Abstract：【Objective】To explore the relationship of Montreal Cognitive Assessment (MoCA) score with serum levels of protein kinase C (PKC), insulin-like growth factor-1 (IGF-1), and brain-derived neurotrophic factor (BNDF) in epilepsy patients. 【Methods】Based on the MoCA scores, 80 epilepsy patients treated in our hospitals were divided into the cognitive impairment group (group A with MoCA score <26) and the non-cognitive impairment group (Group B with MoCA score ≥26). The basic information, electroencephalogram results, and serum indicators [PKC, IGF-1, BNDF, Interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-α)] of the two groups were compared. The relationship of cognitive impairment with serum PKC, IGF-1, and BNDF levels was analyzed using Receiver Operating Characteristic (ROC) curve analysis. Multivariate Logistic regression analysis was used to identify the risk factors for cognitive impairment in epilepsy patients. 【Results】Among the 80 patients, 52 (65.00%) cases had cognitive impairment and were categorized into the group A, while 28 (35.00%) cases did not have cognitive impairment and were categorized into the group B. The proportion of patients with generalized seizures and epileptiform waves on electroencephalogram in Group A was higher than that in Group B. The levels of PKC, IGF-1, and BNDF in Group A were lower than in Group B (P<0.05). There were no significant differences in age, gender, duration of illness, family history of epilepsy, history of febrile seizures, IL-6, and TNF-α levels between the two groups (P>0.05). ROC analysis confirmed that the levels of PKC, IGF-1, and BNDF could be used to predict cognitive impairment, with area under the curve (AUC) values of 0.927, 0.732, and 0.862, respectively (all P<0.05). Multivariate Logistic regression analysis showed that generalized seizures, epileptiform waves on electroencephalogram, PKC<3.015 pg/mL, IGF-1<126.57 μg/L, and BNDF<7.635 μg/L were risk factors for cognitive impairment (P<0.05). 【Conclusion】MoCA scores in epilepsy patients are positively correlated with serum levels of PKC, IGF-1, and BNDF. Lower scores of MoCA indicate more severe cognitive impairment and lower serum levels of PKC, IGF-1 and BNDF. Generalized seizures, epileptiform waves on electroencephalogram, PKC<3.015 pg/mL, IGF-1<126.57 μg/L, and BNDF<7.635 μg/L are all risk factors for cognitive impairment in epilepsy patients, which should be given clinical attention.
[1] CAITLIN S,JACKSON T, WHATLEY B P,et al. A prospective pilot study of cognitive impairment and mood in adults with first seizure, new-onset epilepsy, and newly diagnosed epilepsy at time of initial seizure presentation[J].Epilepsy Behav,2020, 112(6):107359. [2] LIU A H,CHU M, WANG Y P.Up-regulation of trem2 inhibits hippocampal neuronal apoptosis and alleviates oxidative stress in epilepsy via the PI3K/Akt pathway in mice[J].Neurosci Bull,2019, 35(3):471-485. [3] IVES-DELIPERI V,BUTLER J T. Mechanisms of cognitive impairment in temporal lobe epilepsy: A systematic review of resting-state functional connectivity studies[J].Epilepsy Behav,2021, 115(2):107686. [4] 尤华琴, 张延英, 吴俊晓, 等. 吡仑帕奈对癫痫大鼠ERK/CREB/BDNF信号通路及认知功能的影响[J].中国老年学杂志, 2022, 42(15):3715-3720. [5] 高微, 吴伟,周凯丽, 等. IGF-1对睡眠剥夺模型小鼠认知功能的影响及海马IGF-1/PI3K/Akt信号通路的调节作用[J].中华行为医学与脑科学杂志, 2020, 29(5):419-425. [6] 中国抗癫痫协会. 临床诊疗指南:癫痫病分册[M]. 北京:人民卫生出版社, 2015:29-31. [7] 杨晓燕, 马临庆, 龙莉莉,等. 头部MRI阴性的颞叶内侧癫痫患者认知功能障碍研究[J].国际神经病学神经外科学杂志, 2019, 46(1):45-49. [8] GERHARD K, CELINA S,STEPHAN A, et al. Positive short-term effect of low-dose rosuvastatin in a patient with SYNGAP1-associated epilepsy.[J].Neuropediatrics,2019,50(4):266-267. [9] USLU S C,YUKSEL B,TEKIN B,et al. Cognitive impairment and drug responsiveness in mesial temporal lobe epilepsy[J].Epilepsy Behav,2019, 90:162-167. [10] 张飞飞, 高丽华, 丁一,等. 癫痫患者深睡期血流动力学改变与认知功能障碍的关系[J].国际神经病学神经外科学杂志, 2021, 48(3):244-248. [11] 张婷, 岳伟. 癫痫患者认知功能障碍影响因素的研究进展[J].中华神经医学杂志, 2019, 18(7):674-677. [12] 辛翠娟, 郝小生, 李秀杰,等. 癫痫伴肌阵挛-失张力发作的临床及脑电图特征分析[J].中风与神经疾病杂志, 2019, 36(8):714-716. [13] 藏春光, 王剑. 藤苦参介导PKCγ/GAP-43通路下调癫痫大鼠免疫细胞因子表达对神经元损伤的保护机制[J].现代医学, 2022, 50(3):360-365.
2023, Vol. 40 
