伴中央颞区棘波癫痫：认知与运动 干预进展

Epilepsy with Centrotemporal Spikes: Advances in Cognitive and Motor Interventions

摘要: 伴中央颞区棘波的自限性癫痫(self-limiting centrotemporal spike wave epilepsy, SeLECTS)属于儿童时期较为常见的癫痫类型，以往被称作良性中央颞区癫痫(benign epilepsi med centrotemporale spikes, BECTS)，曾被认为预后状况良好，但是近年来众多证据显示其伴随着广泛的认知功能方面的障碍。本综述意在全面梳理SeLECTS患儿认知损伤的临床特征、病理机理、药物作用以及运动干预的潜在意义，为临床综合管控提供循证支撑。SeLECTS患儿通常伴有认知、注意力、语言以及学习能力等方面的问题，并且这些损害和睡眠期放电指数升高、抗癫痫药物暴露以及共病注意缺陷多动障碍紧密相关。基于SeLECTS的病理机制，包括IED介导的突触可塑性受损、GABA/谷氨酸失衡以及神经炎症，中等强度运动是一项可以同时回应这些病理打击的干预窗口，其通过促进BDNF分泌修复突触可塑性、适度升高儿茶酚胺改善执行功能、触发肌源性IL-6抗炎级联抑制神经炎症；而高强度运动引发的皮质醇升高则可能起到相反作用。对于睡眠期放电以及药物对认知的独立影响仍存有争议，纵向和机制性的证据也较为缺乏。SeLECTS并非全然良性，认知功能方面的障碍是其主要的共病情况。运动干预作为非药物辅助手段具备应用潜力，不过仍需要高质量随机对照实验来验证其效果并确定最优干预方案。

Abstract: Self-contained epilepsy featuring centrotemporal spikes (SeLECTS) is the prevalent focal epilepsy syndrome during childhood, typically regarded as having a positive prognosis. However, mounting evidence in recent years shows that it is often related to extensive cognitive impairments. This review intends to systematically sum up the clinical characteristics, pathophysiological mechanisms, pharmacological impacts, and potential advantages of physical exercise interventions on cognitive dysfunction in children with SeLECTS, offering evidence-based guidance for comprehensive clinical management. Children with SeLECTS display notable deficiencies in multiple cognitive areas, such as attention, executive function, language skills, and memory. These are closely linked to heightened spike activity during sleep, exposure to antiepileptic drugs, and comorbid attention-deficit/hyperactivity disorder (ADHD). Physical training of moderate intensity has demonstrated encouraging impacts on enhancing cognitive performance and brain plasticity in animal models and initial clinical investigations. Based on the pathophysiological mechanisms of SeLECTS, including IED-mediated synaptic plasticity impairment, GABA/glutamate imbalance, and neuroinflammation, moderate-intensity exercise represents an intervention window capable of simultaneously addressing these pathological insults—promoting BDNF secretion to repair synaptic plasticity, moderately elevating catecholamines to improve executive function, and triggering myokine IL-6-driven anti-inflammatory cascades to suppress neuroinflammation; in contrast, cortisol elevation induced by high-intensity exercise may produce the opposite effect. The separate impacts of sleep-related epileptiform discharges and antiepileptic drugs on cognition are still a matter of debate, and long-term and mechanistic proof is still lacking. SeLECTS is not completely harmless, and cognitive impairment is a significant comorbidity. Physical activity intervention, as a non-pharmacological supplementary approach, shows great potential. Nevertheless, its effectiveness needs to be verified via high-quality randomized controlled trials, and the best intervention protocols should be identified.