Allegri R F, Drake M, Thomson A
Laboratorio de Neurología del Comportamiento, Hospital Británico, Buenos Aires, Argentina.
Rev Neurol. 1999;29(12):1160-3.
Cognitive dysfunction in mesial temporal lobe epilepsy (MTLE) is still a controversial subject. Since refractory MTLE is considered a surgically remediable syndrome, the neuropsychological assessment to establish the presence of cognitive impairment in the surgical candidate became an important issue, given its possible relevance in predicting outcome after surgery.
Our aim was to study the cognitive profile of MTLE patients and to correlate the cognitive status with the presence or absence of hippocampal sclerosis.
Fifty patients with MTLE and 20 control subjects were matched by age and educational level. All subjects were studied with EEG, MRI scan, SPECT, and a comprehensive neuropsychological battery that included measures of language (naming and verbal fluency), visuospatial function (Block Design Test), memory (Signoret Battery), attention (Digit Span and Trail Making Test A) and executive abilities (Trail Making Test B and Wisconsin Card Sorting Test).
MTLE patients, particularly those with hippocampal sclerosis, were found to have a considerable lower performance in learning (p < 0.01), naming (p < 0.05), attention (p < 0.05) and executive functions (p < 0.001). Among the MTLE patients a considerable number of subjects showed results within the normal range (n = 27) while others evidenced laterality specific cognitive impairments (n = 13). Material specific memory effects were seen in some patients but not all.
Our results showed the neuropsychological heterogeneity of temporal lobe epilepsy, thus ruling out the existence of a single specific cognitive pattern of impairment in all MTLE patients, and suggesting the need of a thorough pre-surgical neuropsychological evaluation to be used with post-surgical prognosis purposes.
内侧颞叶癫痫（MTLE）中的认知功能障碍仍是一个有争议的话题。由于难治性MTLE被认为是一种可通过手术治疗的综合征，鉴于其在预测手术后结果方面的潜在相关性，对手术候选者进行神经心理学评估以确定是否存在认知障碍就成为了一个重要问题。
我们的目的是研究MTLE患者的认知概况，并将认知状态与海马硬化的存在与否相关联。
50例MTLE患者和20名对照受试者按年龄和教育水平进行匹配。所有受试者均接受脑电图、磁共振成像扫描、单光子发射计算机断层扫描以及一套综合神经心理测试，该测试包括语言（命名和言语流畅性）、视觉空间功能（积木设计测试）、记忆（西诺雷测试组）、注意力（数字广度和连线测验A）以及执行能力（连线测验B和威斯康星卡片分类测验）的测量。
发现MTLE患者，尤其是那些有海马硬化的患者，在学习（p < 0.01）、命名（p < 0.05）、注意力（p < 0.05）和执行功能（p < 0.001）方面表现明显较低。在MTLE患者中，相当数量的受试者结果在正常范围内（n = 27），而其他受试者则表现出特定于一侧的认知障碍（n = 13）。在一些患者中观察到了材料特异性记忆效应，但并非所有患者都如此。
我们的结果显示了颞叶癫痫的神经心理异质性，从而排除了所有MTLE患者中存在单一特定认知障碍模式的可能性，并表明需要进行全面的术前神经心理学评估以用于术后预后目的。
