Neuropsychology, Department of Epileptology, University Hospital of Bonn, Sigmund Freud Strasse 25, Bonn, Germany.
Brain. 2009 Oct;132(Pt 10):2822-30. doi: 10.1093/brain/awp182. Epub 2009 Jul 27.
To what degree does the so-called 'initial hit' of the brain versus chronic epilepsy contribute towards the memory impairment observed in chronic temporal lobe epilepsy (TLE) patients? We examined cross-sectional comparisons of age-related regressions of verbal learning and memory in 1156 patients with chronic TLE (age range 6-68 years, mean epilepsy onset 14 +/- 11 years) versus 1000 healthy control subjects (age range 6-80 years) and tested the hypothesis that deviations of age regressions (i.e. slowed rise, accelerated decline) will reveal critical phases during which epilepsy interferes with cognitive development. Patients were recruited over a 20-year period at the Department of Epileptology, University of Bonn. Healthy subjects were drawn from an updated normative population of the Verbaler Lern- und Merkfähigkeitstest, the German pendant to the Rey Auditory Verbal learning Test. A significant divergence of age regressions indicates that patients fail to build up adequate learning and memory performance during childhood and particularly during adolescence. The learning peak (i.e. crossover into decline) is seen earlier in patients (at about the age of 16-17 years) than for controls (at about the age of 23-24 years). Decline in performance with ageing in patients and controls runs in parallel, but due to the initial distance between the groups, patients reach very poor performance levels much earlier than controls. Patients with left and right TLEs performed worse in verbal memory than controls. In addition, patients with left TLE performed worse than those with right TLE. However, laterality differences were evident only in adolescent and adult patients, and not (or less so) in children and older patients. Independent of age, hippocampal sclerosis was associated with poorer performance than other pathologies. The results indicate developmental hindrance plus a negative interaction of cognitive impairment with mental ageing, rather than a progressively dementing decline in chronic TLE patients. During childhood, and even more so during the decade following puberty, the critical phases for establishing episodic memory deficits appear. This increases the risk of premature 'dementia' later on, even in the absence of an accelerated decline. Material specific verbal memory impairment in left TLE is a characteristic of the mature brain and seems to disappear at an older age. The findings suggest that increased attention is to be paid to the time of epilepsy onset and thereafter. Early control of epilepsy is demanded to counteract developmental hindrance and damage at a younger age.
在慢性颞叶癫痫（TLE）患者中观察到的记忆障碍程度，与所谓的大脑“初始冲击”和慢性癫痫相比，哪个程度更大？我们对 1156 例慢性 TLE 患者（年龄范围 6-68 岁，平均癫痫发作年龄 14+/-11 岁）和 1000 例健康对照者（年龄范围 6-80 岁）进行了年龄相关的语言学习和记忆的横断面比较，以检验以下假设：即年龄回归的偏差（即上升缓慢，下降加速）将揭示出癫痫干扰认知发展的关键阶段。患者是在波恩大学癫痫科的 20 年期间招募的。健康受试者来自德国 Verbaler Lern- und Merkfähigkeitstest 的最新标准人群，这是 Rey 听觉言语学习测试的德语对应物。年龄回归的显著差异表明，患者在儿童期，特别是青春期期间无法建立足够的学习和记忆能力。学习高峰期（即进入衰退期的交叉点）在患者中出现较早（约 16-17 岁），而在对照组中较晚（约 23-24 岁）。患者和对照组的年龄增长过程中的表现下降是平行的，但由于两组之间的初始距离，患者比对照组更早达到非常差的表现水平。左颞叶和右颞叶癫痫患者的言语记忆比对照组差。此外，左颞叶癫痫患者的表现比右颞叶癫痫患者差。然而，只有在青少年和成年患者中，而不是在儿童和老年患者中，才会出现侧别差异（或差异较小）。无论年龄大小，海马硬化与较差的表现相关，而不是慢性 TLE 患者进行性痴呆的衰退。在儿童期，甚至在青春期后的十年中，出现了建立发作性记忆缺陷的关键阶段。这增加了以后提前出现“痴呆”的风险，即使没有加速下降。左颞叶癫痫患者的特定于材料的言语记忆损伤是成熟大脑的特征，似乎在年龄较大时消失。这些发现表明，需要更加关注癫痫发作的时间和此后的时间。需要早期控制癫痫以在较年轻时对抗发育障碍和损害。
