- 期刊
具熱痙攣病史之癲癇學童的智力特性研究
The Intelligence Characteristics of School-aged Epileptic Children with a History of Febrile Convulsions
摘要
目的：熱痙攣是小兒痙攣最常見的原因，發生率為2%~5%，復發率為30%~40%，其中約2%~7%會發生癲癇兒童的智力研究很少。本研究目的在瞭解具熱痙攣病史之癲癇學齡兒童的智力特性。病人與方法：收集三組6-12歲學齡兒童，1997-2000年間在成大醫院、嘉義基督教醫院小兒神經內科門診個案：（1）具熱痙攣史之癲癇組，目前的診為癲癇，並在癲癇發生前曾有熱痙攣；（2）熱痙攣組，選擇具熱痙攣史但無癲癇兒童，與具熱痙攣史之癲癇組年齡相近者配對；（3）手足對照組，選擇具熱痙攣史之癲癇組中年齡相近且無抽痙史的兄弟姊妹。每組各30人。研究工具為魏氏兒童智力測驗與腦部磁振造影檢查。結果：接受測驗實際年齡（平均值±標準差）分別如下：具熱痙攣史之癲癇組（97.9±18.7個月）、熱痙攣組（98.7±18.1個月）、手足對照組（108.1±16.9個月）。具熱痙攣病史之癲癇組、手足對照組中智障比例分別為36.7%、6.7%及3.3%，具熱痙攣史之癲癇組的智障比例顯著較高。與熱痙攣組相較，除記憶廣度分測驗外，具熱痙攣病史之癲癇組的各項智力分數均顯著較低。以統計方法調整年齡變項，與手足對照組比較，具熱痙攣病史之癲癇組智力分數均較差。排除智障兒童，分析智力正常兒童的智力表現，具熱痙攣病史之癲癇組在符號替代分測驗表現較其他兩組差；且在算術分測驗表現較手足對照組差。分析智力剖面圖發現：具熱痙攣病史之癲癇組在符號替代分測驗表現相對於其他分測驗明顯較差。在具熱痙攣病史之癲癇兒童中，有21位接受腦部MRI檢查，其中約半數有異常結果，但腦部MRI異常與正常兒童之智力表現無顯著差異。結論：本研究結果發現具熱痙攣史之癲癇學童在所智力表現均差，特別是符號替代分測驗明顯更差。癲癇的發生對具熱痙攣史之兒童的智能發展有明顯不良的影響。
並列摘要
Objective: Febrile convulsion (FC) is the most common seizure disorder in children, and the incidence before age 6 years is 2%-5%. The recurrence rate of FC is 30%-40%, and the rate of subsequent epilepsy is 2%-7%. Many studies have showed that children with FC performed as well as other children in terms of academic progress, intelligence, and behavior. Few have focused on the intelligence outcome of epileptic children with a history of FC. This study delineated the intelligence characteristics of school-aged epileptic children with a history of FC. Patients and Methods: Epileptic children with a history of FC who visited our Pediatric Neurological Clinic from 1997-2000 were enrolled. The ere were three groups of children between 6 and 12 years old: Epileptic children with a history of FC (FC –epilepsy group), age matched FC group (FC group), and sibling controls of epileptic children wit ha history of FC (sibling group). There were thirty children in each group. The study instruments were the Wechsler Intelligence Scale for Children- Third Edition (WISC-III) and magnetic resonance imaging (MRI). Results: The mean age (±SD, months) of the three groups at assessment were as follows: FC-epilepsy group (97.9±18.7), FC group (98.7±18.1), and sibling group (108.1±16.9). The rate of mental retardation (defined as full IQ below 70) in the FC-epilepsy group (36.7%) was higher than that in the FC group (6.7%), and sibling group (3.3%). All test scores from the WISC-III except the digit span subtest in the FC-epilepsy group were significantly lower than those in the FC group. The intelligence scores of the FC-epilepsy children were even worse than the sibling group. The FC-epilepsy group with normal IQ (defined as full IQ＞69) had a lower mean score on the coding subtest compared with the other two groups, and they also had a lower mean score on the arithmetic subtest compared with the sibling group. The profiles of intelligence revealed that a significantly poor performance was observed for the coding subtest in the FC –epilepsy group. Ten of the 21 patients who had MRI examinations in the FC –epilepsy group had abnormal findings: Six had hippocampal abnormalities, two had cerebral white matter lesions, one had left cerebral hempispheric atrophy, and a frontal lobe tumor. There was no significant difference in the full IQ between children with abnormal and those with normal MRI results in the FC –epilepsy group. Conclusions: We found that the FC –epilepsy group had poorer intellectual performance one all aspects tested, especially in the coding subtest. Epilepsy has significant adverse effects on the intellectual outcome in school-aged children with a history of FC.