Helmstaedter Cristoph, Loer Barbara, Wohlfahrt Rainer, Hammen Axel, Saar Josef, Steinhoff Bernhard J, Quiske Ansgar, Schulze-Bonhage Andreas
University Clinic of Epileptology Bonn, Bonn, Germany.
Epilepsy Behav. 2008 Apr;12(3):402-9. doi: 10.1016/j.yebeh.2007.11.010. Epub 2007 Dec 26.
Epilepsy surgery is a valuable treatment option for patients with pharmacoresistant epilepsy, but seizure freedom is often achieved at the cost of cognitive impairments caused by surgery. The aim of this study was to investigate the short-term effects of cognitive rehabilitation on memory outcome after temporal lobe epilepsy surgery.
Two groups of patients who underwent temporal lobe resection, one followed (n=55) and one not followed (n=57) by postoperative rehabilitation, were evaluated with respect to memory and attention before and 3 months after temporal lobe surgery. The groups came from different epilepsy centers, but were largely matched with respect to age, sex, type of surgery, and seizure outcome.
After surgery, 78% of the patients were seizure-free. Repeated-measures MANOVA revealed a significant "side x surgery" effect on verbal recognition and a "rehabilitation x surgery" effect on verbal learning and recognition. There were no effects for loss in verbal delayed recall or figural memory. Detailed analyses indicated gains as a result of rehabilitation, particularly after right temporal lobe surgery. Attention generally improved. The risk of manifesting losses in verbal memory was about four times higher without than with rehabilitation.
Rehabilitation can counteract the verbal memory decline that is normally seen after temporal lobe resection. Its positive effects were evident particularly with respect to the more cortically associated aspects of verbal learning rather than to the mesial aspects of long-term consolidation/retrieval. Figural memory was not affected at all, and attention improved independent of rehabilitation. Interestingly, left temporal lobe-resected patients, who were most in need of an efficacious rehabilitation, profited less than right temporal lobe-resected patients, indicating that left-sided surgery may reduce the capacity needed for efficient training of verbal memory. Thus, rehabilitation has a positive effect on memory outcome, but its usefulness for risk groups and the question of whether training should be performed after or possibly before surgery are debatable. Further research should also address different interventions, longer-term outcome, and the carryover effects on everyday functioning.
癫痫手术是药物难治性癫痫患者的一种重要治疗选择，但癫痫发作的缓解往往是以手术引起的认知障碍为代价的。本研究的目的是调查认知康复对颞叶癫痫手术后记忆结果的短期影响。
两组接受颞叶切除术的患者，一组术后接受康复治疗（n = 55），另一组未接受康复治疗（n = 57），在颞叶手术前和术后3个月对其记忆和注意力进行评估。两组来自不同的癫痫中心，但在年龄、性别、手术类型和癫痫发作结果方面基本匹配。
手术后，78%的患者癫痫发作得到缓解。重复测量多变量方差分析显示，在言语识别方面有显著的“侧别×手术”效应，在言语学习和识别方面有“康复×手术”效应。言语延迟回忆或图形记忆方面没有影响。详细分析表明，康复治疗有改善效果，特别是在右侧颞叶手术后。注意力总体上有所改善。未接受康复治疗的患者出现言语记忆减退的风险比接受康复治疗的患者高约四倍。
康复治疗可以抵消颞叶切除术后通常出现的言语记忆下降。其积极作用在言语学习中与皮质联系更紧密的方面尤为明显，而不是在长期巩固/检索的内侧方面。图形记忆完全没有受到影响，注意力的改善与康复治疗无关。有趣的是，最需要有效康复治疗的左侧颞叶切除患者比右侧颞叶切除患者获益少，这表明左侧手术可能会降低有效训练言语记忆所需的能力。因此，康复治疗对记忆结果有积极影响，但其对风险人群的有效性以及训练应在手术后还是可能在手术前进行的问题仍存在争议。进一步的研究还应涉及不同的干预措施、长期结果以及对日常功能的延续效应。
