Cognitive impairment in preschool children with epilepsy

Purpose: Studies have shown that underlying pathology and early onset of seizures are both significant factors contributing to cognitive impairment in children with epilepsy. However, there are only few studies focusing on cognitive impairment in preschool children with epilepsy. The purpose of this study was to describe the cognitive performance in a population‐based cohort of preschool children with epilepsy. The aims of the study were to determine frequency of cognitive impairment, level of cognitive functions, and epilepsy‐related factors correlating with cognitive impairment. Methods: The study group consisted of a population‐based cohort (N = 64) of preschool children (3–6 years 11 months) with active epilepsy. Medical data and results from previous psychological evaluations were reviewed retrospectively from the medical records. A logistic regression model was used for the prediction of cognitive impairment. Key Findings: Prevalence of epilepsy was 3.2 per 1,000 children. Cognitive function was considered to be within normal or borderline range for 50%, mildly retarded for 22%, and moderately to severely retarded for 28%. Cognitive impairment was related to complicated epilepsy, age at onset of epilepsy, abnormal magnetic resonance imaging (MRI), and additional neurologic problems. Age at the onset of seizures was the only significant predictor of cognitive impairment. Significance: The results concur with those of earlier studies on cognitive impairment in childhood epilepsy. Age at onset of epilepsy is also an important factor for cognitive impairment on young children with epilepsy. The results suggest that cognitive impairment is evident early in the course of epilepsy.     

Cognitive outcome after epilepsy surgery in children

The ultimate goal of epilepsy surgery in young children is to stop seizures, interrupt the downhill course of the epileptic encephalopathy, and improve developmental capacities. Postoperative outcome after childhood epilepsy surgery should therefore not only be expressed in terms of seizure freedom, cognitive outcome is an equally important outcome measure. Insight in the mutually dependent variables that can determine pre and postoperative cognitive developmental abilities will improve prediction of outcome and presurgical counseling of parents. The purpose of this review is to discuss the literature regarding cognitive outcome and the predictors of postoperative cognitive functioning after epilepsy surgery in children, particularly those with “catastrophic” epilepsy. There are only few studies in which the relation between possible determinants and cognitive outcome or change was statistically tested in a multivariable manner. Duration of epilepsy, presurgical Developmental Quotient (DQ) or Intelligence Quotient (IQ), and postoperative seizure freedom were the only factors reported in different studies to be independently related to eventual cognitive outcome after epilepsy surgery. Underlying etiology, gender, age at surgery, presurgical DQ/IQ, postoperative seizure freedom, cessation of antiepileptic medication, and follow-up interval have all been described in different surgical cohorts to be independently related to a postoperative change of IQ or DQ scores. To appreciate how each of the pre-epileptic, presurgical, and postoperative variables may independently influence eventual cognitive outcome and postoperative cognitive improvement, we need multicenter studies with large homogenous surgical populations, using standardized tests and multivariable analyses.     

儿童良性癫痫伴中央颞区棘波患者的认知损害研究

目的探讨儿童良性癫痫伴中央颞区棘波(Benign epilepsy of childhood with centrotemporal spikes,BECTS)患者的认知损害特点。方法纳入2010年9月-2019年12月于首都医科大学宣武医院神经内科就诊的BECTS患者61例(BECTS组)。选取60名年龄、性别和教育程度相匹配的健康儿童和青少年作为对照组。对BECTS组及对照组进行神经心理学任务测试以评估其注意力、记忆力、计算力、语言功能、执行能力、视空间功能、视知觉及反应能力等多项认知功能。应用SPSS 20.0统计软件,对两组的认知任务测试得分进行独立样本t检验和秩和检验,对影响认知功能损害的各项临床因素进行多元线性回归分析。结果与对照组相比,BECTS组患者的配对联结学习平均(19.56±2.91)分,词语辨析测验的平均(23.67±9.50)分,物体数量认知的平均(61.45±13.14)分,言语工作记忆的平均(6.54±1.47)分,声音知觉测验的平均(5.79±5.90)分,Taylor复杂图形测验的平均(35.10±2.33)分,选择反应时的平均(700.34±493.05)分,均显著低于对照组(P<0.05)。在BECTS组中有36例起病<8岁,与起病≥8岁组相比,前者在视觉追踪任务、空间记忆任务、简单减法任务、数字数量大小比较、汉字押韵测试、词语辨析测试和视觉感知任务等大部分神经心理测试中得分均较低(P<0.05);34例接受单药治疗,27例接受两种及以上抗癫痫药物治疗,多药治疗组在注意力、记忆力、视知觉、反应力等方面均低于单药治疗组(P<0.05)。结论 BECTS患者存在注意力、记忆力、视知觉、声音知觉及反应速度的损害。起病年龄越小其认知损害的程度越重;多药治疗患者的认知损害程度较单药治疗重。     

Prognosis after temporal lobe epilepsy surgery: the value of combining predictors

Purpose: Although several independent predictors of seizure freedom after temporal lobe epilepsy surgery have been identified, their combined predictive value is largely unknown. Using a large database of operated patients, we assessed the combined predictive value of previously reported predictors included in a single multivariable model.
Methods: The database comprised a cohort of 484 patients who underwent temporal lobe surgery for drug-resistant epilepsy. Good outcome was defined as Engel class 1, one year after surgery. Previously reported independent predictors were tested in this cohort. To be included in our final prediction model, predictors had to show a multivariable p-value of <0.20.
Results: The final multivariable model included predictors obtained from the patient's history (absence of tonic–clonic seizures, absence of status epilepticus), magnetic resonance imaging [MRI; ipsilateral mesial temporal sclerosis (MTS), space occupying lesion], video electroencephalography (EEG; absence of ictal dystonic posturing, concordance between MRI and ictal EEG), and fluorodeoxyglucose positron emission tomography (FDG-PET; unilateral temporal abnormalities), that were related to seizure freedom in our data. The model showed an expected receiver-operating characteristic curve (ROC) area of 0.63 [95% confidence interval (CI) 0.57–0.68] for new patient populations. Intracranial monitoring and surgery-related parameters (including histology) were not important predictors of seizure freedom. Among patients with a high probability of seizure freedom, 85% were seizure-free one year after surgery; however, among patients with a high risk of not becoming seizure-free, still 40% were seizure-free one year after surgery.
Conclusion: We could only moderately predict seizure freedom after temporal lobe epilepsy surgery. It is particularly difficult to predict who will not become seizure-free after surgery.     

难治性外伤性癫痫的手术治疗分析

目的 探讨外伤性癫痫的临床特点、致痫灶位置与脑软化灶的关系和手术疗效.方法 沈阳军区总医院神经外科自2003年2月至2006年4月共手术治疗难治性外伤性癫痫患者13例,对其临床资料进行回顾性分析. 结果 8例患者致痫灶位于外伤软化灶周围(2～7 cm);5例为颞叶癫痫,其中4例为颞叶内侧型(3例受伤时年龄1.5～5岁,术后病理显示海马胶质细胞增生)、1例为颞叶外侧型.13例患者均在皮层电极监测下行手术治疗,4例同期行颅骨修补术.经2～5年随访,总手术有效率92.3%,优良率84.6%. 结论 外伤性癫痫致痫灶常位于软化灶周围;小于5岁的重型颅脑损伤易导致海马硬化;难治性外伤性癫痫的手术疗效较好,一经诊断,应积极进行手术治疗.     

Acute postoperative seizures after frontal lobe cortical resection for intractable partial epilepsy

PURPOSE: To evaluate the incidence and prognostic importance of acute postoperative seizures (APOSs) occurring in the first week after a focal corticectomy in patients with partial epilepsy of frontal lobe origin. METHODS: We retrospectively evaluated 65 patients who underwent a frontal lobe cortical resection for intractable partial epilepsy between April 1987 and December 2000. All patients were followed up for a minimum of 1 year after surgery. RESULTS: APOSs occurred in 17 (26%) patients. None of the following factors was shown to be significantly associated with the occurrence of APOSs: gender, duration of epilepsy, etiology for seizure disorder, use of subdural or depth electrodes, surgical pathology, or postoperative risk factor for seizures. Patients with APOSs were older at seizure onset and at the time of surgery (p = 0.003 and p = 0.05, respectively). At last follow-up, patients who had APOSs had a seizure-free outcome similar to that of individuals without APOSs (47.1% vs. 50.0%; p = 0.77). Patients with APOSs appeared less likely to have a favorable outcome [i.e., fewer than three seizures per year and >95% decrease in seizure activity (58.8 vs. 70.8%; p = 0.35)]. This result may not have reached statistical significance because of the sample size. No evidence suggested that precipitating factors or the timing of APOSs was an important prognostic factor. CONCLUSIONS: The presence of APOSs after frontal lobe surgery for intractable epilepsy does not preclude a significant reduction in seizure tendency. These findings may be useful in counseling patients who undergo surgical treatment for frontal lobe epilepsy.     

继发性癫痫的手术治疗

继发性癫痫病因复杂．治疗方法和手段也不尽相同。自2000年7月至2006年5月我们对37例继发性癫痫患者根据病因不同进行不同手术治疗．取得了较好的疗效，现报告如下。     

颞叶癫痫患者认知功能及相关因素的分析

目的分析颞叶癫痫患者认知功能的状况,并进一步探讨性别、病程、临床发作、神经电生理及药物等因素对患者认知功能的影响。方法从我院2002～2010年住院部中抽出符合入选标准的55例颞叶癫痫患者及随机抽取的同期48例健康对照者的韦氏成人智力量表、韦氏成人记忆量表、H.R.成人神经心理成套测验记录测验值进行回顾性分析。结果颞叶癫痫患者全量表智商(full intelligence quotient,FIQ)、记忆商(memory quo-tient,MQ)均明显低于健康对照者(P<0.001),脑病损程度(disease quotient,DQ)明显高于健康对照者(P<0.001)。不同文化程度的颞叶癫痫患者IQ、MQ、DQ有显著性差异,文化程度越高,其IQ及MQ越高(P<0.01),DQ越小(P<0.01);不同发作频率的颞叶癫痫患者IQ、MQ及DQ有显著性差异,发作越频繁,其IQ及MQ越低(P<0.01),DQ越高(P<0.01);不同脑电图异常改变的颞叶癫痫患者IQ、MQ和DQ有显著性差异,癫痫样放电越明显,其IQ及MQ越低(P<0.01),DQ越高(P<0.01)。多元逐步回归分析显示,影响患者IQ、MQ及DQ的因素依次为发作频率和脑电图癫痫样放电。结论颞叶癫痫患者存在不同程度的认知功能障碍。关注颞叶癫痫患者认知功能状况,尽早采取有效的治疗方法控制癫痫发作是避免和减少患者认知功能障碍,提高生活质量的重要前提。     

Cognitive, psychosocial, and family function one year after pediatric epilepsy surgery

PURPOSE: Assumptions regarding the benefits of seizure control after pediatric epilepsy surgery for cognitive, psychosocial, and family function were explored in a prospective study of 51 children with intractable epilepsy. METHODS: Thirty children who underwent surgery were studied before and 1 year after surgery, and a comparison group of 21 children with medically refractory seizures was examined at comparable times. RESULTS: One year after surgery, 57% of the surgical group was seizure free. Seizure status after surgery did not predict change over time in any of the areas measured. Cognitive and psychosocial status did not change over time in either group, and the strongest predictor of individual change in psychosocial status in the surgical group was baseline level of function. Within the surgical group, a trend toward an increase in independence promotion was noted in the family, but the children's satisfaction with the family declined. CONCLUSIONS: These findings challenge the assumption that elimination of seizures will result in improved cognitive, psychosocial, and family functioning, at least within the first year after surgery.     

Development of cognitive functions in children with rolandic epilepsy

An initial investigation of cognitive functions in 32 children, aged 7 to 15 years, with rolandic epilepsy (RE), using an extensive test battery, was followed 2.5 to 3 years later by a second assessment of 26 of these children, using the same technique. The initial investigation reported cognitive deficits in memory and learning of auditory-verbal material together with executive functions compared with controls. At the second assessment, the ability for immediate memory, memory and learning of visuospatial as well as auditory-verbal material and delayed recall was the same in the RE group as in the control group. On one of the tests measuring executive functions, Verbal Fluency, the RE group scored significantly lower than controls. With respect to reading and writing ability, the children with RE had some difficulty with word comprehension. Nonverbal reasoning was the same in the two groups, as was general IQ. In conclusion, the children with RE did not present any major cognitive difficulties when a mean of approximately 5 years had passed since onset of the typical syndrome, and at a time when most of them were seizure-free. Maturational factors apparently are of importance to the course of RE.     

Time to relapse after epilepsy surgery in children: AED withdrawal policies are a contributing factor

Aim. It was recently suggested that early postoperative seizure relapse implicates a failure to define and resect the epileptogenic zone, that late recurrences reflect the persistence or re‐emergence of epileptogenic pathology, and that early recurrences are associated with poor treatment response. Timing of antiepileptic drugs withdrawal policies, however, have never been taken into account when investigating time to relapse following epilepsy surgery. Methods. Of the European paediatric epilepsy surgery cohort from the “TimeToStop” study, all 95 children with postoperative seizure recurrence following antiepileptic drug (AED) withdrawal were selected. We investigated how time intervals from surgery to AED withdrawal, as well as other previously suggested determinants of (timing of) seizure recurrence, related to time to relapse and to relapse treatability. Uni‐ and multivariable linear and logistic regression models were used. Results. Based on multivariable analysis, a shorter interval to AED reduction was the only independent predictor of a shorter time to relapse. Based on univariable analysis, incomplete resection of the epileptogenic zone related to a shorter time to recurrence. Timing of recurrence was not related to the chance of regaining seizure freedom after reinstallation of medical treatment. Conclusion. For children in whom AED reduction is initiated following epilepsy surgery, the time to relapse is largely influenced by the timing of AED withdrawal, rather than by disease or surgery‐specific factors. We could not confirm a relationship between time to recurrence and treatment response. Timing of AED withdrawal should be taken into account when studying time to relapse following epilepsy surgery, as early withdrawal reveals more rapidly whether surgery had the intended curative effect, independently of the other factors involved.     

顽固性癫痫的组合手术治疗

目的对部分顽固性癫痫病人，在严格充分的术前评价之后．依据结果将几种手术方式适当的组合使用，并对其临床效果进行评价。方法对同济大学东方医院神经外科收治的116例顽固性癫痫中的25例病人施行联合手术的治疗方法。发作形式为全身强直一阵挛性发作、复杂部分性发作及失神发作等，其中有14例存在两种发作形式。术前均服过多种抗癫痫药．病程后期同时服用2～3种抗癫痫药。25例病人术前均行24h脑电监测及头颅MRI检查．有19例术前行硬膜下皮层电极和深部电极检测，其中1例行头颅PET检查。手术在皮层脑电及深部电极监测下进行。13例行额颢开颅，颞前叶及海马、杏仁核切除＋额部部分区域的软膜下横切术（MST），其中7例附加胼胝体前部切开术；11例行额部开颅，额部软化灶切除＋运动区MST，其中2例附加胼胝体前部切开术；1例行双侧枕顶部开颅，左枕叶萎缩皮层切除＋胼胝体后部切开＋右侧顶枕的MST。结果术后无死亡及严重并发症。术后抗癫痫药物使用减少，术后23例服用一种抗癫痫药，2例服用两种抗癫痫药。术后随访6～12个月，17例手术效果为Engel 1级，4例为Engel2级，4例为Engel3级。40岁以下的患者手术后癫痫控制的可能性显著大于40岁以上者（P〈0．05）；病程在10年以下的患者术后癫痫无发作的可能性显著大于10年以上者（P〈0．05）。头颅MRI上有无明显的结构异常对病人的预后没有影响（P〉0．05）。结论在严格术前评价的前提下，尤其是在有精通神经电生理知识的神经外科医生综合分析下，采用多种手术方式组合治疗顽固性癫痫效果显著。     

左乙拉西坦添加治疗学龄期难治性癫痫患儿认知功能与生活质量的影响

目的观察并探讨左乙拉西坦(levetiracetam,LEV)添加治疗对学龄期难治性癫痫(refractory epilepsy,RE)患儿认知功能与生活质量的影响。方法入选2013年6月至2015年12月收治的55例RE儿童为研究对象,所有患儿在继续原有治疗方案基础上行LEV添加治疗16周,起始剂量8~10 mg/(kg·d),逐步加量至50 mg/(kg·d),达标后维持剂量30 mg/(kg·d),期间记录药物不良反应,治疗结束后判定临床疗效,采用韦氏儿童智力量表评价患儿认知功能,采用儿童癫痫生活质量量表评价生活质量改变。结果患儿治疗后癫痫平均发作次数(3.8±1.3 vs.6.6±2.3)次/月较入组前明显下降(P0.05)。治疗后临床控制率、显效率、有效率、无效率分别为9.1%、36.4%、43.6%、10.9%,总体有效率为89.1%。患儿治疗后WISC-CR智力评价中算术(10.9±2.6 vs.9.2±2.1)、填图评分(15.1±3.9 vs.13.8±3.3)较治疗前显著提高(P0.05)。患儿治疗后QOLCE评价中生活质量总分(65.7±5.7vs.62.8±4.9)及认知功能(60.0±5.7 vs.57.4±6.2)、社会功能(65.0±6.3 vs.62.5±5.5)评分显著高于治疗前(P0.05)。服药期间,患儿头晕、乏力、嗜睡、易激惹、欣快感、一过性转氨酶升高发生率分别为12.7%、9.1%、20.0%、5.5%、3.6%、3.6%;16周服药保留率96.4%。结论 LEV添加治疗能显著减少RE患儿癫痫发作次数,并有助于改善患儿认知功能与生活质量,但应注意LEV对精神行为的影响。     

Cognitive outcome after extratemporal epilepsy surgery in childhood

Purpose: The present study aims to describe the cognitive profile of children with medically refractory extratemporal epilepsies who undergo focal surgery and to identify determinants for preoperative and postoperative cognitive level. Methods: This is a retrospective cohort study. Children who underwent operations between 1997 and 2008 with a focal lesion in frontal, parietal, or occipital cortices and with a presurgical or postsurgical cognitive evaluation, were eligible for the study. Key Findings: Sixty‐six children (53% male) with a mean age of 9.3 ± 8.8 years were enrolled. The overall full‐scale IQ (FSIQ) at cognitive testing was 77.4 ± 44.4 before surgery. Children did not show any significant change in their FSIQ after surgery. Duration of presurgical epilepsy, age at epilepsy onset, etiology, and gender were found to be independently associated with lower FSIQ before surgery. Presurgical cognitive level was the only factor independently associated with postsurgical FSIQ. Overall, 51.5% of children who underwent surgery were seizure‐free; however, the good postsurgical epilepsy control did not seem to influence the cognitive outcome. Significance: Children with extratemporal lobe epilepsy are below the normal cognitive level range. Intellectual abilities of children undergoing surgery are determined independently by presurgical factors and surgery does not seem to affect the cognitive level in the postsurgical period, even for those who become free from clinical seizures.     

颞叶的局部解剖与癫痫的手术治疗(颞叶切除术的一些改进)

目的：复习颞叶的局部解剖，探讨颞叶切除方法的改进。方法：（１）手术技巧的改进：①首先寻找侧脑室颞角；②经颞上回切除颞叶外侧皮质；③在直视下切除颞叶内侧结构（杏仁、海马、钩回及海马旁回等）。（２）在ＥＣｏＧ监测下，反复描记ＥＣｏＧ，尽可能切除致痫组织。结果：满意者３８％，显著改善者占４０％，良好者占１０％，效差６％，无改善者６％。并发症：偏瘫加重１例，无菌性脑膜炎３例，记忆力下降４例，无手术死亡。结论：熟悉颞叶解剖，应用改进的颞叶切除法，术后的并发症少，控制癫痫效果好     

Sexual function after cervical spine surgery: Independent predictors of functional impairment

Sexual function (SF) is an important component of patient-focused health related quality of life (HRQoL), but it has not been well studied in spine surgery. This study aims to assess SF after cervical spine surgery and identify predictors of SF. This single-center retrospective study evaluates SF of adults who underwent cervical spine surgery 2007–2012. Predictor variables included demographics, medical/surgical history, operative information, HRQoL measures (Neck Disability Index, SF-12), validated SF surveys [Female Sexual Function Index (FSFI) and Brief Sexual Function Inventory (BSFI) for males], and a study-specific SF questionnaire. 59 patients (31M, 28F; mean age = 56 ± 8.4) had significantly lower SF scores compared to age-matched peers: average BSFI = 2.26 ± 1.22 (vs. 06 ± 0.74), average FSFI = 13.05 ± 11.42 (<26.55 indicating sexual dysfunction). In men, lower mental SF-12 and higher NDI, back pain, and number of operated levels were associated with lower BSFI scores (all p < 0.05). In women, higher total number of medications and pain medications were associated with lower FSFI scores (both p < 0.05). 46% of patients reported difficulty performing a sexual position after surgery that they had previously enjoyed. 39% of men had difficulty on top during intercourse, and 32% of participants reported difficulty performing oral sex. 39% of patients reported worse SF, while only 5% reported an improvement in postoperative SF. Men and women who underwent cervical spine surgery had lower SF scores than age-matched peers, likely attributable to general mental health, regional neck disability, back pain, and medications. A large portion of patients reported subjectively worsened SF after surgery.     

Cognitive training as a resolution for early executive function difficulties in children with intellectual disabilities

Core executive functions (EF) such as attention, and working memory have been strongly associated with academic achievement, language development and behavioral stability. In the case of children who are vulnerable to cognitive and learning problems because of an underlying intellectual disability, EF difficulties will likely exacerbate an already compromised cognitive system. The current review examines cognitive training programs that aim to improve EF, specifically focusing on the potential of this type of intervention for children who have intellectual disabilities. We conclude that despite considerable discrepancies regarding reported intervention effects, these inconsistencies can be attributed to flaws in both program and study design. We discuss the steps needed to address these limitations and to facilitate the advancement of non-pharmaceutical interventions for children with intellectual disabilities.     

Design considerations for a multicenter randomized controlled trial of early surgery for mesial temporal lobe epilepsy

Purpose: To describe the trial design for the multicenter Early Randomized Surgical Epilepsy Trial (ERSET). Patients with pharmacoresistant epilepsy are generally referred for surgical treatment an average of two decades after onset of seizures, often too late to avoid irreversible disability. ERSET was designed to assess the safety and efficacy of early surgical intervention compared to continued pharmacotherapy. Methods: ERSET is a randomized controlled, parallel group clinical trial with blinded outcome adjudication. Participants are patients with mesial temporal lobe epilepsy (MTLE) older than the age of 12 who have had pharmacoresistant seizures for not >2 years and are determined by detailed evaluation to be surgical candidates prior to randomization. The primary outcome measure is seizure freedom in the second year of a 2‐year follow‐up period. Health‐related quality of life (HRQOL), neurocognitive function, ancillary outcomes, and adverse events were also measured. Results: Significant methodologic problems addressed by the study design included the following: recruitment of participants early in the course of epilepsy; establishment of operational definitions for “pharmacoresistant” and “early”; and standardization of diagnostic testing, medical treatment, and surgical interventions across multiple centers. Discussion: Rigorous trial designs to assess surgical interventions in epilepsy are necessary to provide evidence to guide treatment. This article is the first of a series; trial results will be reported in subsequent publications.     

The effects on cognitive function and behavioral problems of topiramate compared to carbamazepine as monotherapy for children with benign rolandic epilepsy

PURPOSE: To evaluate the cognitive and behavioral effects of topiramate (TPM) versus carbamazepine (CBZ) using efficacious doses of each drug as monotherapy for children with benign rolandic epilepsy. METHODS: A multicenter, randomized, open-label, observer-blinded, parallel-group clinical trial was conducted. TPM was introduced at a dose of 12.5 mg/day with the minimum target dose of 50 mg/day in patients <30 kg and 75 mg/day in patients >30 kg over 4 weeks. CBZ was started at a dose of 10 mg/kg/day with the minimum target dose of 20 mg/kg/day over 4 weeks. Additional individual escalation was allowed up to a maximum target dose. The primary study end point was change on a neuropsychological test battery after 28 weeks of treatment. RESULTS: Neuropsychological data were available for 88 patients (45 patients for TPM and 43 patients for CBZ). Of the cognitive variables measured, arithmetic showed significant worsening in TPM (p = 0.037). An additional test, for maze, also showed a significantly greater improvement for CBZ (p = 0.026). Of behavioral variables, no significant changes were found but the scores had a negative trend for the TPM. When 30 patients on the minimum target dose for TPM were compared to 40 patients treated with minimum target CBZ, there was no significant worsening of cognitive and behavioral effects in the TPM. CONCLUSION: The pattern of neuropsychometric changes with TPM seemed to be slightly worse overall than CBZ. However, outcome with the minimum target dose did not differ significantly in comparisons between the treatment groups.     

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。