| Objective 1.Analyze the possible influence factors of cognitive function in patients with epilepsy. 2. Evaluate the correlation between 1 H-Magnetic resonance spectrum test results and cognitive function in epileptic patients. 3.Explore the change of cognitive function in epileptic patients before and after antiepileptic drug treatments. 4.By finding the important influence factors of cognitive function in patients with epilepsy and the correlation between 1H-MRS and cognitive function, we can detect early and take effective measures to improve cognitive function and long-term prognosis in patients with epilepsy.Methods 1. In our study,257 epilepsy patients who met inclusion and exclusion criterias were tested with clinical memory scale to detect their cognitive function,and 70 patients at the same time was tested with Mini-Mental state examination(MMSE)?Montreal cognitive assessment(Mo CA)?Digital symbol test(DSy)?Verbal fluency test(VFT)?Digit span test(DSp)?Hamilton anxiety scale(HAMA) and Hamilton depression scale(HAMD) test,and 73 patients accepted 1H-MRS check.We used monadic linear related analysis?multiple stepwise regression analysis to evaluate the demographic factors of epileptic patients(gender, age, educational level), the disease itself factors(onset age, duration, frequency of seizures, seizure type),the treatment factor(the number of antiepileptic drugs),the social psychological factors(state of anxiety or depression)'s effects on cognitive function.We also used variance analysis(ANONA) to compare between any two different degrees of educational level?frequency of seizures?the number of antiepileptic drugs?state of depression.Besides,we used correlation analysis to analyze the correlation between MRS metabolites test resultsand cognitive function test scores of epileptic patients.All these statistics were used statistical software of SPSS for windows20.0 to calculate. 2.We choosed one of antiepileptic drugs of Lamotrigine(LTG)?Oxcarbazepine(OXC)?Sodium valproate(VPA) for new diagnosis epileptic patients or patients that had a shorter duration for 6 months to 1 year.The epileptic patients were compared with normal control group of cognitive function early in the disease,and we also analyzed the change of cognitive function before and after drug treatment of 28 cases of epilepsy patients who insist on follow-up.Results 1.The ralative analysis of factors affecting cognitive function in epileptic patients insists these:(1)Educational level and the cognitive test scores were significantly positive correlation(p<0.01).The greater of the educational level differences, the greater difference of the cognitive function test scores will be.The MMSE test between primary group and the rest groups were significantly statistical different(p < 0.01),and between junior high school group?high school group and university group there was no significantly statistical different;the Memory quotient(MQ) and other separate items scores of clinical memory scale were significantly statistical different between junior high school group and high school group(p<0.01), and part of the separate items were not significantly statistical different between primary group and junior high school group,or high school and university groups;Mo CA, DSy, VFT, the number of DSp along the back test scores were significantly statistical different between junior high school group and high school group(p<0.01 or p<0.05), and they were not significantly statistical different between primary group and junior high school group,or high school and university group.(2)Seizure frequency and clinical memory scale MQ and its separate items?DSy scores were significantly negative correlative(p<0.01),and the scores between group of seizure frequency < 1 year and other groups were statistically significant different(p<0.01).(3)The number of antiepileptic drugs and clinical memory scale MQ and its separate items were negatively correlated(p<0.01 or p<0.05).The scores of image free recallmemory, portrait characteristics contact memory were statistically different between not taking antiepileptic drug group and taking one kind of antiepileptic drug group(p <0.05), while the score of MQ?directed memory, associative learning, meaningless graphics recognition were not statistically different between this two groups.(4)Depression scores and MMSE, Mo CA, DSp scores negatively correlated(p< 0.01 or p<0.05).The cognitive function were not statistically different between the group of patients who may be depressed and the group of patients who were not depressed,while MMSE?Mo CA?the number of DSp along the back scores were statistically different between the group of patients who must be depressed and the group of patients who were not depressed(p<0.01 or p<0.05).(5)The seizure course and DSy scores were negatively correlated(p<0.01).(6)The age of epileptic patients and the Mo CA scores were negatively correlated(p< 0.05).(7)Seizure types are associated with DSy score,and the patients whose type were generalized seizure had poor cognitive function(p <0.05).(8)In the single factor analysis test,anxiety scores was associated with MMSE and Mo CA scores, but it was offseted by other factors in multiple factors analysis.(9)The onset age and cognitive function in patients with epilepsy had no correlation. 2.In the 1 H-MRS detection of patients with epilepsy, we found that NAA/Cr, Cho/NAA + Cr and the score of MQ and separate items of clinical memory scale were positive correlative(p < 0.01 or p < 0.05). 3.There were significant correlation between score of MQ and separate items of clinical memory scale, MMSE, Mo CA, DSy, VFT, the number of DSp along the back scores(p < 0.01). 4.When comparing to normal control group,new diagnosis epileptic patients or patients that have a shorter duration had low scores in MQ,directed memory, associative learning and image free recall(p <0.01 ? p <0.05).Most of the new diagnosis epileptic patients or patients that have a shorter duration have reduced or controled seizure after antiepileptic drugs treatment,and the score of MQ?directedmemory?associative learning?portrait characteristics contact memories were higher than the scores before treatments(p< 0.01 or p< 0.05).The seizure frequency after taking antiepileptic drugs was negatively correlative with MQ?directed memory?associative learning?image free recall test scores(p< 0.01 or p< 0.05).After taking one of antiepileptic drugs of LTG?OXC?VPA for 6 months to 1 year, there was no decline in cognitive function, and the score of portrait characteristics contact memoriy in LTG group were significantlly statistical diffrent before and after the treatment(p< 0.05),and the score of directed memory of VPA group was significantlly statistical diffrent before and after the treatment(p< 0.05).Conclusion 1.Education level, frequency of seizure,the number of antiepileptic drugs?depression are important factors that affect cognitive function in patients with epilepsy.High degree of education level, good seizure control, single drug treatment and healthy psychological emotional state is protective factors to improve cognitive function in patients with epilepsy.Beside, there are significant correlation between 1H-MRS metabolites results of epilepsy patients and cognitive function test scores,and there was also significant correlation between the results of clinical memory scale,MMSE, Mo CA, DSy, VFT, DSp.So it showed that by combining 1H-MRS examination, neuropsychological tests, and considering important clinical variables that may influence cognitive function,we can early find and take corresponding measures to improve cognitive function of patients with epilepsy. 2.Epileptic patients have cognitive function demage in some field of cognitive function in their early disease.After standardization antiepileptic drug treatments, most patients can be better controled with their seizures, and the treatment had no obvious effects on cognitive function. What's more,part of the field of cognitive function are improved, but seizure control was an important impact factor of no decline in cognitive function during a short time. |
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