Rai Vinod K, Shukla Garima, Afsar Mohammad, Poornima Shivani, Pandey R M, Rai Neha, Goyal Vinay, Srivastava Achal, Vibha Deepti, Behari Madhuri
Department of Neurology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India.
Epilepsy Res. 2015 Jan;109:72-80. doi: 10.1016/j.eplepsyres.2014.09.031. Epub 2014 Oct 13.
Cognitive impairment has long been recognized as a co-morbidity or sequel to refractory epilepsy. This study was conducted to evaluate the degree and selectivity of involvement of memory, language and executive functions performance among patients with temporal (TLE) versus extratemporal epilepsy (ETLE).
We prospectively enrolled adolescent and adult patients with medically refractory focal epilepsy, who had undergone pre-surgical evaluation. Language, memory and executive function assessment was done using Western Aphasia Battery, PGI memory scale and battery of four executive function tests (trail making test A & B, digit symbol test, Stroop Task and verbal fluency test), respectively.
Among102 patients enrolled (TLE-59, ETLE-43), mean age of patients 23.0 4± 8.3 years, 83 (82%) had impairment of more than one cognitive domain and 21 (21%) had all three domains involved. Severely impaired memory scores were found in 8.6% patients with MTLE-HS, 8% of the rest of the patients with TLE and 7% patients with ETLE. The differences in the mean scores were also not found statistically significant (p=0.669). Naming impairment was the most common language abnormality, although all aphasia subscores were similar for the ETLE and TLE groups. Executive function impairment was the most common cognitive domain affected. Overall performance on executive function tests was found impaired in almost all patients of both groups without any significant inter-group difference, except on Trail-A test, which revealed better results in patients with mTLE-HS as compared to all other sub-groups.
Our study shows that impairment of memory, language and executive function is common among patients with drug refractory epilepsy. The most prevalent impairment is in executive function. There is no significant difference in the degree, prevalence or selectivity of impairment in either of the three domains, between the TLE versus ETLE groups.
认知障碍长期以来一直被认为是难治性癫痫的一种共病或后遗症。本研究旨在评估颞叶癫痫（TLE）与颞叶外癫痫（ETLE）患者在记忆、语言和执行功能方面受累的程度和选择性。
我们前瞻性纳入了接受过术前评估的青少年和成年药物难治性局灶性癫痫患者。分别使用西方失语成套测验、PGI记忆量表和四项执行功能测试组合（连线测验A和B、数字符号测验、斯特鲁普任务和语言流畅性测验）对语言、记忆和执行功能进行评估。
在纳入的102例患者中（TLE-59例，ETLE-43例），患者平均年龄为23.04±8.3岁，83例（82%）存在一个以上认知领域的损害，21例（21%）三个领域均受累。在海马硬化型内侧颞叶癫痫（mTLE-HS）患者中，8.6%的患者记忆评分严重受损，其余TLE患者中8%以及ETLE患者中7%存在严重受损。平均评分差异无统计学意义（p=0.669）。命名障碍是最常见的语言异常，尽管ETLE组和TLE组的所有失语亚评分相似。执行功能障碍是最常受累的认知领域。除了连线测验A，两组几乎所有患者的执行功能测试总体表现均受损，且组间无显著差异，在连线测验A中，mTLE-HS患者的表现优于所有其他亚组。
我们的研究表明，药物难治性癫痫患者中记忆、语言和执行功能障碍很常见。最普遍的障碍是执行功能障碍。TLE组和ETLE组在这三个领域中任何一个领域的损害程度、患病率或选择性均无显著差异。
