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Yıl:2023; Cilt: 60; Sayı: 1>> Özet
TAM METİN
Nöropsikiyatri Arşivi; 2023;60(1):62-67
Uykuda Elektriksel Status Epileptikus Çocukluk Çağının Kendini Sınırlayan Fokal Epilepsilerinde Dili Olumsuz Etkiler mi?
M Savaş, A M Tunçer, İ Çelik, M A Yaşgüçlükal, A V Demirbilek, A Ö Çokar
İstanbul Atlas Üniversitesi, İstanbul
Amaç: Uykuda elektriksel status epileptikus (electrical status epilepticus in sleep [ESES]), fokal, jeneralize tipte epilepsilere ya da çeşitli sendromlara eşlik edebilmekte ve kognitif-linguistik regresyona neden olmaktadır. Çocukluk çağının kendini sınırlayan fokal epilepsileri (selflimited focal epileptic syndromes of childhood [SFEC]) içinde sayılan Rolandik Epilepsi ve Gastaut tipi oksipital paroksizmli çocukluk çağı epilepsilerinde nöbetlerin ılımlı seyrine rağmen dil tutulumu ve bilişsel tutulum görülmektedir. Bu epilepsilerde atipik bir özellik olarak EEG’de ESES paterninin bulunması halinde dil bozukluğunun şiddeti ve ilişkili olduğu klinik parametreler yeterince aydınlatılmamıştır. Yöntem: Mental ve motor gelişimsel geriliği olmayan 28 SFEC’li çocuktan EEG’de ESES paterni olan (aktif ESES [A-ESES], n=6) ve olmayanlar (non-ESES, n=22) epilepsiye özgü klinik değişkenler ve hem standart hem de betimsel araçlar kullanılarak linguistik parametreler açısından karşılaştırıldı. Otuz iki sağlıklı çocuk kontrol grubu olarak dâhil edildi. Bulgular: A-ESES grubunda önemli ölçüde anlamlı farklılık gösteren klinik özellik, politerapi prevalansının fazla olmasıydı. Sağlıklı kontrollere kıyasla A-ESES ve non-ESES gruplarda linguistik parametrelerin çoğu bozulurken, A-ESES hastaları non-ESES hastalardan yalnızca anlatı analizi ile değerlendirilen kompleks cümle üretiminde azalma açısından farklılık gösterdi. A-ESES hastaları ayrıca anlatı analizi sırasında daha az sayıda sözcük, isim, fiil ve zarf üretim eğilimi gösterdi. Bu dil parametreleri açısından politerapi ve monoterapi alan hastalar arasında fark yoktu. Sonuç: Sonuçlarımız ESES’in, SFEC’de kompleks cümle ve genel sözcük üretimi üzerindeki olumsuz etkisini artırdığını göstermektedir. Objektif testlere yansımayan linguistik bozulmalar, anlatı araçları kullanılarak tespit edilebilir. Anlatı analizi ile elde edilen kompleks sentaktik üretimler, epilepsili okul çağı çocuklarında dil becerilerini kapsamlı bir şekilde karakterize eden önemli bir parametredir.
Does Electrical Status Epilepticus in Sleep Adversely Affect Language in Self-Limited Focal Epilepsies of Childhood?
Introduction: The electrical status epilepticus in sleep (ESES) accompanies a wide spectrum of focal and generalized epilepsies, which manifest with cognitive-linguistic regression. Both ESES and language impairment can be seen in self-limited focal epileptic syndromes of childhood (SFEC). The association between the presence of ESES pattern on the EEG and the severity of the language impairment has not been adequately clarified. Methods: Twenty-eight SFEC cases without intellectual and motor disabilities and 32 healthy children were recruited. Cases with active ESES (A-ESES, n=6) and without ESES pattern on EEG (non-ESES, n=22) were compared in terms of clinical features and linguistic parameters by both standard and descriptive assessment tools. Results: The only significantly different clinical feature in the A-ESES group was the increased prevalence of polytherapy. While most of the linguistic parameters were impaired in A-ESES and non-ESES groups compared to healthy controls, A-ESES patients differed from non-ESES patients only in terms of decreased complex sentence production, which was assessed by narrative analysis. A-ESES patients also showed trends toward producing lower numbers of words, nouns, verbs, and adverbs during narrative analysis. There were no differences among patients under polytherapy and monotherapy in terms of these language parameters. Conclusion: Our results show that ESES increases the negative effect of chronic epilepsy on complex sentence and word production. Linguistic distortions that are not reflected in objective tests can be detected by narrative tools. Complex syntactic production obtained by narrative analysis is an important parameter that extensively characterizes language skills in school-age children with epilepsy

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