Effect Of Subclinical Epileptiform Discharges On Cognitive Function In Adult Epilepsy

BackgroundEpilepsy patients have cognitive impairment,there is a serious impact on the quality of life.Previous studies suggest that the cognitive function of epilepsy patients is affected by many factors,such as starting age,duration,frequency of attack,disease sites and antiepileptic drugs.But in recent years,we found that subclinical epileptiform discharges are also a factor that can not be ignored.It is confirmed in the study of children with epilepsy.However,the study about the cognitive function of subclinical epileptiform discharges in adult patients is rare.Objective1.Investigating the effect of subclinical epileptiform discharges on the cognition of adult epilepsy and analyzing the influence degree of different discharges indexes on cognitive function to raise physicians’ attention about subclinical epileptiform discharges.2.Analyzing the changes of resting brain network connection in adult epilepsy to explore the mechanism of subclinical epileptiform discharges on cognitive impairment and provide theoretical basis for future intervention.MethodsThese cases were collected in the China-Japan Union Hospital of Jilin University department of neurology from March 2016 to March 2017.The age of these patients was between 16 and 55 years old,in accordance with the International Epilepsy Alliance 2014 diagnostic criteria for epilepsy,and more than 3 months without clinical seizures recently.All patients were followed by detailed medical history,including name,sex,age,educational level,starting age,course of disease,frequency of onset,distance from the onset of seizures,seizures,antiepileptic drugs,head imaging findings.The patients were tested for Mo CA,SAS,SDS,PSQI,EEG and the age,sex,and education level were basically the same between the experimental group and the control group.The results of Mo CA in the two groups were compared to investigate whether SED had an effect on cognitive function in adult epilepsy.According to the long-term EEG monitoring results,60 patients in the SED group were classified according to the discharges indexes to compare the effects of different discharges indexes on cognitive function.Furthermore,we analyzed the influencing factors of cognitive function in adult epilepsy.All the data were analyzed by SPSS19.0 statistical software.Statistical methods include chi-square test,nonparametric rank sum tests,Pearson correlation analysis and multivariate stepwise regression analysis,P<0.05 was statistically significant.Fifteen patients were randomly selected for BOLD-f MRI examination.Through the comparison with ten normal people to analyze the resting brain function network connection differences.The data of BOLD-f MRI brain function was processed and analyzed by See CAT software to compare the differences in the resting brain function between the two groups by using two independent samples T test.Results1.Subclinical epileptiform discharges have different effects on cognitive function in adult epilepsy,and the Mo CA score was statistically significant(P= 0.00)compared with the control group.Mainly in visual space and executive function(P=0.00),attention(P=0.00),language ability(P=0.00),abstract thinking(P=0.00),delayed recall(P=0.00).There was no significant difference in naming(P=0.57)and orientation(P=0.10).2.Different discharges indexes have different effects on cognitive function aspects.Cognitive impairment was significant when the discharges indexes>10%.There was no statistical significance between discharges indexes<1%and discharges indexes 1-10%(P=0.14).There was a statistically significant difference between discharges indexes 1-10% and discharges indexes 10-50%(P=0.00).Mainly inthe visual space and executive functions(P=0.03),attention(P=0.00),abstract thinking(P=0.03),delayed recall(P=0.01).3.The cognitive function of epilepsy patients was positively correlated with the duration of education(P=0.00)and the time interval(P=0.02),and the subclinical epileptiform discharges(P=0.00)was negatively correlated.There was no correlation between cognitive function and duration of disease(P=0.23)and onset age(P=0.17).The subclinical epileptiform discharges was the main influencing factor of cognitive function in epilepsy(P=0.00).4.Compared with healthy people,epilepsy patients with subclinical epileptiform discharges have differences in resting brain function network connection,strong connective region: right inferior temporal gyrus,right hippocampus,bilateral thalamus,weak connective region:double inside the amount of back,double back on the back of the amount of back.Conclusion1.Subclinical epileptiform discharges have an effect on the cognitive function of adult epilepsy.The higher the epileptiform discharge index is,the more obvious the cognitive impairment is.Pay attention to the treatment of the subclinical epileptiform discharges.2.The mechanism of cognitive impairment in adult epilepsy with subclinical epileptiform discharges may be related to abnormal brain function in cognitive-related areas.