不同术式选择对颞叶癫痫患者术后记忆功能影响的初步探讨

目的探讨不同术式选择对颞叶癫痫患者术后记忆功能的影响。方法 2009~2013年共248例海马硬化性颞叶癫痫患者在我院接受手术治疗,其中83例行标准前颞叶切除术(anterior temporal lobectomy,ATL),165例行选择性海马杏仁核切除术(selective amygdalohippocampectomy,SAH)。患者在术前、术后3个月及术后两年分别接受临床记忆功能评估。结果 ATL组和SAH组优势半球侧手术的患者临床记忆商数(memory quotient,MQ)在术后3个月(74.5±16.2,75.6±19.5)均有明显下降(P0.05),术后两年(75.1±14.1,76.1±17.6)略有恢复但仍然显著低于术前(82.9±15.8,83.2±21.2)(P0.05),其中SAH组术后3个月及术后两年相较术前MQ的减低程度都小于ATL组(7.6 vs.8.4;7.1 vs.7.8);ATL组和SAH组非优势半球侧手术的患者术后3个月的MQ(87.2±15.1,88.1±16.9)均高于术前(85.5±13.5,85.3±19.7),但无统计学意义,至术后两年时,两组患者的MQ(92.8±12.7,93.7±17.1)对比术前都有了显著的改善(P0.05),其中SAH组患者的改善幅度较ATL组略大(8.4 vs.7.3)。结论相比于ATL,SAH可能更有利于保护海马硬化性颞叶癫痫患者的术后记忆功能。     

手术对颞叶癫痫病人认知功能的影响

目的 探讨手术对颞叶癫痫病人认知功能的影响。方法 回顾性分析2017年1月至2020年1月手术治疗的60例颞叶癫痫的临床资料。38例采用前颞叶切除术（ATL）治疗,22例采用选择性海马杏仁核切除术（SAH）治疗。术后6个月,采用Engle分级评估预后。术前、术后6个月由专业人员采用面对面形式完成认知功能评估,采用韦氏智力测验量表测试智商;术前记忆量表甲套+术后乙套测验记忆功能,采用记忆商数（MQ）评估记忆功能。结果 术后6个月,Engle分级Ⅰ级35例,Ⅱ级20例,Ⅳ级5例。术后6个月,两组MQ和智商均明显增高（P<0.05）,而且,SAH组术后MQ明显高于ALT组（P<0.05）。结论 手术治疗可以改善颞叶癫痫病人的智商和记忆功能,SAH优于ATL。     

头部MRI阴性的颞叶内侧癫痫患者认知功能障碍研究

目的评估头部MRI阴性颞叶内侧癫痫(MTLE)患者认知功能受损特点。方法回顾性分析27名头部MRI阴性的MTLE患者资料,其中左侧MTLE 14例(左侧MTLE组),右侧MTLE 13例(右侧MTLE组)。癫痫患者与性别、年龄和受教育程度严格匹配的14名健康对照者(对照组)均接受蒙特利尔认知评估量表(Mo CA)和失礼识别任务的测评。结果在Mo CA得分方面,两组MTLE患者的Mo CA总分及各分项测试得分均低于对照组(P 0. 05);右侧MTLE组复制立方体得分低于左侧MTLE组和对照组(P 0. 05);右侧MTLE组的画钟试验得分低于左侧MTLE组(P 0. 05);左侧MTLE组句子复述、语言流畅性测试得分低于右侧MTLE组(P 0. 05)。在失礼识别任务得分方面,两组MTLE患者得分均低于对照组(P 0. 05);左侧MTLE组比右侧MTLE组更低(P 0. 05)。结论头部MRI阴性MTLE患者的一般认知功能及高级社会认知功能均受损。     

不同手术入路治疗海马硬化性颞叶内侧癫痫的比较

目的 比较常用的四种手术方式在治疗海马硬化性颞叶内侧癫痫(MTLE/HS)中的优缺点.方法 106例顽固性MTLE/HS患者中23例行经皮层脑室入路选择性海马杏仁核切除术;23例行经侧裂选择性海马杏仁核切除术;30例行前内侧颞叶切除术;30例行经颞下选择性海马杏仁核切除术.随访6个月-9年.采用Engel分级量表评价癫痫治疗效果,并比较并发症发生率.结果 四种术式在对癫痫发作的治疗效果比较上差异无统计学意义,无手术死亡,在并发症发生率方面差异无统计学意义.结论 对于经严格筛选的MTLE/HS,四种手术方式在疗效和安全性方面相当,可根据个人手术经验加以选择.     

裁剪式前颞叶内侧切除术治疗颞叶内侧型癫痫

目的 探讨裁剪式前颞叶内侧切除术治疗颞叶内侧型癫痫的手术方法和治疗效果.方法 21例顽固性颞叶癫痫患者,采用脑功能制图及神经导航等辅助,行裁剪式前颞叶内侧切除术治疗,切除前颞叶、杏仁核及海马.采用分级量表针对癫痫发作控制效果进行评价.结果 术后随访6 ～ 29个月,21例患者神经功能均改善,无严重手术并发症.其中Engel Ⅰ级16例(76％);EngelⅡ级3例(14％);EngelⅢ级2例(10％).结论 裁剪式前颞叶内侧切除术是治疗颞叶癫痫的有效方法.脑功能制图及神经导航辅助下手术切除杏仁核及海马彻底,避免了语言区和视放射的损伤.     

前颞叶切除术对癫痫患者推理智商的影响

目的探讨前颞叶切除术(ATL)后癫痫患者推理智商(CIQ)的变化。方法回顾性分析58例ATL病人手术前后的CIQ,对比总体的CIQ评分变化和个体病例手术前后CIQ的变化情况,并统计手术侧别、术前CIQ、预后与CIQ改变的关系。结果总体术后IQ均值有增加,CIQ提高者占41.4%(24/58),降低者为8.6%(5/58),两侧比较没有统计学差异,所有CIQ提高者均为预后好的病人,术前CIQ低的病人中有21/48术后IQ改善,而术前CIQ正常者只有3/10。结论总体ATL术后CIQ有改善,手术预后和术前CIQ低是影响CIQ提高的重要因素。     

两种术式治疗颞叶癫痫的研究进展

癫痫是最常见的神经系统病症之一,具有产生癫痫发作的持久易患性和出现相应神经生物、认知、心理及社会等方面的后果的特性,约1/3的患者为药物难治性癫痫,其中颞叶癫痫最为常见。既往研究已经证实颞叶切除性手术可有效地控制癫痫发作,常用术式可分为前颞叶切除术(ATL)和选择性杏仁核海马切除术(SelAH)。本文围绕两种术式对颞叶癫痫发作控制的有效性及术后神经心理功能改变的相关研究进行综述,以期为颞叶癫痫的切除性手术术式的选择提供借鉴。     

颞叶癫痫患者颞叶切除术前后的记忆评估

目的探讨颞叶切除术对颞叶癫痫患者术后记忆功能的影响。方法回顾性分析2012年7月至2013年12月收治的17例颞叶癫痫患者的临床资料,采用成人韦氏量表测量患者颞叶切除术前及术后6个月记忆商（MQ）值。结果术前MQ平均值为（89.94±4.45）,术后6个月为（104.76±4.96）,差异显著（P〈0.05）。术前长时MQ值为（37.53±1.95）,术后为（40.53±1.70）,术后长时记忆改善不明显（P〉0.05）。术前短时记忆MQ值为（46.29±2.43）,术后为（54.94±3.18）;术前瞬时MQ均值为（6.12±1.37）,术后为（9.29±1.00）;术后短时及瞬时MQ均较术前有显著差异（P〈0.05）。EngleⅠ～Ⅱ级15例病人中,术后MQ较术前改善11例,无明显变化4例;EngleⅢ～Ⅳ级2例病人中,MQ值较术前下降1例,无改变1例。结论颞叶切除术可明显改善颞叶癫痫患者术后MQ。     

前颞叶切除术对癫痫患者记忆功能影响的临床研究

目的评估前颞叶切除术对癫痫患者记忆功能的影响。方法对30例颞叶癫痫病例往术前、术后2周和术后6个月以上时分别进行记忆测评,比较患者记忆评分的变化;对24例患者进行1H-MRS成像,评估1H-MRS值与韦氏记忆评分之间的相关关系。结果术前MQ均值与术后2周时有显著性差异,术后6个月以上较术后2周时有显著改善;短时记忆在术前、术后无明显变化;非海马硬化组中患侧NAA/Cr与术前、术后短时记忆差值有相关性,患侧NAA/(Cr Cho)以及健侧与患侧NAA/(Cr Cho)之差与术前、术后MQ差值有相关性。结论术后早期多数患者MQ、长时记忆、瞬时记忆有较明显下降,6个月以后有明显恢复,而短时记忆下降不明显。患侧海马1H-MRS值与术前、术后韦氏记忆评分之间存在一定的相关关系。     

前颞叶切除与海马横切治疗颞叶癫痫对认知记忆和睡眠质量的影响

目的探讨前颞叶切除术与海马横切除术治疗颞叶癫痫(TLE)对患者认知记忆功能、睡眠质量的影响差异。方法选取我院2013年2月～2018年4月收治的手术治疗的60例TLE患者进行回顾性分析,其中采取海马横切术治疗的30例(A组)、30例采用前颞叶切除术(B组),对比两组患者术前、术后2周的认知记忆功能、睡眠质量变化。结果术前,A组和B组患者的PIQ、VIQ、FIQ、MQ评分差异不具有统计学意义(P0.05);术后2周,A组患者的PIQ、VIQ、FIQ、MQ评分均高于B组(P0.05);术前,A组和B组患者的主观睡眠质量、入睡时间、睡眠时间、睡眠效率、睡眠障碍、催眠药物、日间功能障碍、PSQI评分差异不具有统计学意义(P0.05);术后2周,A组患者的主观睡眠质量、入睡时间、睡眠时间、睡眠效率、睡眠障碍、催眠药物、日间功能障碍、PSQI评分均低于B组(P0.05)。结论 TLE患者采用前颞叶切除术治疗较海马横切术治疗对认知、记忆功能的影响更严重,患者术后的睡眠质量较差。     

Short-term cognitive changes after surgery in patients with unilateral mesial temporal lobe epilepsy associated with hippocampal sclerosis

We investigated the short-term postoperative cognitive function of patients with unilateral mesial temporal lobe epilepsy associated with hippocampal sclerosis (MTLE/HS). Fourteen unilateral MTLE/HS patients who had undergone selective amygdalohippocampectomy (SAH) or anterior temporal lobectomy (ATL) were enrolled. Cognitive functions related to the frontal and temporal lobes were evaluated using a battery of neuropsychological tests administered before surgery and 3 months after surgery. The battery included the Verbal Fluency Test (VFT), Boston Naming Test (BNT), Stroop Color-Word Test (TST), Trail Making Test (TMT) and Wechsler Memory Scale (WMS). MTLE/HS patients demonstrated significantly improved postoperative performance on the TST regardless of the surgical method or side of resection. There was no significant difference in any of the other neuropsychological tests before and after surgery. After left-side resection, performance on the VFT and the TMT-B was worse than at baseline. After right-side resection, performance on the VFT and WMS short-term memory improved; however, these differences were not statistically significant. SAH patients exhibited improved TST performance but worse TMT-A performance; however, performance on all tests was not significantly different after surgery in ATL patients. In summary, MTLE/HS patients demonstrated improved frontal lobe-related cognitive function after surgery, but no such improvement in temporal lobe-related function was observed. Based on cognitive evaluation, right-sided MTLE/HS patients may be more appropriate surgical candidates than left-sided MTLE/HS patients. SAH may not be better than ATL in improving cognitive function. We hypothesise that postoperative cognitive changes depend on whether the excised cerebral regions are related to the neuropsychological functions examined by specific assessment instruments.     

选择性杏仁核-海马切除术对内侧颞叶癫痫病人神经心理学的影响

目的 探讨选择性杏仁核-海马切除术（SAH）对内侧颞叶癫痫病人认知功能的影响。方法 回顾性分析2009年1月~2017年5月接受SAH治疗的67例内侧颞叶癫痫的临床资料,术前、术后3个月和术后1年均行详细的神经心理学评估,包括智商、记忆商和语言功能。结果 36例行左侧SAH,31例行右侧SAH。术后1年,癫痫控制效果达到Engel分级Ⅰ级50例,Ⅱ级7例,Ⅲ级8例,Ⅳ级2例。术后3个月,左侧手术病人言语功能、记忆商较术前明显降低（P<0.05）,右侧手术病人言语理解指数、语义流畅性测验明显改善（P<0.05）;术后1年,无论是左侧手术病人,还是右侧手术病人,智商、记忆商、言语功能较术后3个月略改善（P>0.05）;手术前后视觉记忆均无明显变化（P>0.05）。结论 海马硬化性内侧颞叶癫痫行SAH后,左侧手术病人会出现比较明显的言语和记忆功能减低。     

颞叶内侧癫痫的两种术式对发作控制的对比分析

目的观察前颞叶切除术和选择性海马、杏仁核切除术对颞叶内侧癫痫的发作控制效果是否有差别。方法 2009年1月至2010年12月在我科行前颞叶切除术的67例颞叶内侧患者为A组;2011年6月至2013年5月在我科行选择性海马、杏仁核切除术的46例颞叶内侧患者为B组;统计分析两组术后1年发作控制为Engel I-II级和Engel III-IV级的人数。结果 A组Engel I-II级56例(83.58%),Engel III-IV级11例(16.42%);B组Engel I-II级40例(86.95%),Engel III-IV级6例(13.05%)。经χ2检验两组术后对MTLE发作的控制率无统计学差异,χ2=0.243,P0.05。结论前颞叶切除术和选择性海马、杏仁核切除术对颞叶内侧癫痫发作都能获得良好的控制,两者疗效无明显差异。     

Granule cell dispersion is associated with memory impairment in right mesial temporal lobe epilepsy

PurposeWe analyzed the association of granule cell dispersion (GCD) with memory performance, clinical data and surgical outcome in a series of patients with mesial temporal lobe epilepsy (MTLE) and mesial temporal sclerosis (MTS).MethodHippocampal specimens from 54 patients with MTLE (27 patients with right MTLE and 27 with left MTLE) and unilateral MTS, who were separated into GCD and no-GCD groups and thirteen controls were studied. Quantitative neuropathological evaluation was performed using hippocampal sections stained with NeuN. Patients’ neuropsychological measures, clinical data, type of MTS and surgical outcome were reviewed.ResultsGCD occurred in 28 (51.9%) patients. No correlation between GCD and MTS pattern, clinical data or surgical outcome was found. The presence of GCD was correlated with worse visuospatial memory performance in right MTLE, but not with memory performance in left MTLE.ConclusionGCD may be related to memory impairment in right MTLE-MTS patients. However, the role of GCD in memory function is not precisely defined.     

Differential effects of temporal pole resection with amygdalohippocampectomy versus selective amygdalohippocampectomy on material-specific memory in patients with mesial temporal lobe epilepsy

PURPOSE: In the surgical treatment of mesial temporal lobe epilepsy, there is converging evidence that individually tailored or selective approaches have a favorable cognitive outcome compared to standard resections. There is, however, also evidence that due to collateral damage, selective surgery can be less selective than suggested. As part of a prospective transregional research project the present study evaluated the outcome in memory and nonmemory functions, following two selective approaches: a combined temporal pole resection with amygdalohippocampectomy (TPR+) and transsylvian selective amygdalohippocampectomy (SAH). METHODS: One year after surgery, cognitive outcomes of postoperatively seizure-free patients with mesial TLE and hippocampal sclerosis, who underwent either TPR+ (N = 35) or SAH (N = 62) in two German epilepsy centers (Bonn/Berlin), were compared. RESULTS: Repeated measurement MANOVA and separate post hoc testing indicated a double dissociation of verbal/figural memory outcome as dependent on side and type of surgery. Verbal memory outcome was worse after left-sided operation, but especially for SAH, whereas figural memory outcome was worse after right-sided operation, preferentially for TPR+. Attention improved independent of side or type of surgery, and language functions showed some improvement after right-sided surgeries. DISCUSSION: The results indicate a differential effect of left/right SAH versus TPR+ on material-specific memory insofar as transsylvian SAH appears to be favorable in right and TPR+ in left MTLE. The different outcomes are discussed in terms of a different surgical affection of the temporal pole and stem, and different roles of these structures for verbal and figural memory.     

经颞下回-侧脑室入路选择性海马杏仁核切除术治疗内侧颞叶癫痫

目的 探讨经颞下回-侧脑室入路选择性海马杏仁核切除术治疗内侧颞叶癫痫的手术方法 、疗效及并发症. 方法 对确诊为药物难治性内侧颞叶癫痫的62例患者,经颞部锁孔开颅,切除中前段颞下回,进入颞角前外侧区,选择性切除海马杏仁核及海马旁回等内侧颞叶结构.结果 62例患者术后随访至少24～80个月,无严重手术并发症;Engel癫痫疗效分级;Ⅰ级45例(72.6%),Ⅱ级12例(19.4%),Ⅲ级5例(8.0%). 结论 经颢下回-侧脑室入路选择性海马杏仁核切除术是治疗内侧颞叶癫痫的有效方法 ,其手术创伤小,可妥善保护语言区和视放射,安全性高.     

Decision-making in temporal lobe epilepsy examined with the Iowa gambling task

Although memory, language, and executive functions have been extensively studied in patients with mesial temporal lobe epilepsy (MTLE), few investigations of the decision-making abilities of these patients have been performed. We studied implicit decision-making (decisions under ambiguity) in right and left MTLE patients using the Iowa Gambling Task. The Iowa Gambling Task is believed to detect deficits in decision-making caused by either ventromedial prefrontal cortex or amygdalo-hippocampal lesions. In the present study, MTLE patients scored poorly compared to healthy controls on this task, and right MTLE patients exhibited worse performance than left MTLE patients. Our findings indicate that the amygdalo-hippocampal complexes play important roles in decision-making. The right amygdalo-hippocampal complexes may play more important roles in implicit decision-making in particular.     

Nonvisual spatial navigation fMRI lateralizes mesial temporal lobe epilepsy in a patient with congenital blindness

Nonvisual spatial navigation functional magnetic resonance imaging (fMRI) may help clinicians determine memory lateralization in blind individuals with refractory mesial temporal lobe epilepsy (MTLE). We report on an exceptional case of a congenitally blind woman with late-onset left MTLE undergoing presurgical memory fMRI. To activate mesial temporal structures despite the lack of visual memory, the patient was requested to recall familiar routes using nonvisual multisensory and verbal cues. Our findings demonstrate the diagnostic value of a nonvisual fMRI task to lateralize MTLE despite congenital blindness and may therefore contribute to the risk assessment for postsurgical amnesia in rare cases with refractory MTLE and accompanying congenital blindness.     

Emotional facial paresis in temporal lobe epilepsy: its prevalence and lateralizing value.

The selection of patients with medically refractory temporal lobe epilepsy (TLE) for surgery depends on the concordance of data from clinical, imaging and electroencephalographic evaluation. Though clinical examination is often normal, emotional facial paresis has been described in patients with TLE. Utilizing a well-characterized group of mesial TLE (MTLE) patients, who have achieved excellent seizure outcome following anterior temporal lobectomy with amygdalohippocampectomy (ATL), we investigated the prevalence, predictive value and associations of emotional facial paresis. When compared to 8 out of 50 control subjects (16%), 36 out of 50 MTLE patients (72%) exhibited unilateral emotional facial paresis; the difference was highly significant (P<0.0001). The presence of contralateral emotional facial paresis correctly predicted the side of ATL in 86.1% patients. The occurrence of emotional facial paresis was significantly associated with longer duration of epilepsy prior to ATL and left ATL. Our observations confirm that emotional facial parersis contralateral to the side of mesial temporal sclerosis (MTS) is a valuable localizing sign in correctly predicting the epileptogenic temporal lobe. We hypothesize that the presence of an intact right hemisphere and pathological changes more extensive than MTS may be required for emotional facial paresis to readily manifest.