Anterior Temporal Lobectomy and Medically Refractory Temporal Lobe Epilepsy of Childhood

The evaluation and outcome of 22 patients who had onset of complex partial seizures (CPS) of temporal lobe origin in childhood and subsequently underwent anterior temporal lobectomy are described. All patients showed improved seizure control; 81.8% had a reduction greater than or equal to 95% in seizure frequency. However, many patients had difficulty adjusting to a seizure-free life. Psychosocial, behavioral, and educational problems occurred more frequently in patients whose surgery was delayed until adult life. We conclude that attempts should be made early in the course of CPS of childhood to determine whether the seizures are truly intractable to medical management so that surgical intervention can be expedited.     

Changes in Central Auditory Processing in Patients with Mesial Temporal Lobe Epilepsy after Anterior Temporal Lobectomy with Amygdalohippocampectomy

MethodsFrequency-pattern, duration-pattern, and dichotic tests were performed before and after epilepsy surgery in 22 patients with normal hearing according to pure-tone audiometry.ResultsNo significant difference in CAP scores was detected between pre- and postoperative tests, but there was a strong association between surgery in the language-dominant temporal lobe and postoperative worsening in the non-dominant-side dichotic test (p<0.05). The probability of a decreased performance in a non-dominant-side dichotic test after surgery was 7.5-fold greater in patients who underwent surgery on the dominant temporal lobe compared with the nondominant temporal lobe. No significant association of postoperative worsening in CAP with the verbal, nonverbal intelligence quotient, or right- or left-side lobectomy was noted.ConclusionsThese results suggest that ATL-AH on the dominant side in patients with mTLE-HS worsens the CAP ability in the non-dominant-side dichotic test.     

前颞叶切除术对癫痫患者临床记忆商的影响

目的探讨前颞叶切除术前后癫痫患者临床记忆力的变化。方法58例颞叶癫痫患者均经前颞叶切除手术治疗,其中左侧手术者27例,右侧手术者31例。在手术治疗前后对其记忆商(MQ)进行测定,并比较分析手术预后、术前MQ与术后MQ的关系。结果51例预后EngleⅠ-Ⅱ级,其中术后MQ改善16例(31.4%),无变化30例,下降5例;7例预后Ⅲ-Ⅳ级,其中术后MQ无变化1例,下降6例;两组术后MQ改善率相差显著(P<0.01)。右侧手术者术后MQ评分均值显著高于术前(P<0.01),但左侧手术者手术前后MQ评分均值没有显著差异(P>0.05)。右侧手术组术后MQ改善率(35.5%,11/31)明显高于左侧手术组(18.5%,5/27)。术前MQ障碍者术后MQ改善率(38.5%,10/26)明显高于术前MQ优秀(0.0%,0/5)和中等者(22.2%,6/27)。结论经受了右侧前颞叶手术切除的癫痫病人术后MQ有明显改善,左侧手术者则无明显变化;颞叶癫痫患者的手术预后和术前MQ是影响其术后MQ变化的重要因素。     

Cognitive Consequences of Two-Thirds Anterior Temporal Lobectomy on Verbal Memory in 144 Patients: A Three-Month Follow-Up Study

Previous studies have shown that left temporal lobectomy for intractable epilepsy can lead to verbal memory deficits. However, patients with left temporal lobe epilepsy (LTLE) frequently have impaired verbal memory preoperativel. The present analysis of 144 patients who underwent temporal lobe resections for either left (n = 68) or right (n = 76) temporal lobe epilepsy (LTLE, RTLE) addressed the questions of (a) whether a left two-thirds anterior temporal lobectomy (ATL) increases deficits in these qualitative aspects of verbal memory already impaired preoperatively, and (b) whether other aspects of verbal memory are additionally affected. We also evaluated possible determinants of preoperative abilities and postoperative changes, using multiple regression analysis. Preoperatively, patients with LTLE differed from patients with RTLE only in poorer performance on measures of long-term consolidation/retrieval (delayed recall). This was related to hippocampal pathology and seizure severity. Only left temporal lobe resections resulted in significant deterioration in verbal learning and memory. Acquisition over learning trials and recognition deteriorated most markedly, whereas performance in long-term consolidation/retrieval showed only minor changes. Preoperative performance levels, chronological age, the extent of the en bloc resection, preoperative performance on figural memory, and preoperative seizure severity were valuable determinants of postoperative changes in acquisition and recognition. In contrast, changes in consolidation/retrieval related only to preoperative ability. Left two-thirds ATL leads to new impairment in addition to preexisting memory deficits. The finding that left temporal lobectomy affects verbal acquisition and recognition more than long-term consolidatiodretrieval, including the different determinants of these changes, most likely reflects the differential effects of surgery on mesial temporal and neocortical temporal functions.     

颞叶癫患者的头颅磁共振显像异常表现分析

目的对颞叶癫(TLE)患者头颅磁共振成像(MRI)异常表现进行分析,为临床诊治TLE提供参考。方法对56例TLE患者的头颅MRI异常表现进行分析总结。结果 56例TLE患者头颅MRI主要表现为海马硬化、颞叶软化灶、颞叶肿瘤、颞叶皮质萎缩等。其中,颞叶肿瘤类型多样,主要为少突胶质瘤、星形细胞瘤、脑膜瘤。结论 TLE患者头颅MRI异常表现复杂多样,正确掌握其特点有助于TLE的诊治。     

Magnetic Resonance Analysis of Postsurgical Temporal Lobectomy

BACKGROUND AND PURPOSE: The effect of temporal lobe transection area, volume of postoperative gliosis, and surgical technique on patients' seizure-free outcome is unknown. The authors studied the effects of these variables on patients' seizure-free outcome. METHODS: A retrospective review of magnetic resonance imaging examinations acquired 3 to 18 months after temporal lobe resection was carried out for 18 patients with intractable temporal lobe seizures and known postsurgical outcomes for more than 2 years. The total volume of radiologically probable gliosis evident on axial proton-density-weighted images was calculated for each patient using software on an independent console. The total area of temporal lobe surface transected by the scalpel was calculated as well, using sagittal T1-weighted images. The total volume of gliosis, the total area of transected temporal lobe, and the specific type of surgery (sparing vs no sparing of the superior temporal gyrus) were then correlated with the postsurgical outcome of the patients. An examiner with no prior knowledge of the patients' postsurgical outcomes carried out the above calculations and measurements. The patients' postoperative outcome was defined using Engel classifications, and patients were divided into 2 groups: group A with Engel class 1 (n = 9) and group B with Engel classes 2-4 (n = 9). RESULTS: The mean volumes of postoperative gliosis were not significantly different between group A (3592.3 mm3) and group B (4270 mm3). The mean area of transected temporal lobe was also similar between group A (1865.2 mm2) and group B (1930 mm2). With regard to surgical technique, there were 5 patients who had the superior temporal gyrus resected and 13 who did not. Eighty percent of patients with the superior temporal gyrus resected were Engel class 1 or 2, whereas only 20% were of Engel class 3 or 4. CONCLUSIONS: The authors found no clear association between postoperative outcome and residual temporal lobe gliosis, the surgical technique, or the total area of temporal lobe transected by the scalpel.     

Cognitive Impairments in Children with Nonidiopathic Temporal Lobe Epilepsy

Summary:  Ictal and interictal activities occurring in a mature brain can disorganize the neural network activity involved in one or various specific cognitive processes. In children, the situation might be more complex: the epileptic process occurs in a period when the cortex is still maturing and it may interfere with normal cerebral development. Although neural plasticity in children is greater than it is in adults, greater plasticity does not necessarily mean adaptive plasticity. Studies have shown that temporal lobe epilepsy in children is not systematically associated with global mental retardation. However, various difficulties in specific cognitive domains are more often found in children than in patients with adult-onset epilepsy. Language, memory, socioperceptive competence, and also executive functions, which can be impaired by the disruption of the temporofrontal circuit, are among such cognitive functions that need to be evaluated. Early detection of specific deficits is of primary importance for the implementation of appropriate remediation measures.     

颞叶癫痫认知下降特点及其相关因素分析

目的:比较颞叶癫痫海马硬化者和非海马硬化者之间认知的差别,并分析颞叶癫痫患者认知下降的相关性因素。方法:收集110例颞叶癫痫患者临床资料,包括发病年龄、病程、发作情况;用修订韦氏记忆和韦氏智力量表来评价患者的记忆和智力水平;总结手术后患者的病理资料以确定患者是否伴有海马硬化。结果:伴有海马硬化颞叶癫痫患者的长期记忆和总记忆商分别为37．4±10．0,81．8±19．1;非海马硬化颞叶癫痫患者的长期记忆和总记忆商分别为42．0±8．2,88．3±13．4,伴有海马硬化颞叶癫痫患者的长期记忆和总记忆商显著低于非海马硬化颞叶癫痫患者的长期记忆和总记忆商(P值分别为0．01和0．049)。左侧起源与右侧起源的颞叶癫痫患者的语言智商分别为88．9±9．8和95．0±11．4,二者相比有显著性差异(P=0．013<0．05)。颞叶癫痫患者的总记忆商与癫痫病程呈负相关(r=-0．256,P=0．007<0．01),操作智商与癫痫发作频率呈负相关(r=-0．206,P=0．031<0．05),总智商与教育程度呈正相关(r=0．189,P=0．048<0．05)。结论:海马硬化的颞叶癫痫患者比非海马硬化的颞叶癫痫患者具有更差的长期记忆和总记忆商,左侧起源的颞叶癫痫患者比右侧起源的颞叶癫痫患者语言智商损伤更明显。颞叶癫痫患者病程越长其记忆商越差;癫痫发作越频繁其操作智商越差;教育对保护颞叶癫痫患者的智能有一定的作用。     

颞叶癫 的EEG和MR术前定位研究

目的：探讨 ＥＥＧ、ＭＲ对颞叶癫癎（ＴＬＥ）术前定位。方法：用 ＭＲ、ＥＥＧ对 ２０例 ＴＬＥ病例进行术前定位,与术中 ＥＥＧ和术后随访结果比较。结果：２０例病例中１７例依据ＭＲ及ＥＥＧ获得定位,主要在海马区域病变１２例,前颞叶５例．另３例ＭＲ检查正常,依据多次ＥＥＧ检查获得定位,随访疗效满意。结论：ＥＥＧ是诊断ＴＬＥ的重要手段,ＭＲ可对继发性ＴＬＥ作出正确诊断,ＭＲ对海马硬化检查可协助ＥＥＧ对ＴＬＥ定位诊断。     

Cognitive Outcomes in Patients with Chronic Temporal Lobe Epilepsy

Summary:  Cognitive impairment is frequent in temporal lobe epilepsy (TLE). In particular, specific deficits in temporal lobe related functions occur, but deficits in extratemporal lobe functions and global intelligence are also found. The degree and type of the impairment are first determined by structural damage and functionally dynamic factors. Most cognitive problems in TLE are already detectable at, or even before, the onset of the epilepsy. Accumulation of damage during the course of chronic epilepsy may add to this. This additional damage may be caused directly by severe seizures, head trauma, intoxication etc., or indirectly by interference of the epilepsy with mental development. Surgical treatment of TLE may also affect the cognitive outcome of patients with chronic TLE, with a risk of additional impairments on the one hand and functional recovery due to seizure control on the other hand. With regard to patient-associated factors, better baseline performance, younger age, cerebral plasticity, and good mental reserve capacities are associated with a better outcome. With regard to treatment-associated factors, prevention of additional brain dysfunction/damage and successful seizure control are important.     

外科治疗颞叶继发性癫痫的临床分析

目的 探讨颞叶继发性癫痫的原因并总结手术治疗经验。方法 对我院自1994年1月至2002年12月手术治疗的26例颞叶继发性癫痫患者的临床资料进行回顾性分析。手术方式是在皮层脑电图(ECoG)监测下采用病灶切除、病灶周致痫皮质切除、前颞叶切除和病灶周围皮质区多处软膜下横纤维切断等多种方法的组合。结果 26例病人无手术死亡及并发症。23例病人随访3个月∽7年，症状完全消失者16例(占69．6％)，术后癫痫发作显著减少者(发作频率不到原来的25％)5例(21．7％)。术后癫痫发作减少者(发作频率不到原来的50％)2例(8．7％)。结论 多种手术方法结合治疗颞叶继发性型癫痫患者安全有效。     

颞叶新皮质癫痫的手术治疗

目的 总结新皮质颞叶癫痫病人临床特征、手术方法和疗效。方法 对28例新皮质颞叶癫痫病人术前行电生理学、影像学、脑磁图(MEG)定位以及术中皮层和深部电极描记，采取病灶切除加周围皮质切除术、皮质切除术、病灶切除加多处软膜下横切术以及多处软膜下横切术进行治疗，并进行3个月～2年的随访观察。结果 28例颞叶新皮质癫痫经手术和病理证实，其中患胶质增生9例，胶质细胞瘤8例，血管畸形5例，新生儿缺氧性脑损害和外伤后脑膜脑瘢痕3例，灰质异位l例，无结构性病变2例。无手术致残和死亡。随访3～24个月后，根据Engel等人的标准分类，I级16例，Ⅱ级6例，Ⅲ级4例，Ⅳ级2例。结论 根据电生理学、影像学和MEG准确颞叶定位，采取不同术式治疗新皮质颞叶癫痫可达到良好的治疗效果。     

Nondominant Temporal Lobe Epilepsy with Depressive Reaction

Abstract: A 56-year-old woman was admitted to our hospital because of insomnia and psychomotor retardation. This is her second admission. She was diagnosed as having depression and began to receive antidepressants. Her conditions got better after the treatment but the depressive state occurred again after she stopped taking those drugs. As EEG showed some spike discharges at the nondominant temporal lobe area, she was given anticonvulsants this time. Her depressive state improved rapidly by taking anticonvulsants instead of the antidepressants. The spike discharges at the nondominant temporal lobe area disappeared when the clinical symptoms improved.     

鉴别额叶癫痫及颞叶癫痫的临床症状学提示

目的:比较额叶癫痫(FLE)及颞叶癫痫(TLE)的临床症状学区别。方法:纳入2005年10月至2007年3月我院癫痫中心门诊临床诊断为额叶癫痫患者190名,颞叶癫痫患者257名。纳入病例满足发作间期脑电图至少一次具有局限于额叶或颞叶的放电或发作期脑电图明确提示额或颞叶起源;排除所有发作间期脑电图正常、存在多灶或定位不清的脑电异常及影像学检查具有额或颞叶以外的局灶损害者。由两位不知道患者脑电图和影像学结果的临床医生单独分析患者发作情况(先兆、复杂部分发作(CPS)、继发全面强直阵挛发作(SGTC))。用χ2检验统计数据。结果:提示颞叶癫痫最有意义的先兆是经验现象和胃气上升感(P<0.01)。情感表现在TLE中更常见(P<0.05)。口咽自动症与手部自动症是颞叶癫痫患者的典型CPS表现(P<0.01)。而躯体自动症,偏转性强直-肢体与头眼及SGTC、姿势性强直,局部阵挛发作,发作时伴随出声、植物神经症状是额叶癫痫患者的典型CPS表现(P<0.01)。发笑、震颤症状在二类中均可出现,以额叶居多(P<0.05)。言语终止,自言自语,单纯凝视发作对于二者的鉴别意义不大。额叶癫痫组具有两种以上CPS发作的病例更多(P<0.01)。结论:额叶癫痫与颞叶癫痫的症状学特征是不同的,对于临床诊断有重要价值。     

颞叶癫Xian术前综合定位诊断

目的:研究术前对颞叶癫癎不同定位手段的综合应用。方法:采用ＥＥＧ、ＰＥＴ、ＭＲＩ、ＭＲＳ对２４例顽固性颞叶癫癎患者进行术前定位。结果:结合ＥＥＧ,ＭＲＩ,ＭＲＳ,ＰＥＴ对８３%,７９%,８５%病例作出定位;ＥＥＧ结合ＭＲＩ与ＭＲＳ,可对９２%病例作出定位;ＥＥＧ结合ＭＲＩ,ＭＲＳ,ＰＥＴ,可对９６%的病例作出定位。结论:结合ＥＥＧ,综合采用ＭＲＩ,ＭＲＳ,ＰＥＴ等手段可提高对颞叶癫癎术前定位的准确率。