额叶癫痫共患注意缺陷多动障碍儿童的临床特征及认知损害

Clinical features and cognitive impairments in children with frontal lobe epilepsy comorbid with attention deficit hyperactivity disorder

  • 摘要: 目的 探讨智商正常的额叶癫痫(FLE)共患注意缺陷多动障碍(ADHD)儿童的临床特征及认知损害情况。方法 选取2018年1月至2024年6月在广东省人民医院被诊断为FLE的167例6~14岁患儿,筛查是否共患ADHD,将其分为FLE组和FLE+ADHD组,纳入同期确诊、同年龄的单纯ADHD患儿72例为ADHD组,以在儿童保健门诊保健的同期、同年龄的74名健康儿童为健康对照组,比较4组的韦氏儿童智力量表(WISC-Ⅳ)、威斯康星卡片分类测验(WCST)评估结果;对比分析FLE组和FLE+ADHD组的临床特征。结果 167例FLE患儿中62例(37.1%)符合ADHD的诊断,且以注意缺陷型为主(68.3%)。与健康对照组比较,FLE+ADHD组、FLE组、ADHD组言语理解指数(VCI)、知觉推理指数 (PRI)、工作记忆指数(WMI)、加工速度指数(PSI)、总智商(FSIQ)分值降低,WCST分类数分值降低,错误数、持续错误数、非持续错误数分值增加(均P < 0.05)。与FLE组比较,FLE+ADHD组VCI、PRI、WMI、PSI、FSIQ分值降低,WCST分类数分值降低,错误数、持续错误数分值增加(均P < 0.05)。与ADHD组比较,FLE+ADHD组VCI、PRI、FSIQ分值降低,WCST错误数、非持续错误数增加(均P < 0.05)。起病年龄<6岁、发作未完全控制、多种抗癫痫药物联用、脑电图左侧或双侧放电与共患ADHD相关。结论 FLE共患ADHD患儿与单纯FLE或单纯ADHD患儿比较,其认知功能损害领域基本一致,但某些领域的损害程度更为严重。

     

    Abstract: Objective To investigate the clinical characteristics and cognitive impairments in children with frontal lobe epilepsy (FLE) comorbid with attention deficit hyperactivity disorder (ADHD) who have normal intelligence. Methods A total of 167 children aged 6-14 years, diagnosed with FLE at Guangdong Provincial People’s Hospital from January 2018 to June 2024, were screened for comorbid ADHD. They were divided into the FLE group and the FLE+ADHD group. Additionally, 72 children with ADHD alone and 74 healthy children of the same age from the child health clinic were included as the ADHD group and the healthy control group, respectively. The assessment results of the Wechsler Intelligence Scale for Children-Fourth Edition (WISC-IV) and the Wisconsin Card Sorting Test (WCST) were compared among the four groups. Clinical characteristics were compared between the FLE group and the FLE+ADHD group. Results Among the 167 FLE children, 62 (37.1%) cases met the diagnostic criteria for ADHD, with the inattentive subtype being the most common (68.3%). Compared with the healthy control group, the FLE+ADHD group, the FLE group, and the ADHD group exhibited decreased scores in verbal comprehension index (VCI), perceptual reasoning index (PRI), working memory index (WMI), processing speed index (PSI) and full-scale intelligence quotient (FSIQ), alongside a lower score of WCST categories completed, and higher scores of WCST responses errors, perseverative responses errors, and non-perseverative responses errors (all P < 0.05). Compared with the FLE group, the FLE+ADHD group demonstrated significantly lower VCI, PRI, WMI, PSI, FSIQ scores, lower score of WCST categories completed, and higher scores of WCST responses errors and perseverative responses errors (all P < 0.05). Compared with the ADHD group, the FLE+ADHD group had lower VCI, PRI, FSIQ scores, and higher scores of WCST responses errors and non-perseverative responses errors (all P < 0.05). Early onset of epilepsy (<6 years), incomplete seizure control, use of multiple antiepileptic drugs, and interictal discharges on the left or bilateral sides on EEG were correlated with ADHD comorbidity. Conclusions Compared with children with FLE or ADHD alone, those with FLE and comorbid ADHD exhibit similar domains of cognitive impairment but show greater severity in some of these domains.

     

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