苯巴比妥治疗对学龄期癫痫患儿认知功能的影响及相关因素分析
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摘要
目的：以韦氏儿童智力量表(WISE-CR)为标准评价和比较学龄期癫痫患儿苯巴比妥(Phenobarbital, PB)治疗前、治疗6个月后的认知功能状况,分析影响认知功能的相关因素,从而判断PB的治疗效果及筛选影响认知的相关因素,为农村癫痫儿童的治疗提供依据。
方法：选取52例云南罗平、禄丰两县农村癫痫防治项目PB治疗的学龄期癫痫儿童分别于PB治疗前、治疗6个月时接受韦氏儿童智力量表的测试。并详细记录年龄、性别、入学情况、首发年龄、癫痫病程、癫痫发作频率、PB服用剂量、癫痫控制情况等。对服药前后认知功能进行比较,并对认知功能影响因素进行分析,筛选出影响癫痫患者认知功能的主要危险因素。
结果：1.治疗后6个月癫痫控制情况：显效37例占71.2%,有效8例占15.4%,无效7例占13.5% 2.PB治疗前后智商比较,VIQ治疗后较治疗前降低、PIQ治疗后较治疗前升高具有统计学意义,FSIQ前后比较无统计学意义3.各分测项PB治疗前后比较,算术、背数较治疗前降低,具有统计学意义；积木、拼图、译码较治疗前提高,具有统计学意义；其余分测项治疗前后比较无统计学意义4.不同癫痫控制效果(按癫痫发作频率较少百分比划分)组的智商进行比较,显效、有效、无效组之间VIQ、PIQ、FSIQ均显效组>有效组>无效组,比较具有统计学意义5.服药前VIQ、PIQ、FSIQ分别与性别、年龄、入学情况、病程、癫痫发作频率进行相关性分析,VIQ、PIQ、FSIQ与癫痫病程、癫痫发作频率呈负相关,与入学情况、首发年龄呈正相关,与年龄、性别无相关性；PB治疗6个月后VIQ、PIQ、FSIQ分别与性别、年龄、入学情况、首发年龄、癫痫病程、癫痫发作频率、发作减少率、PB维持剂量进行相关性分析,VIQ、PIQ、FSIQ与病程、发作频率呈负相关,与入学情况、首发年龄、发作减少率呈正相关,与年龄、性别、PB维持剂量无相关性6.FSIQ与相关因素的多元逐步回归分析,PB治疗前首发年龄、癫痫病程是影响FSIQ的主要危险因素；PB治疗6个月首发年龄、癫痫病程、发作减少率是影响FSIQ的主要危险因素。
结论：1.PB治疗对学龄期儿童全身强直阵挛发作性癫痫控制具有很好的控制率2.PB治疗6个月,对FSIQ无影响,VIQ下降,PIQ升高3.各分测项目中,服药后6个月构成VIQ的算术、背数的量表得分下降,而构成PIQ的积木、拼图、译码的量表得分提高4.癫痫控制显效组、有效组、无效组之间存在认知的差别,VIQ、PIQ、FSIQ均显效组>有效组>无效组5.PB治疗前的VIQ、PIQ、FSIQ均与癫痫病程、发作频率呈负相关,与入学情况、首发年龄呈正相关,与年龄、性别无相关性；PB治疗6个月后VIQ、PIQ、FSIQ均与癫痫病程、癫痫发作频率呈负相关,与入学情况、首发年龄、发作减少率呈正相关,与年龄、性别、PB剂量无相关性6.首发年龄、癫痫病程是PB治疗前影响FSIQ的主要危险因素,首发年龄、癫痫病程、发作减少率是影响PB治疗后影响FSIQ的主要危险因素。
Objective:To evaluate and compare cognitive conditions between the epileptic school-age children without and with treatment 6 months, using Wechsler Intelligence Scales for Children (WISC) and analyzing related factors.We expected to supply evidences of the treatment for children with epilepsy in rural areas through our research.
Methods:WISC was tested in 52 epileptic school-age children who received Phenobarbital treatment before and after 6 month in Luoping and Lufeng in Yunnan; some details such as the age, gender, educational background, age of onset, epilepsy duration, seizures frequency, PB dose, seizure control situation were recorded; cognitive status with and without treatment were compared; influencing factors that maybe result in cognitive impairment were analyzed and screened out.
Results:1. Seizure-controlled condition after 6 months treatment:A markedly effective case was 37, accounted for 71.2%; a normal effective case was 8, accounted for 15.4%; an invalid case was 7, accounted for 13.5%.2. Comparing IQ before and after treatment with PB:VIQ decreased and PIQ increased after treatment than before; no significant differences were observed in FSIQ between before and after treatment. 3. Comparing Sub-test items before and after treatment:Arithmetic and Digit Span Scores decreased after treatment; Block Design, Object Assembly and Digit Symbol increased after treatment.4. Comparing IQ among groups with different seizure-controlled condition:there is statistic significance among VIQ, PIQ and FSIQ, the comparison of test score is:invalid group< normal effective group< markedly effective group.5. Correlation analysis shows that:epilepsy duration and seizures frequency negatively correlated to IQ (VIQ, PIQ and FSIQ); Educational background and age of onset positively correlated to IQ, the age and the gender didn't have correlation with IQ, the same as after 6 months treatment of PB. Additionally, seizure-controlled rate positively and drug dose does not correlated to IQ.6. Multiple stepwise regression analysis shows that the age of onset and epilepsy duration may be major risk factors influenced FSIQ.
Conclusion:1.PB treatment is significantly available to control generalized tonic-clinic epilepsy in school-age children.2. After 6 months treatment of PB, epileptic children's VIQ score decreased, PIQ score increased and FSIQ have no change 3. After 6 months treatment of PB, average scores of Arithmetic and Digit Span decreased, that of Block Design, Object Assembly and Digit Symbol increased. 4. There are sharply different scores in IQ test:effective group> normal effective group> invalid group. 5. Whether before or after 6 months treatment, IQ(VIQ,PIQ,FSIQ) negatively correlated to epilepsy duration and frequency of seizures, and positively correlated to age of onset and seizure control rate,non-correlated to PB dose. 6. The age of onset and epilepsy duration are major risk factors may contribute to FSIQ.
方法：选取52例云南罗平、禄丰两县农村癫痫防治项目PB治疗的学龄期癫痫儿童分别于PB治疗前、治疗6个月时接受韦氏儿童智力量表的测试。并详细记录年龄、性别、入学情况、首发年龄、癫痫病程、癫痫发作频率、PB服用剂量、癫痫控制情况等。对服药前后认知功能进行比较,并对认知功能影响因素进行分析,筛选出影响癫痫患者认知功能的主要危险因素。
结果：1.治疗后6个月癫痫控制情况：显效37例占71.2%,有效8例占15.4%,无效7例占13.5% 2.PB治疗前后智商比较,VIQ治疗后较治疗前降低、PIQ治疗后较治疗前升高具有统计学意义,FSIQ前后比较无统计学意义3.各分测项PB治疗前后比较,算术、背数较治疗前降低,具有统计学意义；积木、拼图、译码较治疗前提高,具有统计学意义；其余分测项治疗前后比较无统计学意义4.不同癫痫控制效果(按癫痫发作频率较少百分比划分)组的智商进行比较,显效、有效、无效组之间VIQ、PIQ、FSIQ均显效组>有效组>无效组,比较具有统计学意义5.服药前VIQ、PIQ、FSIQ分别与性别、年龄、入学情况、病程、癫痫发作频率进行相关性分析,VIQ、PIQ、FSIQ与癫痫病程、癫痫发作频率呈负相关,与入学情况、首发年龄呈正相关,与年龄、性别无相关性；PB治疗6个月后VIQ、PIQ、FSIQ分别与性别、年龄、入学情况、首发年龄、癫痫病程、癫痫发作频率、发作减少率、PB维持剂量进行相关性分析,VIQ、PIQ、FSIQ与病程、发作频率呈负相关,与入学情况、首发年龄、发作减少率呈正相关,与年龄、性别、PB维持剂量无相关性6.FSIQ与相关因素的多元逐步回归分析,PB治疗前首发年龄、癫痫病程是影响FSIQ的主要危险因素；PB治疗6个月首发年龄、癫痫病程、发作减少率是影响FSIQ的主要危险因素。
结论：1.PB治疗对学龄期儿童全身强直阵挛发作性癫痫控制具有很好的控制率2.PB治疗6个月,对FSIQ无影响,VIQ下降,PIQ升高3.各分测项目中,服药后6个月构成VIQ的算术、背数的量表得分下降,而构成PIQ的积木、拼图、译码的量表得分提高4.癫痫控制显效组、有效组、无效组之间存在认知的差别,VIQ、PIQ、FSIQ均显效组>有效组>无效组5.PB治疗前的VIQ、PIQ、FSIQ均与癫痫病程、发作频率呈负相关,与入学情况、首发年龄呈正相关,与年龄、性别无相关性；PB治疗6个月后VIQ、PIQ、FSIQ均与癫痫病程、癫痫发作频率呈负相关,与入学情况、首发年龄、发作减少率呈正相关,与年龄、性别、PB剂量无相关性6.首发年龄、癫痫病程是PB治疗前影响FSIQ的主要危险因素,首发年龄、癫痫病程、发作减少率是影响PB治疗后影响FSIQ的主要危险因素。
Objective:To evaluate and compare cognitive conditions between the epileptic school-age children without and with treatment 6 months, using Wechsler Intelligence Scales for Children (WISC) and analyzing related factors.We expected to supply evidences of the treatment for children with epilepsy in rural areas through our research.
Methods:WISC was tested in 52 epileptic school-age children who received Phenobarbital treatment before and after 6 month in Luoping and Lufeng in Yunnan; some details such as the age, gender, educational background, age of onset, epilepsy duration, seizures frequency, PB dose, seizure control situation were recorded; cognitive status with and without treatment were compared; influencing factors that maybe result in cognitive impairment were analyzed and screened out.
Results:1. Seizure-controlled condition after 6 months treatment:A markedly effective case was 37, accounted for 71.2%; a normal effective case was 8, accounted for 15.4%; an invalid case was 7, accounted for 13.5%.2. Comparing IQ before and after treatment with PB:VIQ decreased and PIQ increased after treatment than before; no significant differences were observed in FSIQ between before and after treatment. 3. Comparing Sub-test items before and after treatment:Arithmetic and Digit Span Scores decreased after treatment; Block Design, Object Assembly and Digit Symbol increased after treatment.4. Comparing IQ among groups with different seizure-controlled condition:there is statistic significance among VIQ, PIQ and FSIQ, the comparison of test score is:invalid group< normal effective group< markedly effective group.5. Correlation analysis shows that:epilepsy duration and seizures frequency negatively correlated to IQ (VIQ, PIQ and FSIQ); Educational background and age of onset positively correlated to IQ, the age and the gender didn't have correlation with IQ, the same as after 6 months treatment of PB. Additionally, seizure-controlled rate positively and drug dose does not correlated to IQ.6. Multiple stepwise regression analysis shows that the age of onset and epilepsy duration may be major risk factors influenced FSIQ.
Conclusion:1.PB treatment is significantly available to control generalized tonic-clinic epilepsy in school-age children.2. After 6 months treatment of PB, epileptic children's VIQ score decreased, PIQ score increased and FSIQ have no change 3. After 6 months treatment of PB, average scores of Arithmetic and Digit Span decreased, that of Block Design, Object Assembly and Digit Symbol increased. 4. There are sharply different scores in IQ test:effective group> normal effective group> invalid group. 5. Whether before or after 6 months treatment, IQ(VIQ,PIQ,FSIQ) negatively correlated to epilepsy duration and frequency of seizures, and positively correlated to age of onset and seizure control rate,non-correlated to PB dose. 6. The age of onset and epilepsy duration are major risk factors may contribute to FSIQ.
引文
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