Baxendale Sallie
Department of Clinical and Experimental Epilepsy, Institute of Neurology UCL, Queen Square, London, UK.
Epilepsy Behav. 2008 May;12(4):592-9. doi: 10.1016/j.yebeh.2007.12.015. Epub 2008 Mar 4.
Famous historical cases and current clinical experience clearly indicate that the success of epilepsy surgery cannot be judged with the basic algorithm "fewer seizures = better outcome." Many factors combine and entwine with the experience of medically intractable seizures to create associated patterns of behavior and cognition. Obtaining freedom from seizures does not automatically undo the historical tangle of these salient factors, many of which remain or are exacerbated after surgery. This review examines the preoperative, perioperative, and postoperative factors that influence postoperative cognition and behavior in adult patients with temporal lobe epilepsy. Consistent findings from group studies have long masked the considerable individual variations in cognitive and behavioral outcomes following surgery. Although more recent multivariate studies provide useful clinical data for prospective surgical candidates, comprehensive long-term follow-up studies are rare. We have certainly become more proficient at measuring both cognitive and behavioral outcomes following surgery, although the ecological validity of many follow-up measures, particularly in the cognitive domain, remains low. A reliance on test scores can mask significant differences in strategy, which can also be used as a sign of lateralized dysfunction. A shift away from the "can do versus can't do" approach to the assessment of cognitive strategies may hold the key to more meaningful pre- and postoperative cognitive assessments from the patient's perspective. Emergent functional imaging paradigms show much promise in this regard. A renewed focus on cognitive strategies may also be useful in planning postoperative rehabilitation programs. New directions for outcome research in epilepsy surgery are suggested with an emphasis on a patient-centered approach.
著名的历史病例和当前的临床经验清楚地表明，不能用“发作次数减少=更好的结果”这一基本算法来判断癫痫手术的成功与否。许多因素与药物难治性癫痫的经历相互交织，形成相关的行为和认知模式。摆脱癫痫发作并不能自动消除这些显著因素的历史纠葛，其中许多因素在手术后仍然存在或加剧。本综述探讨了影响成年颞叶癫痫患者术后认知和行为的术前、术中和术后因素。长期以来，群体研究的一致结果掩盖了手术后认知和行为结果的巨大个体差异。尽管最近的多变量研究为潜在的手术候选人提供了有用的临床数据，但全面的长期随访研究却很少见。我们在测量手术后的认知和行为结果方面肯定变得更加熟练了，尽管许多随访措施的生态效度，尤其是在认知领域，仍然很低。依赖测试分数可能会掩盖策略上的显著差异，而策略差异也可以用作功能偏侧化障碍的标志。从“能做与不能做”的评估方法转向评估认知策略，可能是从患者角度进行更有意义的术前和术后认知评估的关键。新兴的功能成像范式在这方面显示出很大的前景。重新关注认知策略也可能有助于规划术后康复计划。本文提出了癫痫手术结果研究的新方向，强调以患者为中心的方法。
