Детска церебрална парализа, епилепсия и интелектуален дефицит
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Дата
2020
Автори
Родопска, Елена Пламенова //
Rodopska, Elena Plamenova
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Издател
Медицински университет - София // Medical University - Sofia
Резюме
ЦЕЛ И ЗАДАЧИ
ЦЕЛ: Анализ на симптоматичната епилепсия и интелектуалният дефицит при деца с ЦП (честота, етиологични фактори, епилептични пристъпи, електроенцефалографски находки, степени на умствена изостаналост, невроизобразяващи находки и терапевтична резистентност на епилептичните пристъпи при различните форми на ЦП). Търсене на връзка между симптоматичната епилепсия и интелектуалният дефицит.
ЗАДАЧИ. За постигането на посочената цел са поставени следните задачи: 1.Разпределение на пациентите с ЦП по клинични форми (спастична, дискинетична, атаксична и смесена) и разделяне на спастичната форма по топография (квадрипареза, дипареза и хемипареза) с определяне на честотата на всяка от тях.
2. Определяне честотата на симптоматичната епилепсия и интелектуалният дефицит при различните форми на ЦП.
3. Определяне на етиологичните фактори допринесли за ЦП. Анализиране на рисковите фактори за симптоматична епилепсия и интелектуален дефицит при пациенти с ЦП.
4. Анализ на видовете епилептични пристъпи при различните клинични форми на ЦП.
5. Провеждане на видео-ЕЕГ изследване и анализ на електроенцефалографските находки при различните форми на ЦП.
6. Класифициране на интелектуалният дефицит по степени на тежест спрямо формите на ЦП.
7. Търсене на зависимост между епилепсията и интелектуалният дефицит, както и връзкамежду ранната изява на епилептичните пристъпи и тежестта на интелектуалният дефицит. Анализиране на тежките епилептични енцефалопатии и търсене на корелация със степента на умствена изостаналост.
8. Анализиране на образните находки при различните форми на ЦП. Определяне на риска за симптоматична епилепсия при различните абнормни лезии установени в образните изследвания на главен мозък.
9. Търсене на връзка между формите на ЦП и терапевтичният ефект от антиепилептичната терапия.
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Summary: Cerebral palsy (CP) combines a group of non-progressive, residual motor syndromes (paresis, muscle tone disorders, impairment of coordination, posture changes and involuntary movements) often combined with mental retardation, speech disorders and symptomatic epilepsy due to brain malformations or brain injury in the prenatal, perinatal and postnatal period. The aim of the present study is to analyze the characteristics of the symptomatic epilepsy and the intellectual deficiency in children with CP (their frequency, etiological factors, electroencephalographic findings, degrees of mental retardation, neuroimaging findings, types and therapeutic resistance of the epileptic seizures in different forms of CP) as well as to look for a link between symptomatic epilepsy and intellectual disability. Materials and methods : A retrospective and prospective analysis of 521 children with different forms of CP (spastic quadriparesis - 30.1%, spastic diparesis-15.7%, spastic hemiparesis-27.4%, dyskinetic CP - 3.6%, ataxic CP - 8.3%, mixed CP - 14.8%) diagnosed and treated in MHATNP "St. Naum" between 2008 and 2018 was carried out. The methods used for the analysis of the data about epilepsy and mental retardation were: detailed history of the epileptic seizures and their types according to the ILAE classification; neurological and somatic examination; video-electroencephalography (EEG) conducted on a 64- channel device Deltamed with Coherence software 5.1.2. The relative risk for symptomatic epilepsy was determined depending on the lesions in the imaging studies (CT and MRI of the brain). Neuropsychological battery included tests for intelligence quotient (IQ) such as Wechsler Intelligence Scale for Children, Binet-Terman Test, Raven Progressive Matrices. Results: The most common risk factors for CP such as prematurity, intrauterine growth retardation (IGR), maternal- fetal infections (MFIs), hypoxic-ischemic encephalopathy (HIE), perinatal strokes and hyperbilirubinemia were analyzed. Thirty six percent of children with CP were premature, most of them are with spastic quadriparesis - 38.0% (n = 68) and diparesis - 24.0% (n = 48). Epilepsy was registered in 31.8% of the premature infants with CP and in 74% we found mental retardation. Children with IGR have the highest incidence of spastic quadriparesis - 42.2%, 14.7% of them have epilepsy, and 89.8% have mental retardation. There are 191 children with MFIs (36.7%), 38.3% of them have epilepsy and 20.7% are with normal intelligence. In the group of the patients with congenital brain malformations (CBM) (n=83,16%), symptomatic epilepsy was reported in 19.5% of cases. Fifty seven percent (n = 298) of the patients with CP had history of HIE, 54.5% of them reported epileptic seizures. There were 123 children with perinatal ischemic strokes (23.6%), 97 - with intraventricular hemorrhages (18.6%) and 4 (0.8%) - with subarachnoid hemorrhages. Most of the patients with perinatal ischemic strokes are with spastic hemiparesis - 65.0% (n = 80). Epilepsy was reported in 26.4% (n = 80) of the patients with perinatal ischemic strokes. Epilepsy is common in children with cerebral palsy (CP). In a group of 521 children with cerebral palsy epilepsy was reported in 58% (n=303) of them, 74.0% (n=386) had mental retardation. We found a higher percentage of symptomatic epilepsy in the group of children with CP and mental retardation - 83.8% (n=254), while only 16.2% (n=49) of the children with CP and with normal intellect had epilepsy. Focal seizures were the most common type of epileptic seizures - 34, 7% (n=181), followed by secondary generalized - 29,6% (n=154) and generalized seizures (tonic, clonic and generalized tonic-clonic) - 25,3% (n=132). Most of the patients experienced early onset epileptic seizures, in 43.5% (n=132) of them the seizures started in the first year of life. The earlier onset of the epileptic seizures correlated with a more severe mental retardation. We found that symptomatic epilepsy and severe me ntal retardation are most common in children with spastic quadriparesis.
Among the lesions in MRI with the highest relative risk for symptomatic epilepsy are ventriculomegaly RR -1,702 (95% Cl 1,521-1,905), cortical atrophy RR-1,634 (95% Cl 1,443-1,851) and lesions in the gray matter RR -1.611 (95% Cl 1.42-1.827). Anticonvulsant drug therapy was used in 75.3% of the children with mixed form of CP, in 70.1% of patients with spastic quadriparesis and in only 20.7% of those with spastic diparesis. Children with severe mental retardation had the greatest need for anticonvulsant polytherapy - 40.5% (n=62). Respectively, the percentage of the children with CP and with normal intelligence who were on polytherapy was only 9.8% (n=15).
Conclusion: In children with CP, severe motor impairments and mental retardation, who suffered from epilepsy, rehabilitation is difficult and their quality of life deteriorates.
Описание
Ключови думи
деца; нервна система - болести - деца; церебрална парализа - деца; епилепсия - деца; умствено изоставане - деца //
child; nervous system diseases; cerebral palsy - infancy and childhood; epilepsy - infancy and childhood; mental retardation - infancy and childhood