Helmstaedter Christoph, Kurthen Martin, Lux Silke, Reuber Markus, Elger Christian Erich
University Clinic of Epileptology, Bonn, Germany.
Ann Neurol. 2003 Oct;54(4):425-32. doi: 10.1002/ana.10692.
It remains unclear whether uncontrolled epilepsy causes mental decline. This longitudinal study contrasts change of memory and nonmemory functions in 147 surgically and 102 medically treated patients with temporal lobe epilepsy. All participants were evaluated at baseline (T1) and after 2 to 10 years (T3). Surgical patients underwent additional testing 1 year postoperatively (T2). Data were analyzed on an individual and group level. Sixty-three percent of the surgical and 12% of the medically treated patients were seizure-free at T3. Fifty percent of the medically treated and 60% of the surgical patients showed significant memory decline at T3 with little change in nonmemory functions (difference not significant). Surgery anticipated the decline seen in the medically treated group and exceeded it when surgery was performed on the left, or if seizures continued postoperatively. Seizure-free surgical patients showed recovery of nonmemory functions at T2 (p < 0.001) and of memory functions at T3 (T3, p = 0.03). Multiple regression indicated retest interval, seizure control, and mental reserve capacity as predictors of performance changes. In addition, psychosocial outcome was better when seizures were controlled. In conclusion, chronic temporal lobe epilepsy is associated with progressive memory impairment. Surgery, particularly if unsuccessful, accelerates this decline. However, memory decline may be stopped and even reversed if seizures are fully controlled.
目前尚不清楚未得到控制的癫痫是否会导致智力衰退。这项纵向研究对比了147例接受手术治疗和102例接受药物治疗的颞叶癫痫患者的记忆和非记忆功能变化。所有参与者在基线期（T1）以及2至10年后（T3）接受评估。手术患者在术后1年（T2）接受额外测试。对个体和组水平的数据进行分析。在T3时，63%的手术患者和12%的药物治疗患者无癫痫发作。50%的药物治疗患者和60%的手术患者在T3时出现显著的记忆衰退，而非记忆功能变化不大（差异不显著）。手术预期了药物治疗组出现的衰退，并且当在左侧进行手术或术后癫痫仍持续时，衰退程度超过药物治疗组。无癫痫发作的手术患者在T2时非记忆功能恢复（p<0.001），在T3时记忆功能恢复（T3，p = 0.03）。多元回归表明复测间隔、癫痫控制和心理储备能力是表现变化的预测因素。此外，癫痫得到控制时社会心理结果更好。总之，慢性颞叶癫痫与进行性记忆损害相关。手术，尤其是如果手术不成功，会加速这种衰退。然而，如果癫痫得到完全控制，记忆衰退可能会停止甚至逆转。
