Effect Of Levetiracetam On Risky Decision-making Ability In Children With Electrical Status Epilepticus During Sleep

Objective:Electrical status epilepticus during sleep(ESES)refers to the electroencephalogram(EEG)phenomenon of spikes and slow waves that continue to occur during non-rapid eye movement sleep(NREM).The epileptiform activity of ESES EEG often subsides automatically in adolescence,and despite treatment,cognitive impairment usually still exists.Therefore,the main purpose of ESES treatment is not only to control seizures,eliminate epileptiform EEG activity,but also to improve neuropsychological function and prevent possible cognitive impairment.The purpose of this study was to investigate the changes of risk decision-making ability of children with electrical status epilepticus during sleep(ESES)after 6 months of treatment with levetiracetam(LEV)and its clinical related influencing factors.Method:Forty-three children with ESES admitted to the Department of Pediatric Neurology of the Provincial Children’s Hospital of Anhui Medical University from September 2020 to December 2022 were selected for the study,and complete clinical and long-range video EEG test data were collected before and after 6 months of LEV treatment and the Iowa gambling task(IGT)was performed to evaluate the children’s risk decision-making ability,and the changes in clinical episodes,EEG data and risk decision-making ability before and after treatment were analyzed.Results:This study included 43 children with ESES,including 20 male children and 23female children.The average age of onset of epilepsy was(5.77±1.99)years old,and the diagnosis age of ESES was(7.95±2.62)years old.After 6 months of LEV treatment,16 patients were completely relieved,16 patients were effective,and 11 patients were ineffective.The total effective rate was 73.53%.By analyzing the influence of the basic clinical data of children with ESES on the efficacy of LEV treatment,it can be found that there is a statistically significant difference between the complete remission group,the effective group,and the ineffective group compared with the onset age of epilepsy and the diagnosis age of ESES(x~2==11.597,P=0.003;x~2==8.557,P=0.014,respectively).There was no significant difference between the three groups in gender,EEG discharge side,seizure frequency,family history of epilepsy,and history of febrile convulsion(x~2==4.905,P=0.086;x~2==2.803,P=0.246;x~2==0.185,P=0.912;x~2==0.318,P=0.853;x~2==2.659,P=0.260;x~2==0.340,P=0.844).Correlation analysis showed that there was a positive correlation between clinical symptom control and EEG discharge relief after 6 months of LEV treatment(r_s=0.528,P=0.000).After 6 months of LEV treatment,the children’s net score(8.93±14.36)was higher than that before treatment(-0.02±18.14),the difference was statistically significant(t=-2.790,P=0.008).The total number of favorable choices after treatment(54.65±7.29)was higher than that before treatment(49.93±8.94),the difference was statistically significant(t=-2.970,P=0.005).Conclusion:LEV can reduce clinical seizures and EEG SWI in children with ESES,and improve their risk decision-making ability.The treatment effect of LEV was poor in children with small age of onset of epilepsy and small age of diagnosis of ESES.Gender,EEG discharge side,seizure frequency,seizure family history and febrile convulsion history did not affect the treatment effect of LEV.