前颞叶切除术或选择性海马杏仁核切除术治疗顽固性内侧颞叶癫痫患者神经心理功能改变的研究

目的 探讨前颞叶切除术(ATL)或选择性海马杏仁核切除术(SAH)治疗顽固性内侧颞叶癫痫(MTLE)患者神经心理功能的改变情况。方法 选择2010年1月-2014年12月来本院接受ATL或SAH治疗的MTLE患者60例; 根据MTLE手术部位分为左颞部MTLE组(n=35)和右颞部MTLE组(n=25); 利用神经心理功能评分系统(DST、VMPT、WMSLM、WMS视觉、BNT、视觉技能、Stroop、WCST、分类、VFT)对患者术前及术后1年神经心理功能进行评分,比较2组患者左右颞部手术前后神经心理测试及手术前后左右颞部神经心理测试差异。结果 60例MTLE患者中35例(58.33%)左颞部MTLE,25例(41.67%)右颞部MTLE; 2组患者在性别、年龄、手术方式、癫痫发作平均年龄、病程、术前WAIS评分方面无显著性差异(P>0.05); 2组患者左右颞部手术前后神经心理测试比较显示,右颞部MTLE组术后在最大学习得分、短时记忆得分、长时记忆得分、第5卡片时间、矫正、转换错误方面与术前比较有显著差异(P<0.05); 左颞部MTLE组术后在合计得分方面与术前比较有显著差异(P<0.05); 2组患者手术前后左右颞部神经心理测试比较显示,左颞部MTLE组在回忆得分、识别得分、短时记忆得分方面显著高于右颞部MTLE组(P<0.05)。结论 尽管ATL或SAH治疗顽固性MTLE患者会引起部分常见的认知副作用,但该手术治疗也可提高患者部分认知功能。

The study on neuropsychological function changes in patients with intractable mesial temporal lobe epilepsy by anterior temporal lobectomy or selective resection of hippocampal amygdala

ObjectiveTo investigate the changes of neuropsychological function in patients with intractable mesial temporal lobe epilepsy(MTLE)by anterior temporal lobectomy(ATL)and selective hippocampal amygdala resection(SAH).Methods 60 patients with intractable mesial temporal lobe epilepsy by ATL or SAH in our hospital from Jan 2010 to Dec 2014 were selected as study subjects.According to MTLE,the surgical sites were divided into left temporal MTLE group(n=35)and right temporal MTLE group(n=25).The scores of neuropsychological function scoring system(DST,VMPT,WMS,LM,WMS visual,BNT,visual skills,Stroop,WCST,classification,VFT)of neuropsychological function in patients before and after 1 years of operation were compared between comparison of pre- and postoperative neuropsychological test results of the patients for each side and comparison of the two sides for the pre- and postoperative neuropsychological test results.Results 35 of 60 MTLE cases(58.33%)had left temporal MTLE,while 25 of 60 MTLE cases(41.67%)had satisfactory temporal MTLE.There were no significant difference between the two groups in gender,age,mode of operation,average age of epilepsy,course of disease and preoperative WAIS score(P>0.05).Neuropsychological tests were compared between the two groups before and after the temporal surgery.In the right temporal MTLE group,there were significant differences in the maximum learning score,short-term memory score,long memory score,fifth card time,correction and conversion error(P<0.05),while in the left temporal MTLE group,the total score was significantly different from that before the operation(P<0.05).The results of psychological tests were compared between the two groups before and after the operation.It was found that in the left temporal MTLE group,the score of recall,identification and short-term memory were significantly higher than those in the right temporal MTLE group(P<0.05).Conclusion While epilepsy surgery was associated with some adverse cognitive changes,it might also improve some cognitive functions.