Research on early assessment significance of analysis of interictal electroencephalogram based on the Grand Total Electroencephalography score for cognitive impairment in epilepsy patients
10.3760/cma.j.cn113694-20240419-00284
- VernacularTitle:基于总脑电图评分的发作间期脑电图分析对癫痫患者认知障碍早期评估的意义
- Author:
Honghua CHEN
1
;
Lingli JU
1
;
Yanyan JI
1
;
Lihong TAO
1
Author Information
1. 扬州大学附属医院神经内科，扬州大学，扬州 225009
- Publication Type:Journal Article
- Keywords:
Epilepsy;
Cognitive impairment;
Grand Total Electroencephalography score
- From:
Chinese Journal of Neurology
2025;58(1):36-45
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the association between cognitive impairment and manifestation of interictal electroencephalogram (EEG) in epilepsy patients, and the early assessment significance of the Grand Total Electroencephalography (GTE) score.Methods:A totall of 100 patients with primary epilepsy admitted to the Department of Neurology of the Affiliated Hospital of Yangzhou University were continuously collected from January 2019 to January 2024, and they were classified according to the latest version of the epilepsy classification by the International League Against Epilepsy in 2017. General information of all research subjects was recorded, including age, gender, educational level, etc. The disease details of epilepsy patients were recorded, including seizure duration, severity, seizure precursors, post seizure status, and use of anti-seizure medications (ASM). The survey scales and questionnaires used included the interictal GTE, Montreal Cognitive Assessment (MoCA), Hamilton Anxiety Scale, Hamilton Depression Scale, National Hospital Seizure Severity Scale (NHS3), Status Epilepticus Severity Score (STESS). All research subjects were classified into normal cognitive (NC) group, mild cognitive impairment (MCI) group, and dementia group according to MoCA score. Comparisons among multiple groups and pairwise comparisons were conducted. The correlation between 2 variables was analyzed using Spearman rank correlation analysis, and multiple linear regression analysis was employed to screen variables that have an impact on cognitive impairment. The receiver operating characteristic curve was plotted to determine the optimal cut-off point for predicting cognitive impairment in epilepsy.Results:According to the MoCA score, there were 32 (32%) patients in the NC group, 49 (49%) patients in the MCI group, and 19 (19%) patients in the dementia group. There were statistically significant differences in age [(26.31±10.01) years, (43.96±16.19) years, (57.68±16.83) years,respectively; F=29.440, P<0.001], education ( χ2=28.894, P<0.001), ASM ( χ2=11.258, P<0.017), STESS score [2.00(1.75, 2.25), 2.00(2.00, 3.00), 3.50(2.75, 4.25),respectively; H=12.646, P=0.002], STESS score>2 ( χ2=10.075, P=0.006), frequency of rhythmic background activity ( H=17.429, P<0.001), diffuse slow activity ( H=42.033, P<0.001), reactivity of the rhythmic background activity ( H=15.206, P<0.001), paroxysmal activity ( H=25.279, P<0.001), sharp wave activity ( H=15.492, P<0.001) and total GTE score [1 (1, 3), 6 (2, 8), 8 (7, 11),respectively; H=47.871, P<0.001] among the 3 groups. A significant negative correlation was observed between cognitive level (MoCA scores) and total GTE score ( ρ=-0.766, P<0.001), frequency of rhythmic background activity ( ρ=-0.520, P<0.001), diffuse slow activity ( ρ=-0.734, P<0.001), reactivity of the rhythmic background activity ( ρ=-0.438, P<0.001), paroxysmal activity ( ρ=-0.566, P<0.001), and sharp wave activity ( ρ=-0.407, P<0.001). The results of multiple linear regression analysis indicated that total GTE score ( t=-5.566, P<0.001), diffuse slow activity ( t=-2.548, P=0.014), reactivity of the rhythmic background activity ( t=-3.891, P<0.001), paroxysmal activity ( t=-3.139, P=0.003), age ( t=-5.493, P<0.001), education ( t=3.379, P=0.001), and STESS ( t=-2.183, P=0.033) were independent risk factors for cognitive impairment. In evaluating the cognitive impairment of epilepsy patients, the GTE score had a certain sensitivity (75.0%) and specificity (93.8%), with an optimal critical point value of 5. Conclusions:The interictal EEG of patients with poorer cognitive function is mainly characterized by an increase in slow waves and a decrease in overall background. The increase in slow waves, poor background responsiveness, paroxysmal activity and a high total GTE score may be important factors in predicting the outcome of cognitive impairment in epilepsy.
