Fuerst D, Shah J, Kupsky W J, Johnson R, Shah A, Hayman-Abello B, Ergh T, Poore Q, Canady A, Watson C
Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI 48201, USA.
Neurology. 2001 Jul 24;57(2):184-8. doi: 10.1212/wnl.57.2.184.
To examine the relationships between age at onset and duration of seizure disorder with severity of hippocampal sclerosis (HS) and cognitive functioning in patients with HS and unilateral temporal lobe epilepsy.
Twenty-six subjects had left temporal lobe seizure onset; 20 had right temporal onset. Measures were age at seizure onset, duration of seizure disorder divided by age (seizure duration), history of febrile convulsion (FC), ratio of the smaller hippocampal volume to the larger (HF) as determined by volumetric MRI, and pathologic HS grade.
Results showed that pathologic HS grade and HF were positively related to seizure duration, and negatively related to seizure onset. When subjects were divided into onset prior to age 10 versus later, subjects with earlier onset had higher mean pathologic HS grade and smaller (more asymmetric) mean HF. When subjects were divided into seizure duration <0.5 (i.e., less than half current lifetime) vs greater, subjects with seizure duration > or =0.5 had higher mean pathologic HS grade and lower mean HF. There was also evidence for earlier age at seizure onset and longer seizure duration being associated with worse performance on neuropsychological measures. FC was not related to either seizure duration or age at seizure onset, but patients with a history of FC showed higher pathologic HS grade and lower HF. A history of FC was not related to cognitive functioning.
Unilateral HS patients with earlier seizure onset and longer duration of epilepsy have more severe HS and greater hippocampal volume asymmetry. This suggests that HS may be a progressive disorder with risk for cognitive dysfunction.
研究海马硬化（HS）患者及单侧颞叶癫痫患者的癫痫起病年龄、癫痫发作持续时间与HS严重程度及认知功能之间的关系。
26名受试者癫痫发作起始于左侧颞叶；20名起始于右侧颞叶。测量指标包括癫痫发作起始年龄、癫痫发作持续时间除以年龄（发作时长）、热性惊厥（FC）病史、通过容积性MRI测定的较小海马体积与较大海马体积之比（HF）以及病理HS分级。
结果显示，病理HS分级和HF与癫痫发作持续时间呈正相关，与癫痫发作起始年龄呈负相关。当将受试者分为10岁之前起病和之后起病两组时，起病较早的受试者平均病理HS分级较高，平均HF较小（更不对称）。当将受试者分为癫痫发作持续时间<0.5（即小于当前寿命的一半）和≥0.5两组时，癫痫发作持续时间≥0.5的受试者平均病理HS分级较高，平均HF较低。也有证据表明癫痫发作起始年龄较早和癫痫发作持续时间较长与神经心理学测量表现较差有关。FC与癫痫发作持续时间或癫痫发作起始年龄均无关，但有FC病史的患者病理HS分级较高，HF较低。FC病史与认知功能无关。
癫痫发作起始较早且癫痫持续时间较长的单侧HS患者HS更严重，海马体积不对称性更大。这表明HS可能是一种具有认知功能障碍风险的进行性疾病。
