20%)或严重(3/35例，8%)听觉-语言或视觉-空间缺陷有关。恶化期从发病后2~36个月开始，持续9~39个月。非典型演变的发生与5种定性和1种定量的发作间期脑电模式显著相关：间歇性慢波灶、多个非同步棘波灶、长棘波群、广泛性3-c/S“缺失型”棘波放电、发作间期阵发伴负性或正性肌阵挛、以及清醒和睡眠时大量发作间期异常。临床恶化与癫痫发作特征或治疗无关。结论：至少6种不同的发作间期脑电模式中的3种的不同组合及其持续时间长(大于或等于6个月)似乎是BECTS患者神经心理损害风险的特征。
Background: Although so-called "benign" epilepsy with centrotemporal spikes (BECTS) always has an excellent prognosis with regard to seizure remission, behavioral problems and cognitive dysfunctions may sometimes develop in its course. To search for clinical or EEG markers allowing early detection of patients prone to such complications, the authors conducted a prospective study in a cohort of unselected patients with BECTS. Methods: In 35 children with BECTS, academic, familial, neurologic, neuropsychological, and wake and sleep EEG evaluations were repeated every 6 to 12 months from the beginning of the seizure disorder up to complete recovery. Results: In 25 of 35 patients (72%), behavioral and intellectual functioning remained unimpaired. In 10 of 35 patients (28%), educational performance and familial maladjustment occurred. These sociofamilial problems were correlated with impulsivity, learning difficulties, attention disorders, and minor (7/35 cases, 20%) or serious (3/35 cases, 8%) auditory-verbal or visual-spatial deficits. Worsening phases started 2 to 36 months after onset and persisted for 9 to 39 months. Occurrence of atypical evolutions was significantly correlated with five qualitative and one quantitative interictal EEG pattern: intermittent slow-wave focus, multiple asynchronous spike-wave foci, long spike-wave clusters, generalized 3-c/s "absence-like" spike-wave discharges, conjunction of interictal paroxysms with negative or positive myoclonia, and abundance of interictal abnormalities during wakefulness and sleep. Clinical deterioration was not linked with seizure characteristics or treatment. Conclusion: Different combinations of at least three of six distinctive interictal EEG patterns and their long-lasting (greater than or equal to6-month) persistence seem to be the hallmarks of patients with BECTS at risk for neuropsychological impairments.