背景:儿童癫痫受几个因素的影响,包括临床和社会变量。在这些变量中,认知下降和行为障碍,对耻辱的看法,疲劳会导致生活质量(QOL)下降。癫痫活动,包括癫痫的严重程度,频繁的癫痫发作,和癫痫持续状态(SE),已被确定为QOL的重要预测因子。此外,脑电图(EEG)上的发作间癫痫样放电(IED)的频率也可能是QOL的重要预测因子,因为IED会导致认知能力下降和行为障碍。此外,频繁的癫痫发作和/或IED可能在情绪中介中起作用,比如耻辱和疲劳,在儿童癫痫中。癫痫发作的严重性和/或IED是,因此,儿童癫痫的重要QOL相关因素。癫痫发作严重程度是QOL相关因素:额叶功能障碍,比如认知衰退和行为障碍,可能会导致孩子及其家人的生活质量下降。在某些神经心理障碍的儿童中,在活动期癫痫期间可能存在额叶和前额叶生长障碍。从前额叶生长障碍的恢复可能取决于活跃的癫痫发作期。活跃发作期较短的儿童可以更快地从前额叶生长障碍中恢复。相比之下,活跃发作期较长的儿童可能会延迟恢复。此外,频繁的癫痫发作会导致癫痫发作相关的头痛,对自我污名和父母污名的看法,和疲劳。因此,在癫痫患儿中,严重的癫痫发作可导致与前额叶生长障碍相关的神经心理障碍.脑电图异常是QOL相关因素:脑电图上的IED,代表持续的病理性神经元放电,可能与几个病理方面有关。额叶IED可能是反复发作的危险因素,认知能力下降,和行为障碍,他们也可能扮演类似污名的情感中介者的角色。此外,行为障碍可能导致EEG上存在继发性双侧同步(SBS)。患有额叶IED和SBS的儿童的IED减少可以改善行为障碍。因此,脑电图异常,比如正面简易爆炸装置和SBS,也会导致癫痫患儿的神经心理障碍。儿童癫痫的治疗策略:癫痫发作的严重程度和脑电图上的IED可能与神经心理障碍有关,导致QOL降低。治疗管理可能是可取的,以减少癫痫发作和脑电图异常,比如正面简易爆炸装置和SBS,尽早提高癫痫患儿的生活质量。在抗癫痫药物(ASM)选择和调整期间,医师应制定治疗策略,以控制癫痫患儿的癫痫发作和抑制脑电图异常.在各种ASM中,新型ASM,比如左乙拉西坦和潘帕内,可以抑制脑电图上的临床癫痫发作和IED;因此,这些新型ASM可能是对出现额叶IED和SBS的癫痫儿童治疗的重要补充。
Back ground: Children with epilepsy are affected by several factors, including clinical and social variables. Among these variables, cognitive decline and behavioral disturbances, perceptions of stigma, and fatigue can lead to reductions in quality of life (QOL). Epileptic activities, including seizure severity, frequent seizures, and status epilepticus (SE), have been identified as important predictors of QOL. In addition, the frequency of interictal epileptiform discharges (IEDs) on electroencephalogram (EEG) may also be an important predictor of QOL, because IEDs can lead to cognitive decline and behavioral disturbances. Moreover, frequent seizures and/or IEDs may play a role in emotional mediators, such as stigma and fatigue, in childhood epilepsy. Seizure severity and/or IEDs are, therefore, important QOL-related factors in childhood epilepsy. Seizure severity as a QOL-related factor:
Frontal lobe dysfunctions, such as cognitive decline and behavioral disturbances, can result in reduced QOL for both the child and their family.
Frontal and prefrontal lobe growth disturbances can be present during active-phase epilepsy in some children with neuropsychological impairments. Recovery from prefrontal lobe growth disturbances may depend on the active seizure period. Children with a shorter active seizure period can recover from disturbances in prefrontal lobe growth more rapidly. In contrast, recovery may be delayed in children with a longer active seizure period. Moreover, frequent seizures can lead to seizure-associated headaches, perceptions of self-stigma and parental stigma, and fatigue. Accordingly, severe seizures can lead to neuropsychological impairments in association with prefrontal lobe growth disturbances in children with epilepsy. EEG abnormalities as QOL-related factors: IEDs on EEG, representing persistent pathological neuronal discharges, may be associated with several pathological aspects.
Frontal IEDs can be a risk factor for recurrent seizures, cognitive decline, and behavioral disturbances, and they may also play a role as emotional mediators similar to stigma. In addition, behavioral disturbances may result in the presence of secondary bilateral synchrony (SBS) on EEG. Behavioral disturbances can be improved in association with a reduction in IEDs in children with
frontal IEDs and SBS. Therefore, EEG abnormalities, such as frontal IEDs and SBS, can also lead to neuropsychological impairments in children with epilepsy. Therapeutic strategies in children with epilepsy: Seizure severity and IEDs on EEG may be associated with neuropsychological impairments, leading to QOL reduction. Therapeutic management may be desirable to reduce seizures and EEG abnormalities, such as
frontal IEDs and SBS, as early as possible to improve QOL in children with epilepsy. During antiseizure medication (ASM) selection and adjustment, physicians should strategize the therapeutic approach to controlling seizures and suppressing EEG abnormalities in children with epilepsy. Among various ASMs, novel ASMs, such as levetiracetam and perampanel, may suppress both clinical seizures and IEDs on EEG; thus, these novel ASMs may represent an important addition to the treatments available for epileptic children presenting with frontal IEDs and SBS.