Evaluation of middle cerebral artery blood flow velocity in children with electrical status epilepticus during sleep by transcranial Doppler-video electroencephalography and its significance / 中国医师进修杂志

ABSTRACT

Objective:To evaluate the middle cerebral artery blood flow velocity in children with electrical status epileptic during sleep (ESES) by transcranial Doppler (TCD)-video electroencephalography (VEEG), and analyze its clinical significance.Methods:The clinical data of 40 children with ESES (ESES group) in Zhangjiakou First Hospital of Hebei Province from January 2019 to January 2021 were retrospectively analyzed. The mean flow velocity of middle cerebral artery (MCA mean) and middle cerebral artery (MCA) flow fluctuation value during deep sleep were measured by TCD-VEEG, and the results were compared with 40 healthy children (healthy control group) during the same period. The relationship between MCA mean, MCA flow fluctuation value during deep sleep and clinical characteristics was analyzed by multivariate stepwise regression. Results:The MCA mean and MCA flow fluctuation value during deep sleep in ESES group were significantly higher than those in healthy control group (17.87 ± 7.38)% vs. (2.07 ± 1.11)% and (92.92 ± 21.64) cm/s vs. (58.11 ± 8.04) cm/s, and there were statistical differences ( t = 13.389 and 9.536, P<0.01). There was no statistical difference in MCA mean and MCA flow fluctuation value during deep sleep in children with benign epilepsy with central temporal spinous wave (16 cases), benign epilepsy variant with central temporal spinous wave (13 cases) and acquired epileptic aphasia (11 cases) ( P>0.05). There was no statistical difference in MCA mean and MCA flow fluctuation value during deep sleep in children with multifocal epileptic foci (16 cases), bilateral asymmetric epileptic foci (16 cases) and bilateral synchronous symmetric epileptic foci (8 cases)( P>0.05). The MCA flow fluctuation value during deep sleep in children with absolute synchronization and fully generalized ESES (16 cases) was significantly higher than that in children with asymmetric ESES (24 cases) (22.37 ± 2.37)% vs. (15.37 ± 5.37)%, and there was statistical difference ( t = 4.890, P<0.01); there was no statistical difference in MCA mean during deep sleep between 2 types of children ( P>0.05). The MCA flow fluctuation value during deep sleep in children with non obvious cognitive impairment (14 cases), mild cognitive impairment (13 cases) and severe cognitive impairment (13 cases) was (14.21 ± 5.20)%, (17.97 ± 7.45)% and (22.10 ± 7.94)%, and there was statistical difference ( F = 4.376, P<0.05); there was no statistical difference in MCA mean during deep sleep in 3 types of children ( P>0.05). Multivariate stepwise regression analysis result showed that the MCA flow fluctuation value during deep sleep had positive correlation with the degree of cognitive impairment in children with ESES ( r = 0.391, P<0.05). Conclusions:The fluctuation value of MCA during deep sleep by TCD-VEEG examination is positively correlated with the degree of cognitive impairment in children with ESES, which may be a reliable way for clinical evaluation of the degree of cognitive impairment in children with ESES.