Martin Roy C, Kretzmer Tracy, Palmer Cheryl, Sawrie Stephen, Knowlton Robert, Faught Edward, Morawetz Richard, Kuzniecky Ruben
Department of Neurology, UAB Epilepsy Center, Birmingham, AL 35294, USA.
Arch Neurol. 2002 Dec;59(12):1895-901. doi: 10.1001/archneur.59.12.1895.
Previous investigations indicate low risk for memory loss following anterior temporal lobectomy (ATL) in patients with severe hippocampal sclerosis (HS) compared with patients with mild HS. However, these conclusions have been established primarily with group-level analyses.
To investigate individual base rate risk for verbal memory loss following ATL in patients who have pathologically verified mild, moderate, or severe HS.
One hundred fifteen patients with unilateral temporal lobe epilepsy (68 with left-sided and 47 with right-sided epilepsy) were included. Acquisition, retrieval, and recognition components of verbal memory, as measured by the California Verbal Learning Test, were assessed before and after ATL. Postoperatively, the degree of neuronal loss and reactive gliosis of the hippocampus was assessed via a 3-tiered rating system establishing mild, moderate, and severe pathologic features. Patients with preoperative magnetic resonance imaging-based evidence of lesions outside the mesial temporal area (side of surgical resection) were excluded.
Neither seizure laterality nor severity of HS was associated with preoperative verbal memory performance. Postoperatively, the left-sided ATL group demonstrated significant decline across the acquisition (P<.01), retrival (P<.001), and recognition (P<.001) verbal memory components compared with the right-sided ATL group. Patients who underwent left-sided ATL and had mild HS displayed the largest magnitude and percentage proportion of postoperative decline across all verbal memory components. However, 28 (48%) of the 58 patients who underwent left-sided ATL and who had moderate and severe HS displayed statistically reliable declines on retrieval aspects of verbal memory. Most patients undergoing right-sided ATL, regardless of the extent of hippocampal pathologic features, displayed no postoperative memory change.
Substantial individual heterogeneity of memory outcome exists across groups of patients undergoing ATL, with various degrees of pathologically verified HS. Patients undergoing left-sided ATL who have mild HS seem at greatest risk for broad-spectrum verbal memory decline. However, when examining outcome on a patient-by-patient basis, many patients undergoing left-sided ATL who have moderate to severe HS were also vulnerable to verbal memory loss. This risk seems selective to a retrieval-based aspect of verbal memory.
先前的研究表明，与轻度海马硬化（HS）患者相比，重度海马硬化患者接受前颞叶切除术（ATL）后记忆丧失风险较低。然而，这些结论主要是通过组水平分析得出的。
研究经病理证实为轻度、中度或重度HS的患者接受ATL后言语记忆丧失的个体基础风险率。
纳入115例单侧颞叶癫痫患者（68例左侧癫痫，47例右侧癫痫）。通过加利福尼亚言语学习测试评估ATL前后言语记忆的获取、检索和识别成分。术后，通过三级评分系统评估海马神经元丢失和反应性胶质增生的程度，确定轻度、中度和重度病理特征。排除术前基于磁共振成像有内侧颞叶区域（手术切除侧）以外病变证据的患者。
癫痫发作的侧别和HS的严重程度均与术前言语记忆表现无关。术后，与右侧ATL组相比，左侧ATL组在言语记忆的获取（P<0.01）、检索（P<0.001）和识别（P<0.001）成分方面均有显著下降。接受左侧ATL且患有轻度HS的患者在所有言语记忆成分上术后下降的幅度和百分比最大。然而，58例接受左侧ATL且患有中度和重度HS的患者中，有28例（48%）在言语记忆的检索方面表现出统计学上可靠的下降。大多数接受右侧ATL的患者，无论海马病理特征的程度如何，术后记忆均无变化。
在接受ATL且有不同程度病理证实HS的患者组中，记忆结果存在显著的个体异质性。患有轻度HS且接受左侧ATL的患者似乎发生广谱言语记忆下降的风险最大。然而，在逐例检查结果时，许多患有中度至重度HS且接受左侧ATL的患者也易发生言语记忆丧失。这种风险似乎仅限于言语记忆基于检索的方面。
