MMSE评分、MoCA评分和事件相关电位P300对不同部位脑卒中患者认知功能的评价研究

目的通过对不同部位脑卒中患者进行MMSE评分、MoCA评分和事件相关电位P300评估研究,了解不同部位脑卒中患者的认知功能障碍情况。方法选取2015年9月至2017年5月间在本院治疗的脑卒中患者126例为观察组,按患者责任病灶不同又分为额叶(34例)、颞叶(25例)、基底核(43例)、脑干(24例)共4组,选取同期来本院就诊的非脑卒中患者50例为对照组。全部患者均采用MMSE、MoCA和事件相关电位P300评估认知功能。结果观察组的MMSE各子项目和总的评分均较对照组低(P0.05);观察组的MoCA中定向力、回忆力、命名、视空间和执行能力及总的评分较对照组低(P0.05);观察组的潜伏期要长于对照组(P0.05),波幅低于对照组(P0.05);不同部位脑卒中组间比:额叶组、颞叶组的MMSE和MoCA评分低于基底核组(P0.05),P300潜伏期长于基底核组(P0.05)。额叶组、颞叶组和基底核组的P300潜伏期长于脑干组(P0.05);与对照组比较:额叶组、颞叶组、基底核组的MMSE和MoCA评分降低(P0.05),P300潜伏期延长(P0.05);额叶组、颞叶组的P300波幅下降(P0.05)。结论 MoCA和MMSE及事件相关电位P300可较好的检出脑卒中患者认知功能障碍,额叶与颞叶部位脑卒中患者认知功能障碍最为明显。     

颞叶切除术后视觉障碍的原因分析和预防

目的分析颞叶癫痫患者颞叶切除术后出现视觉障碍的原因,改进手术方法,以进一步提高手术疗效,减少术后视觉障碍并发症的发生。方法通过熟悉与视觉相关的颞叶解剖,改进治疗颞叶癫痫患者前颞叶切除术的技术。①针对滑车神经和动眼神经损伤所致的复视,在切除颞叶内侧结构时,在软膜内切除,避免双极电凝的热损伤。②针对视放射损伤导致的视野缺损,离断颞叶的范围距颞极不要超过3.5cm。结果 42例颞叶癫痫患者颞叶切除术后仅2例出现复视,其余没有视野缺损症状。39例随访7～26个月,癫痫发作控制达到EngelⅠ～Ⅱ级者31例(79.5%),Ⅲ～Ⅳ级8例。3例失访。结论颞叶癫痫患者颞前叶切除术后出现复视和视野缺损的主要原因是手术中滑车神经、动眼神经和视放射受损。手术中严格限制切除颞叶范围,防止视放射受损和良好的显微外科操作技巧,避免损伤动眼和滑车神经,可以有效防止术后视觉障碍并发症的发生。     

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.     

顽固性颞叶癫痫患者海马或颞叶BDNF及其受体TrkB的测定

目的检测脑源性神经营养因子(BDNF)及其受体酪氨酸激酶B受体(TrkB)在难治性颞叶癫痫(TLE)患者颞叶和/或海马中的含量,探讨其在癫痫发病机制中的作用。方法选取经手术治疗的82例难治性TLE患者术中切除的海马或颞叶脑组织,用免疫组化方法对BDNF及其受体TrkB含量进行检测,并与11例对照进行比较。结果在难治性TLE患者中,BDNF在颞叶和海马中含量明显增加(分别P<0.05,P<0.01),且海马中含量明显高于颞叶(P<0.01);TrkB在颞叶和海马中含量显著增加(P<0.01),且海马中含量高于颞叶(P<0.05)。结论难治性TLE患者海马和颞叶中BDNF和TrkB含量增高,可能在癫痫发生、发展中起重要作用。     

前颞叶切除术对颞叶癫痫病人认知功能的影响

目的分析不同侧别前颞叶切除手术对颞叶癫痫(TLE)病人认知功能的影响。方法回顾性分析2014~2015年行标准单侧前颞叶及内侧结构切除的44例TLE的临床资料,分析术前及术后1年韦氏智力分测验即言语智商(VIQ)、操作智商(PIQ),以及术前、术后3个月、术后1年复查韦氏记忆量表(MQ)中的理解和再生分测验结果。结果左侧手术TLE病人术后1年PIQ较术前显著提升(P0.05),右侧手术TLE病人术后1年MQ较术前显著提升(P0.05)。左侧手术TLE病人术后3个月理解分测验分数较术前明显下降(P0.05),术后1年与术前无显著性差异(P0.05);再生分测验分数术后3个月较术前无明显变化(P0.05),术后1年较术前明显提升(P0.05)。右侧手术TLE病人理解分数和再生分数手术前后均无显著差异(P0.05)。结论左侧颞叶手术主要改善TLE病人PIQ,而右侧颞叶手术则主要改善TLE病人记忆力。     

难治性颞叶癫痫患者颞叶皮层GRP78、caspase4的表达

目的观察难治性颞叶癫痫患者脑组织内质网应激相关分子GRP78、caspase4的表达,探讨内质网应激在难治性颞叶癫痫脑损伤中的作用。方法应用免疫组化、Western blot方法检测32例难治性颞叶癫痫患者手术切除的颞叶皮层脑组织GRP78、caspase4的表达,并与性别、年龄相匹配的对照组进行比较。结果与对照组相比,GRP78、caspase4在癫痫组表达明显上调(P0.05)。结论癫痫诱发了内质网应激,caspase4可能参与了癫痫后脑损伤,很可能为癫痫脑损伤的治疗提供新的靶点。     

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(癎)患者前颞叶切除对认知功能影响的短期观察

目的评价难治性颞叶癫患者一侧标准前颞叶切除术后短期内对认知功能的影响。方法23例左前颞叶切除和42例右前颞叶切除患者在术前及术后3个月分别行韦氏智力及韦氏记忆量表测定,观察相应指标的变化。结果65例标准前颞叶切除患者术前言语智商(VIQ)、操作智商(PIQ)及全量表智商(FIQ)各值分别为80.5±15.6、89.9±16.2和83.3±15.2;术后3个月为74.3±16.1、81.8±15.9和76.1±15.2,术后各值虽较术前下降,但经配对t检验,差异无统计学意义(P>0.05)。记忆商数(MQ)值术前为70.7±20.5,术后3个月为57.5±22.3,较术前下降明显(P<0.05)。左前颞叶切除患者术前VIQ、PIQ、FIQ及MQ各值分别为78.6±15.6、87.5±17.8、81.1±16.2和69.1±22.4,术后3个月分别为66.5±11.9、77.9±18.6、69.7±14.2和49.9±18.8,术后各项指标下降明显,与术前比较差异均有统计学意义(P<0.05);右前颞叶切除患者术前VIQ、PIQ、FIQ及MQ各值分别为81.9±15.7、91.9±14.9、84.9±14.4和71.8±19.3,术后3个月分别为80.2±16.6、84.7±13.1、81.0±14.3和63.3±23.3,术后所有指标下降均无统计学意义(P>0.05)。结论一侧标准右前颞叶切除患者短期内对认知功能的影响较左前颞叶切除者小。     

前颞叶和海马切除治疗难治性颞叶癫痫对认知功能影响的研究

目的 探讨前颞叶和海马切除治疗难治性颞叶癫痫对认知功能的影响.方法 19例难治性颞叶癫痫患者接受前颞叶和海马切除手术,手术前和手术后3、6月进行认知神经心理学测评以了解认知功能的变化.结果 19例难治件颞叶癫痫患者接受了前颞叶和海马切除术后取得了良好的疗效,术后1例有-过性的言语障碍,2例有-过性的欣快等精神症状.难治性颞叶癫痫患者存在严重的认知功能障碍(特别是智力、注意力、记忆功能障碍),前颞叶和海马切除手术没有加重认知功能障碍.在手术后6月一些认知功能反而有改善的趋势.结论 难治性颞叶癫痫患者存在认知功能障碍,采用前颞叶和海马切除能治愈或减少颞叶癫痫发作,并且对认知功能障碍有一定的改善作用.     

颞叶与非颞叶胚胎发育不良性神经上皮肿瘤的对比分析

目的探讨颞叶和非颞叶胚胎发育不良性神经上皮肿瘤的不同临床特点并探究影响预后的相关因素。方法收集2010年1月至2019年1月期间就诊于我院的33例确诊为胚胎发育不良性神经上皮肿瘤的患者的临床资料进行回顾性分析。根据肿瘤发生部位将患者分为颞叶组和非颞叶组,对患者的一般资料、影像学特点、病理学特点以及预后进行统计对比分析。结果 5例(15. 15%)患者术后仍有癫痫发作,且均为颞叶组患者。统计学分析提示术后癫痫症状控制不佳的患者起病年龄更大、患病时间更长(P 0. 05)。非颞叶组患者的预后更好(P=0. 018)。结论病灶部位、起病年龄以及患病时间与胚胎发育不良性神经上皮肿瘤患者的预后密切相关。     

Transient P300 abnormality of event-related potentials following unilateral temporal lobectomy

Abstract Event-related potentials (ERP) were recorded during auditory oddball tasks for a patient prior to and soon after left anterior temporal lobectomy. The N100 amplitude decreased bilaterally although the latency did not change after the lobectomy. The P300 amplitude decreased in the left hemisphere at 1 and 2 weeks after surgery, then recovered to the pre-operative level at 4 weeks. These findings suggest that the medial temporal structure participates in the generating system of P300.     

Interictal spike-wave complexes in the human medial temporal lobe: typical topography and comparisons with cognitive potentials

Ten of 16 patients with complex partial epilepsy displayed an interictal spike-slow wave sequence with characteristic morphology and depth voltage topography. This 'typical slow wave' (TSW) lasted 300-600 msec, was usually largest and negative in the anterior hippocampus, and positive in the amygdala. Simultaneous recordings from ipsilateral cingulate, supplementary motor, orbitofrontal, and lateral temporal cortices, as well as from the contralateral medial temporal lobe (MTL), revealed only small, apparently volume-conducted, wave forms. Simultaneously recorded multiunit activity within the focal MTL was profoundly inhibited during the TSW. The TSW propagated to the scalp, producing a large widespread positivity. A large endogenous potential with similar latency range and task correlates as the scalp-P3 was recorded from the MTL to infrequent tones in a simple discrimination task. This 'depth-P3' had very similar polarity and relative amplitude across MTL sites, as was observed for the TSW at the same electrode contacts. However, at more superficial intracranial sites, the TSW was relatively smaller than the P3. Similarly, from MTL to surface, the P3 was found to decrement about half as much as the TSW decrements. This evidence suggests that the surface P3 is generated, but in part only, by the MTL.     

Endogenous potentials after anterior temporal lobectomy

The scalp topography of endogenous potentials was studied in patients who had previously undergone unilateral anterior temporal lobectomy (ATL). These excisions include medial temporal lobe (MTL) structures that have been shown to generate large potentials during tasks that evoke P3 at the scalp. Following right or left ATL, patients showed no differences from unoperated control subjects in overall amplitude of P3 or any other potential measured. The topography of P3 was very similar in both ATL groups and the control subjects, with no differences in laterality. These results suggest that the MTL is not the major generator of the P3 recorded at the scalp in the tasks studied here.     

Absence of an early hippocampal encoding signal after medial temporal lesions: No consequence for the spacing effect

Immediately repeated meaningful pictures in a continuous recognition task induce a positive frontal potential at about 200–300 ms, which appears to emanate from the medial temporal lobe (MTL) centered on the hippocampus, as concluded from inverse solutions, coherence measurements, and depth electrode recordings in humans. In this study, we tested patients with unilateral MTL lesions due to stroke to verify the provenance of this signal and its association with the spacing effect (SE)—the improved learning of material encountered in spaced rather than massed presentation. We found that unilateral left or right MTL lesions abolished the early frontal MTL‐mediated signal but not the spacing effect. We conclude that the SE does not depend on MTL integrity. We suggest that the early frontal signal at 200–300 ms after immediate picture repetition may serve as a direct biomarker of MTL integrity that may be useful in the early stages of diseases like Alzheimer's.     

The medial temporal lobes distinguish between within‐item and item‐context relations during autobiographical memory retrieval

During autobiographical memory retrieval, the medial temporal lobes (MTL) relate together multiple event elements, including object (within‐item relations) and context (item‐context relations) information, to create a cohesive memory. There is consistent support for a functional specialization within the MTL according to these relational processes, much of which comes from recognition memory experiments. In this study, we compared brain activation patterns associated with retrieving within‐item relations (i.e., associating conceptual and sensory‐perceptual object features) and item‐context relations (i.e., spatial relations among objects) with respect to naturalistic autobiographical retrieval. We developed a novel paradigm that cued participants to retrieve information about past autobiographical events, non‐episodic within‐item relations, and non‐episodic item‐context relations with the perceptuomotor aspects of retrieval equated across these conditions. We used multivariate analysis techniques to extract common and distinct patterns of activity among these conditions within the MTL and across the whole brain, both in terms of spatial and temporal patterns of activity. The anterior MTL (perirhinal cortex and anterior hippocampus) was preferentially recruited for generating within‐item relations later in retrieval whereas the posterior MTL (posterior parahippocampal cortex and posterior hippocampus) was preferentially recruited for generating item‐context relations across the retrieval phase. These findings provide novel evidence for functional specialization within the MTL with respect to naturalistic memory retrieval. © 2015 Wiley Periodicals, Inc.     

Structure and function of medial temporal and posteromedial cortices in early Alzheimer's disease

Medial temporal lobe (MTL) atrophy and posteromedial cortical hypometabolism are consistent imaging findings in Alzheimer's disease (AD). As the MTL memory structures are affected early in the course of AD by neurofibrillary tangle pathology, the posteromedial metabolic abnormalities have been postulated to represent remote effects of MTL alterations. In this study, we investigated with functional MRI (fMRI) the structure-function relationship between the MTL and posteromedial regions, including the retrosplenial, posterior cingulate and precuneal cortices, in 21 older controls (OCs), 18 subjects with amnestic mild cognitive impairment (MCI) and 16 AD patients during a word list learning task. In the voxel-based morphometric and volumetric analyses, the MCI subjects showed smaller entorhinal volume than OCs (P = 0.0001), whereas there was no difference in the hippocampal or posteromedial volume. AD patients, as compared with MCI patients, showed pronounced loss of volume in the entorhinal (P = 0.0001), hippocampal (P = 0.01) and posteromedial (P = 0.001) regions. The normal pattern of posteromedial fMRI task-induced deactivation during active encoding of words was observed bilaterally in the OCs, but only in restricted unilateral left posteromedial areas in the MCI and AD patients. Across all subjects, more extensive impairment of the retrosplenial and posterior cingulate function was significantly related to smaller entorhinal (P = 0.001) and hippocampal (P = 0.0002) volume. These findings demonstrate that entorhinal atrophy and posteromedial cortical dysfunction are early characteristics of prodromal AD, and precede and/or overwhelm atrophy of the hippocampus and posteromedial cortices. Disturbances in posteromedial cortical function are associated with morphological changes in the MTL across the continuum from normal aging to clinical AD.     

Potentials evoked in human and monkey medial temporal lobe during auditory and visual oddball paradigms.

Event-related potentials (ERPs) were recorded from epileptic patients with electrodes chronically implanted in the medial temporal lobe (MTL) and other intracranial locations, and from monkeys with epidural, transcortical, and MTL electrodes. For both humans and monkeys, the eliciting events consisted of trains of auditory or visual stimuli in which a random 10-20% deviated in pitch or pattern from the remaining stimuli. The distribution of ERPs elicited by the rare (oddball) stimuli in both species was similar, consisting of a P3 recorded from the scalp or cortical surface and a slightly later, but temporally overlapping, focal negativity in the hippocampus and nearby MTL structures. The similarity between the patterns of ERPs in humans and monkeys establishes the feasibility of studying the electrogenesis of P3-like activity with detailed intracranial recordings in an animal model. The data also establish that the MTL ERPs in human patients represent a normal neurophysiological process unrelated to epilepsy.     

Memory fMRI lateralizes temporal lobe epilepsy.

BACKGROUND: The assessment of mesial temporal lobe (MTL) function is important for the diagnosis and treatment of temporal lobe epilepsy (TLE) and other brain diseases. Declarative memory depends on the integrity of the MTL region. OBJECTIVE: To investigate hemispheric asymmetries of MTL activity in patients with symptomatic TLE. METHODS: With use of blood oxygenation level-dependent fMRI, hemispheric asymmetries in MTL activation of 30 individual patients with refractory symptomatic TLE and 17 healthy control subjects were studied. Activation was induced by a task employing mental navigation and recall of landmarks based on the retrieval of individually familiar visuospatial knowledge. RESULTS: The study demonstrated that the memory task used reliably activated MTL structures in individual control subjects and patients with refractory TLE including children, older subjects, and patients with low formal IQ. Interhemispheric differences in MTL activation lateralized the side of seizure onset in 90% of patients with symptomatic unilateral TLE. In contrast, healthy control subjects did not show a systematic asymmetry of MTL activation. Correlations between MTL activation and neuropsychological measures suggest that the fMRI-detectable MTL changes were specifically related to memory rather than to memory-independent visuospatial abilities. CONCLUSION: fMRI of memory-induced MTL activation lateralizes the side of seizure onset in patients with refractory symptomatic TLE and may provide complementary information for presurgical evaluation.     

Medial temporal lobe structure and cognition in individuals with schizophrenia and in their non-psychotic siblings

Medial temporal lobe (MTL) structures play a central role in episodic memory. Prior studies suggest that individuals with schizophrenia have deficits in episodic memory as well as structural abnormalities of the medial temporal lobe (MTL). While correlations have been reported between MTL volume loss and episodic memory deficits in such individuals, it is not clear whether such correlations reflect the influence of the disease state or of underlying genetic influences that might contribute to risk. We used high resolution magnetic resonance imaging and probabilistic algorithms for image analysis to determine whether MTL structure, episodic memory performance and the relationship between the two differed among groups of 47 healthy control subjects, 50 control siblings, 39 schizophrenia subjects, and 33 siblings of schizophrenia subjects. High-dimensional large deformation brain mapping was used to obtain volume measures of the hippocampus. Cortical distance mapping was used to obtain volume and thickness measures of the parahippocampal gyrus (PHG) and its substructures: the entorhinal cortex (ERC), the perirhinal cortex (PRC), and the parahippocampal cortex (PHC). Neuropsychological data was used to establish an episodic memory domain score for each subject. Both schizophrenia subjects and their siblings displayed abnormalities in episodic memory performance. Siblings of individuals with schizophrenia, and to a lesser extent, individuals with schizophrenia themselves, displayed abnormalities in measures of MTL structure (volume loss or cortical thinning) as compared to control groups. Further, we observed correlations between structural measures and memory performance in both schizophrenia subjects and their siblings, but not in their respective control groups. These findings suggest that disease-specific genetic factors present in both patients and their relatives may be responsible for correlated abnormalities of MTL structure and memory impairment. The observed attenuated effect of such factors on MTL structure in individuals with schizophrenia may be due to non-genetic influences related to the development and progression of the disease on global brain structure and cognitive processing.     

Rapid memory stabilization by transient theta coherence in the human medial temporal lobe

Presenting stimuli again after presentation of intervening stimuli improves their retention, an effect known as the spacing effect. However, using event‐related potentials (ERPs), we had observed that immediate, in comparison to spaced, repetition of pictures induced a positive frontal potential at 200–300 ms. This potential appeared to emanate from the left medial temporal lobe (MTL), a structure critical for memory consolidation. In this study, we tested the behavioral relevance of this signal and explored functional connectivity changes during picture repetition. We obtained high‐density electroencephalographic recordings from 14 healthy subjects performing a continuous recognition task where pictures were either repeated immediately or after 9 intervening items. Conventional ERP analysis replicated the positive frontal potential emanating from the left MTL at 250–350 ms in response to immediately repeated stimuli. Connectivity analysis showed that this ERP was associated with increased coherence in the MTL region—left more that right—in the theta‐band (3.5–7 Hz) 200–400 ms following immediate, but not spaced, repetition. This increase was stronger in subjects who better recognized immediately repeated stimuli after 30 min. These findings indicate that transient theta‐band synchronization between the MTL and the rest of the brain at 200–400 ms reflects a memory stabilizing signal. © 2015 Wiley Periodicals, Inc.