Neurology:小儿癫痫手术后认知预测模型的建立和验证:智商/发育商是强大预测因子

2022-02-01 Naomi MedSci原创

近日,有研究人员试图确定术后智力和发育商的预测因子,开发和验证临床应用的智力和发育商预测模型。儿童癫痫术后认知退化的风险很低。接受癫痫手术的儿童术前智商/发育商是术后认知的最强预测因子。

认知功能障碍常见于癫痫患儿,尤其是在那些幼年发病、耐药性发作和皮质发育延长性畸形的儿童中。除了癫痫自由发作和减少抗癫痫药物(ASM)外,儿童癫痫手术的目的是保护认知、恢复认知。通过对466名患者的研究回顾,总结出大约20% 的婴儿在手术后认知能力明显提高。相比之下,70% 的患儿认知能力保持稳定,在发育过程中没有显著变化。癫痫性脑病(EE)的破坏,特别是在幼儿和术后痉挛的消退对认知发展有积极的影响。其他几个影响术后认知预后和认知功能改变的独立因素已被确定。术前发育商(DQ)智商(IQ)越高,癫痫持续时间越短,术后癫痫发作自由度越高,这些常预示着良好的结果。尽管已知有许多因素会影响认知结果,但这些联系并不明确,而且缺乏对足够大的队列分析。

术前充分告知患儿父母预期的认知预后仍然是一个挑战,相对乐观还是保守的预后沟通往往需要由儿科癫痫病专家来把握。对术后发育商和智商决定因素的研究可以部分解答上述问题,以制定针对性的术后认知预后的期望。近日,有研究人员试图确定术后智力和发育商的预测因子,开发和验证临床应用的智力和发育商预测模型。

回顾性分析1990年以来贝塞尔和乌得勒支地区儿童的神经心理结局及其可能影响因素。分别对有IQ资料和只有DQ资料的病人进行了分析。建立了基于手术前决定因素的预测模型来预测二分性的表现水平(IQ ≥85,IQ ≥70,DQ ≥50)。

  • 492例患者术前和术后2年的 IQ/DQ 数据有效(IQ n = 365,DQ n = 127)。
  • 在一个临界水平 ± 10点时,改善的几率明显高于恶化的几率(IQ 分别为37.3% vs 6.6% 和 dq 分别为31.5% vs 15.0%)。
  • 术前 IQ/DQ 是术后认知功能的最强预测因子(IQr = 0.85,p < 0.001; DQr = 0.57,p < 0.001)。
  • 在 Bethel 队列(n = 258)中建立两个IQ 模型,并在 utrecht 队列(n = 102)中进行外部验证。
  • 对于 DQ,开发了 Bethel 队列的模型,并使用了10倍的交叉验证。模型允许在所有3个截止水平上进行良好的预测(正确分类为 IQ ≥85 = 86% ,IQ ≥70 = 91% ,DQ ≥50 = 76%)。智商模型的外部验证显示出高准确性(IQ≥85:0.82,置信区间[ CI ]0.75-0.91; IQ≥70:0.84,CI 0.77-0.92)和优秀的辨别力(ROC曲线曲线: IQ ≥85: 曲线下面积[ auc ]0.90,CI 0.84-0.96; ≥70: auc 0.92,CI 0.87-0.97)。

儿童癫痫术后认知退化的风险很低。手术前的发展对术后的轨迹有很大的影响。所提出的模型可以可靠地预测认知结果,从而应答患者和家长的术前咨询。

证据分类本研究提供了 ii 类证据,证明接受癫痫手术的儿童术前智商/发育商是术后认知的最强预测因子。

文献来源:Cloppenborg T, van Schooneveld M, Hagemann A, et al. Development and Validation of Prediction Models for Developmental and Intellectual Outcome Following Pediatric Epilepsy Surgery [published online ahead of print, 2021 Nov 18]. Neurology. 2021;10.1212/WNL.0000000000013065. doi:10.1212/WNL.0000000000013065

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    2022-08-20 yinhl1978
  4. 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topicList=[TopicDto(id=60034, encryptionId=a38660034ac, topicName=智商)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a5712500001, createdName=晓辰, createdTime=Tue Feb 01 05:31:45 CST 2022, time=2022-02-01, status=1, ipAttribution=)]
    2022-02-11 ms3000000637975859

    新新发现,有用

    0

  5. 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topicList=[TopicDto(id=60034, encryptionId=a38660034ac, topicName=智商)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a5712500001, createdName=晓辰, createdTime=Tue Feb 01 05:31:45 CST 2022, time=2022-02-01, status=1, ipAttribution=)]
    2022-02-10 yesaisai133

    非常好

    0

  6. 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topicList=[TopicDto(id=60034, encryptionId=a38660034ac, topicName=智商)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a5712500001, createdName=晓辰, createdTime=Tue Feb 01 05:31:45 CST 2022, time=2022-02-01, status=1, ipAttribution=)]
    2022-02-02 robbert123

    学习

    0

  7. 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    2022-02-02 查查佳佳

    着经济发展和生活水平的提高,在全世界范

    0

  8. 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  9. 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    2022-02-01 晓辰

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