| Background: In all nervous system diseases, epilepsy is a common disease next to cerebrovascular disease. Reports from around the world: the prevalence of epilepsy is approximately 20-50/100,000/year. According to the assessment of World Health Organization, there are about 50 million people with epilepsy. In china, according to the survey, the incidence rate of epilepsy is 35/100,000/year, the prevalence rate of 0.4%, in the high incidence of 1%.Accordingly, there are 6 million people with epilepsy, while adding about 400,000 per year in patients with epilepsy in our country. In patients with epilepsy, 20%-30% of patients can not be effectively controlled by medication, called refractory epilepsy. Patients with epilepsy, not only to live, work, who brought a serious impact, but also to the family, the community generation to a heavy burden. Recurrent seizures can affect cognitive function of patients. Cognitive function refers to a variety of human conscious mental activity, knowledge, ability to apply knowledge, including computing ability, judgment, memory and ability to learn other. It has been reported that more than 80% below normal cognitive function in patients with epilepsy, of whom more than 50% have significant cognitive dysfunction[1].The relation between epilepsy and cognitive function is one of the hot topics in clinical and research.Objective: Through cognitive function of adult patients with drug refractory epilepsy, to evaluate the overall cognitive level of patients with epilepsy. Analysis the factors of affecting cognitive function of patients with epilepsy. Summarizes the different cognitive impairment features in patients with epilepsy. Further investigate the role of cognitive function assessment to guide the diagnosis and treatment of epilepsy.Methods: The study included 57 patients with refractory epilepsy. They come from the Second Department of Neurosurgery of Hebei General Hospital from April 2014 to December 2014. These patients underwent a detailed history collection, including age of epilepsy onset, duration of epilepsy, seizure frequency, etc. Whether accompanied generalized tonic-clonic seizures are also included as a single record. The patients medical history include whether there is a history of febrile seizures, and whether born diseases. All patients been checked by video-EEG and MRI. To determine the epileptic foci, some patients were been checked by MEG, PET, WADA test and so on. All the patients underwent cognitive function assessment before surgery one week. Tests involving Wechsler intelligence scales(WAIS-RC) and Wechsler memory scale(WMS). There are 5 patients can not cope with. The patients with successful completion of the tests are 52 cases.Results: In the 52 patients, 29 males and 23 females, age 17-55 years old, with an average age of 28.90±10.73-year-old, duration of 2-33 years, an average of 10.81±8.16 year. age of epilepsy onset 1-53 years old, an average of 18.10±10.53, seizure frequency, 1-12 times per month, with an average of 4.53±2.77 times per month.There are 52 cases of patients with the completion of the Wechsler intelligence scales(WAIS-RC). The results of these tests: FIQ 68-117, mean scores 87.23±10.12, VIQ 65-114, mean scores 86.26±8.79, PIQ 74-123, mean scores 100.32±14.18. Compared with the norm mean(100), the FIQ of patients with epilepsy is reduced, with a statistically significant difference. Which VIQ than normal norm mean reduced too, with statistically significant difference. In the subtests of VIQ, Arithmetic and Vocabulary are lower than the normal norm mean, with statistically significant difference. Other comparisons showed no significant difference.By sex, age of epilepsy onset, duration of epilepsy, seizure frequency, epileptic foci site and seizure type 7factors, the patients were divided into different subgroups in each of these factors. Comparative analysis, we find the FIQ of the group with younger than 14 years old in age of epilepsy onset is lower than the group with not less than 14 years old, and the difference is statistically significant. The FIQ of multidrug therapy group is lower than mono therapy group, with significant difference. In frontal epilepsy group, VIQ and Arithmetic, Vocabulary of subtests had lower than temporal epilepsy, with a significant difference. Other comparisons showed no significant difference.The 52 case of patients with the completion of the Wechsler memory scale(WMS).The results of these tests: Long time memory 23-45, mean scores 29.38±3.69, Short-term memory 36-61, mean scores 50.05±4.03, Instantaneous memory 7-11, mean scores 9.08±2.67, MQ 68-113, mean scores 82.31±8.42. Compared with the norm, the MQ and Short-term memory subtest of epilepsy group are lower, the difference is statistically significant. Other comparisons showed no significant difference.Similarly, by sex, age of epilepsy onset, duration of epilepsy, seizure frequency, epileptic foci site and seizure type 7factors, the patients were divided into different subgroups in each of these factors. Comparative analysis, we find that the MQ and Short-term memory subtest of temporal epilepsy group are lower than frontal epilepsy group, with a significant difference. Other comparisons showed no significant difference.Conclusion:1 The FIQ and VIQ of patients with refractory epilepsy are reduced compared with the norm.2 Refractory epilepsy seizures start early and multidrug therapy may be key factors to affect cognitive function in patients with epilepsy.3 Frontal lobe epilepsy patients have more serious damage in VIQ, than temporal lobe epilepsy and other epilepsy patients. Temporal lobe epilepsy patients have more serious damage in MQ, than frontal lobe epilepsy and other epilepsy patients. So, cognitive assessment has some significance for the positing of intractable epilepsy. |
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