Hermann Bruce P, Seidenberg Michael, Dow Christian, Jones Jana, Rutecki Paul, Bhattacharya Abhik, Bell Brian
Matthews Neuropsychology Lab, Department of Neurology, University of Wisconsin-Madison, 53792, USA.
Ann Neurol. 2006 Jul;60(1):80-7. doi: 10.1002/ana.20872.
First, to determine whether patients with chronic temporal lobe epilepsy have a different cognitive trajectory compared to control subjects over a prospective 4-year interval; second, to determine the proportion of patients who exhibit abnormal cognitive change and their profile of demographic, clinical epilepsy, and baseline quantitative magnetic resonance imaging characteristics; and third, to determine the most vulnerable cognitive domains.
Participants with chronic temporal lobe epilepsy (n = 46) attending a tertiary referral clinic and healthy control subjects (n = 65) underwent neuropsychological assessment and reevaluation 4 years later. Analysis of test-retest patterns identified individual patients with adverse cognition outcomes.
The prospective cognitive trajectory of patients with chronic temporal lobe epilepsy differs from age- and sex-matched healthy control subjects. Lack of practice effects is common, but frank adverse cognitive outcomes are observed in a subset of patients (20-25%), particularly in vulnerable cognitive domains that include memory. Cognitive declines are associated with a profile of abnormalities in baseline quantitative magnetic resonance volumetrics, lower baseline intellectual capacity, as well as longer duration of epilepsy and older chronological age.
Cognitive prognosis is poor for a subset of patients characterized by chronicity of epilepsy, older age, lower intellectual ability, and more baseline abnormalities in quantitative magnetic resonance volumetrics.
第一，确定慢性颞叶癫痫患者与对照受试者相比在4年的前瞻性随访期间是否有不同的认知轨迹；第二，确定出现认知异常变化的患者比例及其人口统计学、临床癫痫和基线定量磁共振成像特征；第三，确定最易受影响的认知领域。
在三级转诊诊所就诊的慢性颞叶癫痫患者（n = 46）和健康对照受试者（n = 65）接受了神经心理学评估，并在4年后进行了重新评估。通过分析重测模式确定认知结果不良的个体患者。
慢性颞叶癫痫患者的前瞻性认知轨迹与年龄和性别匹配的健康对照受试者不同。缺乏练习效应很常见，但在一部分患者（20% - 25%）中观察到明显的不良认知结果，特别是在包括记忆在内的易受影响的认知领域。认知能力下降与基线定量磁共振体积测量的异常情况、较低的基线智力水平、较长的癫痫病程以及较大的实际年龄有关。
对于以癫痫慢性化、年龄较大、智力能力较低以及定量磁共振体积测量存在更多基线异常为特征的一部分患者，认知预后较差。
