特发性全面性癫痫的认知功能研究

发布时间：2018-08-05 15:21

【摘要】：第一部分青少年肌阵挛性癫痫患者的认知功能研究目的：研究新诊断青少年肌阵挛性癫痫(juvenile myoclonic epilepsy,JME)患者的认知功能,探讨影响其认知功能的主要因素。方法：对纳入研究的JME患者进行连线测验、Stroop测验、词汇流畅性测验、听觉词汇回忆测验以及数字广度测验等神经心理学测试；使用焦虑和抑郁自评量表、以及简易智力状态量表等分别对JME患者进行情绪及智能测验。对比研究63例新诊断JME患者和63例健康自愿者的认知功能,与此同时,对于影响认知功能的可能因素如患者的年龄、性别、文化程度、有无家族史、脑电图情况及癫痫的病程、发病的年龄以及发作频率等也进行相关的分析。结果：与对照组相比,病例组患者在连线测验中的A型连线时间(P0.01)和B型连线时间(P0.01),Stroop字色干扰测验上的卡片A和卡片B的耗时数,卡片B和卡片C的正确数(p0.01),词汇流畅性测验的词汇总数(P0.01),听觉词汇回忆测验中的短时延迟回忆、长时延迟回忆以及再认回忆(P0.01),数字广度测验的顺背数及倒背数(p0.01)上差异有统计学意义；而在智力测验和情绪测验的结果上,病例组与对照组相比,差异无统计学意义(P0.05)。通过对认知功能的危险因素进行相关分析,表明患者发病的年龄与词汇的记忆存在密切的关系(r=0.443,p0.05),而在注意力和执行能力上,两者无明显的差异。结论：新诊断的青少年肌阵挛性癫痫患者在注意力、记忆力以及额叶的认知功能方面可能存在着不同程度的障碍。第二部分儿童失神癫痫患者认知功能研究目的：测试儿童失神癫痫的认知功能状态(children with absence epilepsy, CAE)。方法：对纳入研究的CAE患者进行连线测验、Stroop测验、词汇流畅性测验、听觉词汇回忆测验以及数字广度测验等神经心理学测试；使用焦虑和抑郁自评量表、以及简易智力状态量表等分别对CAE患者进行情绪及智能测验。对比研究25例新诊断CAE患者和25例健康自愿者的认知功能,结果：与对照组相比,病例组患者在连线测验中的A型连线时间(P0.01)和B型连线时间(P0.01), Stroop字色干扰测验上的卡片A和卡片B的耗时数,卡片B和卡片C的正确数(p0.01),词汇流畅性测验的词汇总数(P0.01),听觉词汇回忆测验中的短时延迟回忆、长时延迟回忆以及再认回忆(P0.01),数字广度测验的顺背数及倒背数(p0.01),智力测验(P0.01)上差异有统计学意义；而在情绪测验的结果上,病例组与对照组相比,差异无统计学意义(P0.05)。结论：儿童失神癫痫患者存在一定程度认知功能障碍,这种功能障碍趋向总的认知水平,而非是某一方面认知功能缺陷。第三部分新诊断青少年肌阵挛性癫痫患者的fMRI研究目的：运用fMRI研究新诊断青少年肌阵挛性癫痫患者静息态下的神经网络,探讨影响其认知功能损伤的病理生理机制。方法：对纳入研究的23例JME患者及23例健康对照组进行全脑rs-fMRI数据采集,采用fALFF法分析JME患者及健康对照组静息态下脑功能活动特点,并构建脑功能网络分析JME患者的脑网络异常；同时采集JME患者及健康对照组的全脑3D TIWI图像,采用基于曲面的皮层形态学方法,观察JME患者及健康对照组皮层厚度的差异。结果：与健康对照组相比较,JME患者fALFF减低的区域主要分布于左侧内侧额上回、右侧顶下小叶脑区,fALFF增高的区域主要分布于右侧梭状回、左侧中央前回、左侧中央后回。ReHo值增加的脑区为左侧颞下回、右侧中央前回,ReHo值降低的脑区为左侧前扣带回、左侧额叶中部。左眶额部Hub节点消失。皮层厚度减少的区域位于右角回、右颞中回及右颞下回。差异具有统计学意义(P0.01)。结论：青少年肌阵挛性癫痫患者静息态下神经网络存在异常,而神经网络的异常导致了患者在记忆力、注意力和执行能力上的障碍。
[Abstract]:Part 1 cognitive function study in the patients with juvenile myoclonic epilepsy: To study the cognitive function of the newly diagnosed juvenile myoclonic epilepsy (JME) patients and to explore the main factors affecting their cognitive function. Methods: a connection test, a Stroop test, and a fluency of vocabulary were conducted for the JME patients enrolled in the study. The neuropsychological tests, such as test, auditory vocabulary recall test and digital breadth test, were used to conduct emotional and intelligent tests on JME patients with anxiety and depression scale and simple mental state scale. The cognitive functions of 63 newly diagnosed JME patients and 63 healthy volunteers were compared and the effects of recognition on the cognitive function were compared. Possible factors such as patient's age, sex, education, family history, electroencephalogram and the course of epilepsy, age and frequency of seizures were also analyzed. Results: compared with the control group, the A connection time (P0.01) and B connection time (P0.01), Stroop word in the case group were compared with the control group. The time consuming number of card A and card B on the color interference test, the correct number of card B and card C (P0.01), the total number of vocabulary (P0.01) in the vocabulary fluency test, the short time delay memory in the auditory lexical recall test, the long time delayed recall and the recollection (P0.01), the number of breadth quizzes and the inverse number (P0.01) of the digital span test are statistically significant. The difference between the case group and the control group was not statistically significant (P0.05). The correlation analysis of the risk factors of cognitive function showed that there was a close relationship between the age of the patient and the memory of the vocabulary (r=0.443, P0.05), and there was no obvious difference between the two groups in attention and execution. Differences. Conclusions: the newly diagnosed juvenile myoclonic epilepsy may have different levels of impairment in attention, memory and cognitive function of the frontal lobe. The cognitive function of the second children with epileptic seizures is tested in the cognitive function of children with epilepsy (children with absence epilepsy, C Methods: (AE) methods: the CAE patients enrolled in the study were tested by the connection test, Stroop test, vocabulary fluency test, auditory vocabulary recall test, and digital breadth test, and other neuropsychological tests were performed on CAE patients with anxiety and depression scale, and simple mental state scale. 25 cases were compared and studied. Cognitive function of the newly diagnosed CAE patients and 25 healthy volunteers. Results: compared with the control group, the A type time (P0.01) and B connection time (P0.01) in the case group were in the connection test, the time time of the card A and card B on the Stroop color interference test, the correct number of card B and card C (P0.01), and the vocabulary of the vocabulary fluency test. The total number (P0.01), the short time delayed memory in the auditory lexical recall test, the long time delayed recall and the reminiscence recall (P0.01), the number of back numbers and the back number (P0.01) of the digital span test (P0.01), and the intelligence test (P0.01) were statistically significant, but there was no significant difference between the case group and the control group (P0.05). Conclusion: there is a certain degree of cognitive impairment in children with epileptic seizures. This dysfunction tends to a general cognitive level, not a cognitive impairment. The third part of the new diagnosis of juvenile myoclonic epilepsy: the use of fMRI to study the resting state of the newly diagnosed juvenile myoclonic epilepsy patients. The neuropathophysiological mechanism of the cognitive impairment was investigated by neural network. Methods: the whole brain rs-fMRI data were collected from 23 JME patients and 23 healthy controls. The brain functional activities of JME patients and healthy controls were analyzed by fALFF method, and the brain network of JME patients was constructed to analyze the brain network of the patients with the brain function network. At the same time, the whole brain 3D TIWI images of the JME patients and the healthy control group were collected, and the cortical thickness difference between the JME patients and the healthy control group was observed by the surface based cortical morphological method. Results: compared with the healthy control group, the region of the fALFF reduction in the JME patients was mainly distributed in the upper left medial frontal gyrus, the right parietal lobular region, fA The region of LFF increased mainly in the right fusiform gyrus, left anterior central gyrus, left posterior central gyrus and.ReHo value in the left temporal gyrus, right anterior central gyrus, and lower ReHo value in the left anterior cingulate gyrus, the left frontal lobe, and the left orbital frontal Hub node disappearing. The cortex thickness decreased in the right angle gyrus, right temporal gyrus and right The difference was statistically significant (P0.01). Conclusion: there is an abnormal neural network in the resting state of the juvenile myoclonic epilepsy, and the abnormal neural network causes the patient's impairment of memory, attention and executive ability.
【学位授予单位】：重庆医科大学
【学位级别】：博士
【学位授予年份】：2014
【分类号】：R742.1

【相似文献】