| Summary: | 碩士 === 國立成功大學 === 行為醫學研究所 === 89 === Objective: Febrile convulsion (FC) is the most common seizure disorder in children, and the incidence is 2-5 %. The recurrent rate of FC is 30-40 %, and subsequent epilepsy is 2-7 %. Many studies have showed that children with FC performed as well as with other children in terms of their academic progress, intellect, and behavior. Few have focused on the cognitive outcome of epileptic children with a history of FC. This study was to delineate the cognitive characteristics of school-aged epileptic children with a history of FC, and the influence of intractable epilepsy and brain lesion to cognitive functions.
Patients and methods: The epileptic children with a history of FC who visited our Pediatric Neurological Clinic from 1998-2000 were enrolled. There are three groups of children aged 6 to 15 as follows: epileptic children with a history of FC (FC-epilepsy group), FC group (FC group), and sibling control of epileptic children with a history of FC (sibling group). The study instruments were WISC-III, WCST-R, PPVT-R, Verbal Memory Test (VMT), Visual memory (VM) and Visual-spatial relationship (VSR) subtests of TVPS, Conners’ Parental Rating Scales and MRI.
Results: The case number and age (mean age ±SD, months) of the three groups at assessment were: 72 children of FC-epilepsy group (104.7±24.8), 71 children of FC group (105.1±21.6), and 36 children of sibling group (113.4±22.2). The rate of mental retardation (MR) (FIQ below 70) in the FC-epilepsy group (34.7 %) was higher than that in the FC group (11.3 %), and sibling group (2.8 %). The onset age of epilepsy in FC-epilepsy group was 60.629.5 months (age range 10-158 months), and there was 16 children were intractable epilepsy (22.2 %). Twenty-four of the 65 patients who had MRI examination in the FC-epilepsy group had abnormal findings (36.9 %): fourteen had hippocampal abnormalities (21.5 %). We found that much more higher rate of MR in FC-epilepsy group. The FIQ of FC-epilepsy group was lower than FC group about 16 points (77.1±24.0 vs 93.4±16.4, p<0.001) and sibling group about 23 points (77.1±24.0 vs 99.7±13.7, p<0.001). Except perseverative errors, the test scores of the WISC-III, WCST-R, PPVT-R, VMT, VM and VSR in the FC-epilepsy group were significantly lower than those in FC and sibling group. The intractable epilepsy and brain lesion had adverse effects on cognitive functions in the FC-epilepsy group. The FIQ of intractable epilepsy children was lower than non-intractable epilepsy ones about 20 points (61.6±23.1 vs 81.6±22.5, p=0.005). The intractable ones performed worse in WISC-III, WCST-R, PPVT-R, VMT, VM and VSR. The FIQ of abnormal MRI in FC-epilepsy group was lower than normal ones about 20 points (64.6±23.0 vs 84.4±21.0, p=0.001). The abnormal MRI children got even lower scores in all cognitive tests than normal ones, but there was no significant difference in scores of WCST-R. Even excluded intractable epilepsy and abnormal MRI ones, the rate of MR in FC-epilepsy group was still higher and cognitive test scores were lower than the other two groups. Relatively to intractable epilepsy and brain lesion, there was much importance of intellectual factor in the other cognitive test scores in this study. The early onset epilepsy (onset age before 5 years old) had higher rates of intractable epilepsy, abnormal MRI results and hippocampal abnormalities than late onset epilepsy group in FC-epilepsy group. The MR rate of early onset epileptic children was significant higher than late ones (48.7 % vs 18.2 %, p=0.007), and the age onset of FC in former was at 1.5 years old and significantly early about one year than latter (p=0.022). The FIQ of early onset epileptic children was significantly lower than late onset ones (70.6±25.1 vs 84.8±20.4, p=0.010), and worse performance in the other cognitive tests.
Conclusions: The occurrence of epilepsy significantly has an adverse effect on cognitive functions in the school-aged children with a history of FC. These children have high rate of mental retardation and global cognitive impairments, including intellectual performance, problem-solving skills, abstract ability, concept formulation, expressive and receptive language, verbal memory, visual memory and visual spatial-relationship skills. Intractable epilepsy and brain lesion also have adverse effects on cognitive characteristics. The onset age of epilepsy, especially the onset age before 5 years old, is an important risk factor for cognitive impairments. They also have high rate of behavioral problems, especially in learning, psychosomatic problems and hyperactivity. History of developmental delay in children with FC followed by epilepsy onset before age five should be followed up carefully of the cognitive performance and neurocognitive rehabilitation be initiated as early as possible in those with intellectual deficit.
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