양성 부분 간질 환아에서 간질 발생 위치에 따른 음성언어 분석 = Acoustic differences according to the epileptic focus in benign partial epilepsy with centrotemporal spikes patients

다국어 초록 (Multilingual Abstract)

Purpose : The aim of this study was to investigate the speech problems in benign rolandic epilepsy (BRE) according to the seizure focus in EEG and semiology.
Methods : Twenty three patients [right origin (13 patients) or left side (10 patients)] who met the BRE criteria by International League Against Epilepsy (ILAE) were prospectively enrolled. We excluded the patients who had abnormal MRI or showed both side spikes in EEG. Computerized Speech Lab was used to assess the speech characteristics of the patients.
Results : The error pattern of laryngeal articulation in BRE was exclusively substitution of stop consonants, these errors showed more frequent in the left group (16.0% vs 25.5%). Voice onset time (VOT) of stop consonants and Total duration (TD) of word in both groups were prolonged than normal control group, especially in left group (P<0.05). The first formant of vowel /o/ and second formant of /e/ were significantly decreased in left group (P<0.05). The right group scored wider on pitch range (192.9±54.0 Hz) and energy range in spontaneous speech (14.2±6.4 dB) than the left group (233.3±12.5 Hz, 19.4±9.3 dB, respectively, P>0.05). Duration of counting (5 to 9) in left group slower than right group (8.6±1.7 vs 7.9±1.8 sec).
Conclusion : Our data suggested that interictal spikes and seizures in either centrotemporal sides, especially left side group, may induce speech problems. We recommend the logopedic and phoniatric evaluations of speech in BRE patients.

국문 초록 (Abstract)

목 적 : 정량적인 분석으로 양성 로란딕 간질환자의 간질파 발생위치에 따른 음성 언어적 특성을 알아보고자 하였다.
방 법 : 항경련제를 사용한 적이 없고, 임상 증상과 검사 소견으로 양성 로란딕 간질 증후군에 합당한 초진 환자 23명을 대상으로 음성 언어 분석을 하였다. 음성언어평가는 Computerized Speech Lab을 사용하여 분석하였다.
결 과 : 간질파 위치가 좌뇌인 환자군에서 치환에 의한 조음 오류가 빈번하게 관찰되었다. 환자군의 VOT는 정상아동(46.7±10.2 ms)과 비교해 훨씬 길게 나타났으며 특히 간질파 발생위치가 좌뇌인 환자군에서(74.3±36.6 ms) 더욱 길게 나타났다. 억양형태를 비교분석한 결과, 간질파 발생위치가 우뇌인 환자군에서 간질파 발생위치가 좌뇌인 환자군 보다 억양변화가 적어 운율 변동 폭이 낮은 것으로 평가되었다. 숫자세기의 자발화 길이측정에서 간질파 발생위치가 좌뇌인 환자군이 간질파 발생위치가 우뇌인 환자군 보다 길게 측정되었다.
결 론 : 양성 경과를 보이는 양성 로란딕 간질 환자에서도 조음오류 및 유창성 등 음성 언어적 문제점을 정량적으로 확인하였다. 따라서 양성 로란딕 간질환자의 진단과 치료 과정 중 언어음성학적인 평가를 포함시킬 것을 추천하고자 한다.

참고문헌 (Reference)

1 Papavasiliou A, "Written language skills in children with benign childhood epilepsy with centrotemporal spikes" 6 : 50-58, 2005

2 Wyllie E, "The treatment of epilepsy principles & practice" Lippincott williams & Wilkins 475-484, 2001

3 Loiseau P, "The seizures of benign childhood epilepsy with rolandic paroxysmal discharges" 14 : 381-389, 1972

4 Berroya AG, "Speech and language deterioration in benign rolandic epilepsy" 19 : 53-58, 2004

5 Weglage J, "Neuropsychological, intellectual, and behavioral findings in patients with centrotemporal spikes with and without seizures" 39 : 646-651, 1997

6 Croona C, "Neuropsychological findings in children with benign childhood epilepsy with centrotemporal spikes" 41 : 813-818, 1999

7 Traccis S, "Long-term therapy with carbamazepine: effects on nerve conduction velocity" 22 : 410-416, 1983

8 Staden U, "Language dysfunction in children with Rolandic epilepsy" 29 : 242-248, 1998

9 Hommet C, "Cognitive function in adolescents and young adults in complete remission from benign childhood epilepsy with centro-temporal spikes" 3 : 207-216, 2001

10 Saint-Martin AD, "Cognitive consequences of Rolandic Epilepsy" 3 (3): 59-65, 2001

11 Lundberg S, "Children with rolandic epilepsy have abnormalities of oromotor and dichotic listening performance" 47 : 603-608, 2005

12 Gunduz E, "Benign rolandic epilepsy: neuropsychological findings" 8 : 246-249, 1999

13 Wolff M, "Benign partial epilepsy in childhood: selective cognitive deficits are related to the location of focal spikes determined by combined EEG/MEG" 46 : 1661-1667, 2005

14 Beaussart M, "Benign epilepsy of children with rolandic (centrotemporal) paroxysmal foci" 13 : 795-811, 1972

15 Scheffer IE, "Autosomal dominant rolandic epilepsy with speech dyspraxia" 2 (2): 19-22, 2000

16 Park JI, "Acoustic effects of carbamazepine in benign rolandic epilepsy" 7 : 468-471, 2005