| ObjectiveTo analyze the serum ammonia level in epileptic patients and the correlation between serum ammonia level and cognitive function and EEG.MethodsThe following examinations were performed on 187 epileptic patients who met the inclusion and exclusion criteria:1?Neuropsychological test:Clinical memory scale,Mini-Mental state examination(MMSE),Montreal cognitive assessment(MOCA),Digital symbol test(DSy),Verbal fluency test(VFT),Digit span test(DSp);2?Determination of serum ammonia level;3?EEG:the background EEG was selected and the time of 80 s was taken,and the power spectrum and S values((?+?)/(?1+?2+?1+?2))of each brain region and 16 leads were calculated.We used Independent sample t test,one-way analysis of variance and Pearson correlation analysis to evaluate the correlation between ammonia level and cognitive function test score and EEG power spectrum.Monadic linear related analysis and multivariate linear regression analysis were used to evaluate the effects of age,duration,seizure type,frequency of seizures and the number of antiepileptic drugs on serum ammonia.And the pairwise comparison between groups with different frequency of attack and type of medication was performed by one-way analysis of variance.All the data were analyzed by SPSS for Windows 24.0 statistical software.Results 1.Ammonia effects on cognitive function 1.1 High serum ammonia group got lower scores in memory quotient?directmemory?associative learning?image free recall?portrait features association?MOCA and VFT than normal serum ammonia group(p < 0.01 or p < 0.05).There was no significant difference between the two groups in scores of meaningless graphics recognition?MMSE?DSy and DSp.1.2 Serum ammonia and memory quotient?direct-memory?associative learning?image free recall?portrait features association?MOCA?VFT presented negative correlation(p<0.05).1.3 Effects of different serum ammonia concentrations on cognitive function: In terms of memory quotient and image free recall,except that there was no statistical difference between the moderately elevated group and the severely elevated group,there were statistical differences in scores between the other groups(p<0.05 or p<0.01).There were statistical differences in the scores of all cognitive functions between the normal group and the moderately elevated group(p<0.05 or p<0.01).2.The correlation between serum ammonia and EEG power spectrumThe S value in each brain region of the epilepsy group with elevated serum ammonia was higher than that of the normal serum ammonia group,and the differences in the frontal,central,temporal and occipital regions were statistically significant(p<0.05),while there was no significant difference in the parietal region.There was a positive correlation between serum ammonia concentration and S value in each brain region in epilepsy patients,that is,the higher the serum ammonia concentration was,the higher the S value in each brain region was,and the more obvious the slow wave of EEG was.3.The influencing factors of ammonia 3.1 Effects of clinical features on serum ammonia level in epileptic patients :The seizure type?frequency of seizures and the number of antiepileptic drugs are the influencing factors of the serum ammonia level,that is,the generalized seizure?the more frequent of attack and the more the quantity of the drugs,the higher the serum ammonia level will be.Among them,the frequency has the greatest effect on the serum ammonia level.3.2 Effects of VPA on serum ammonia level: The ammonia level of the VPA treatment group was higher than that of the non-VPA treatment group(p<0.01).3.3 Differences in serum ammonia levels among different types of drugs: there were statistically differences in serum ammonia concentrations between the untreated group and the VPA monotherapy group and other antiepileptic drugs group(p<0.05),and statistically significant differences between the VPA+ Oxcarbazepine group and the VPA+ Levetiracetam group(p<0.01).There was a statistically difference in serum ammonia concentration between the VPA monotherapy group and the VPA+ Oxcarbazepine group(p<0.05).Conclusion 1.The average serum ammonia level of epilepsy patients is higher than the normal range,and the increase of serum ammonia level obviously affects the cognitive function of epilepsy patients,especially the memory function.The increase of serum ammonia level can be used as an objective indicator for the early detection of cognitive function decline.When the serum ammonia level exceeded 61mmol/L,the cognitive function decreased significantly.2.Serum ammonia can lead to slower wave of EEG power spectrum in most brain regions,which is positively correlated with the ratio of slow wave to fast wave in each brain region.The neurotoxic effect of serum ammonia on brain tissue may be diffused.3.The influencing factors of the elevation of ammonia: seizure type?frequency of seizures and the number of antiepileptic drugs,that is,patients with generalized seizures,higher frequency of episodes,more types of drugs,and combination of VPA and Oxcarbazepine had higher serum ammonia levels. |
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