Gleissner U, Sassen R, Schramm J, Elger C E, Helmstaedter C
Department of Epileptology, University of Bonn, Bonn, Germany.
Brain. 2005 Dec;128(Pt 12):2822-9. doi: 10.1093/brain/awh597. Epub 2005 Jul 13.
The purpose of our study is to evaluate whether children recover better than adults from memory deficits as a consequence of temporal lobe surgery. We compared 3 and 12 month outcomes obtained in children and adults with medically refractory epilepsy. Each candidate underwent temporal lobe resection for seizure control and children were matched with regard to pathology, onset of epilepsy, side of surgery and type of surgery with adults (N = 30 for each group, mean age at surgery 13 versus 30 years). Three months after surgery, both left-resected groups displayed a significant decline in verbal learning capacity. During the following 9 months, only the children recovered and were able to reach their preoperative level 1 year after surgery. The left-resected adults remained, for the most part, on their low level and one year after surgery, they were still significantly worse than at the time of their preoperative examination. The right-resected adults experienced a deterioration in visual memory 1 year after surgery relative to the results of the short-term follow-up; the children improved. The children also had a better outcome with regard to attentional functions and, as a trend, a better seizure outcome (Engel Outcome I--1 year after surgery: 63% adults, 80% paediatric patients). Our neuropsychological data provide evidence of greater plasticity and compensational capacity in childhood. The results can be taken as a strong argument for early surgical intervention.
我们研究的目的是评估因颞叶手术导致记忆缺陷的儿童是否比成人恢复得更好。我们比较了患有药物难治性癫痫的儿童和成人在术后3个月和12个月时的情况。每位受试者都接受了颞叶切除术以控制癫痫发作，儿童在病理、癫痫发作起始、手术侧别和手术类型方面与成人进行了匹配（每组30例，手术时的平均年龄分别为13岁和30岁）。术后3个月，两组左侧切除的患者言语学习能力均显著下降。在接下来的9个月中，只有儿童恢复了，并且在术后1年能够达到术前水平。左侧切除的成人在很大程度上仍处于较低水平，术后1年，他们仍比术前检查时明显更差。右侧切除的成人在术后1年相对于短期随访结果，视觉记忆出现了恶化；而儿童有所改善。在注意力功能方面，儿童也有更好的结果，并且从趋势上看，癫痫发作的结果也更好（恩格尔结果I级——术后1年：成人63%，儿童患者80%）。我们的神经心理学数据证明了儿童期具有更大的可塑性和代偿能力。这些结果可以作为早期手术干预的有力论据。
