Jokeit H, Ebner A, Arnold S, Schüller M, Antke C, Huang Y, Steinmetz H, Seitz R J, Witte O W
Bethel Epilepsy Center, Clinic Mara I, Epilepsy Surgery Program, Maraweg 21, D-33617 Bielefeld, Germany.
J Neurol. 1999 Oct;246(10):926-33. doi: 10.1007/s004150050484.
In refractory temporal lobe epilepsy (TLE) temporal lobe structures and functions are continuously or intermittently affected by abnormal brain electrical events, noxious neurochemical agents, and metabolic disturbances. There is conflicting evidence regarding the relationship between the duration of refractory mesial TLE and quantitative measures of temporal lobe functions and volumes of the hippocampi. Twenty patients (aged 28 +/- 7 years, 14 males) with an initial precipitating injury before the age of 5 years were subjected to high-resolution magnetic resonance imaging, fluoro-2-deoxy-d-glucose positron-emission tomography (PET), and the Wada test. We investigated whether the duration of unilateral refractory TLE (12 left, 8 right) affects hippocampal volume, glucose metabolism, or Wada hemispheric memory performance. Ipsilateral to the epileptogenic zone the hippocampal volume, metabolism, and Wada hemispheric memory performance were reduced compared to the corresponding contralateral measures. The duration of epilepsy controlled for age at investigation, side of seizure origin, underlying cause, and sex were negatively correlated with ipsi- and contralateral hippocampal volume, hippocampal metabolism, and Wada hemispheric memory performance. Moreover, ipsilateral Wada hemispheric memory performance and contralateral hippocampal glucose metabolism were correlated with the frequency of habitual seizures. Refractory TLE seems to be associated with a slow but ongoing bilateral temporal lobe damage. These cross-sectional results require verification by longitudinal studies carried out over a period of more than two decades.
在难治性颞叶癫痫（TLE）中，颞叶结构和功能持续或间歇性地受到异常脑电活动、有害神经化学物质及代谢紊乱的影响。关于难治性内侧颞叶癫痫的病程与颞叶功能及海马体积的定量测量之间的关系，证据存在矛盾。对20例5岁前有初始诱发损伤的患者（年龄28±7岁，男性14例）进行了高分辨率磁共振成像、氟代脱氧葡萄糖正电子发射断层扫描（PET）及Wada试验。我们研究了单侧难治性TLE（左侧12例，右侧8例）的病程是否会影响海马体积、葡萄糖代谢或Wada半球记忆表现。与相应对侧测量结果相比，致痫区同侧的海马体积、代谢及Wada半球记忆表现均降低。在控制了研究时的年龄、癫痫发作起始侧、潜在病因及性别后，癫痫病程与同侧及对侧海马体积、海马代谢及Wada半球记忆表现呈负相关。此外，同侧Wada半球记忆表现及对侧海马葡萄糖代谢与习惯性癫痫发作频率相关。难治性TLE似乎与缓慢但持续的双侧颞叶损伤有关。这些横断面结果需要通过超过二十年的纵向研究来验证。
