Boucher Olivier, Dagenais Emmanuelle, Bouthillier Alain, Nguyen Dang Khoa, Rouleau Isabelle
Centre de recherche en neuropsychologie et cognition (CERNEC), Département de Psychologie, Université de Montréal, Canada.
Département de Psychologie, Université du Québec à Montréal, Canada.
Epilepsy Behav. 2015 Nov;52(Pt A):230-5. doi: 10.1016/j.yebeh.2015.09.012. Epub 2015 Nov 6.
The advantage of selective amygdalohippocampectomy (SAH) over anterior temporal lobectomy (ATL) for the treatment of temporal lobe epilepsy (TLE) remains controversial. Because ATL is more extensive and involves the lateral and medial parts of the temporal lobe, it may be predicted that its impact on memory is more important than SAH, which involves resection of medial temporal structures only. However, several studies do not support this assumption. Possible explanations include task-specific factors such as the extent of semantic and syntactic information to be memorized and failure to control for main confounders. We compared preoperative vs. postoperative memory performance in 13 patients with SAH with 26 patients who underwent ATL matched on side of surgery, IQ, age at seizure onset, and age at surgery. Memory function was assessed using the Logical Memory subtest from the Wechsler Memory Scales - 3rd edition (LM-WMS), the Rey Auditory Verbal Learning Test (RAVLT), the Digit Span subtest from the Wechsler Adult Intelligence Scale, and the Rey-Osterrieth Complex Figure Test. Repeated measures analyses of variance revealed opposite effects of SAH and ATL on the two verbal learning memory tests. On the immediate recall trial of the LM-WMS, performance deteriorated after ATL in comparison with that after SAH. By contrast, on the delayed recognition trial of the RAVLT, performance deteriorated after SAH compared with that after ATL. However, additional analyses revealed that the latter finding was only observed when surgery was conducted in the right hemisphere. No interaction effects were found on other memory outcomes. The results are congruent with the view that tasks involving rich semantic content and syntactical structure are more sensitive to the effects of lateral temporal cortex resection as compared with mesiotemporal resection. The findings highlight the importance of task selection in the assessment of memory in patients undergoing TLE surgery.
在治疗颞叶癫痫（TLE）方面，选择性杏仁核海马切除术（SAH）相对于前颞叶切除术（ATL）的优势仍存在争议。由于ATL范围更广，涉及颞叶的外侧和内侧部分，可以预测其对记忆的影响比仅涉及内侧颞叶结构切除的SAH更显著。然而，多项研究并不支持这一假设。可能的解释包括特定任务因素，如要记忆的语义和句法信息的程度，以及未能控制主要混杂因素。我们比较了13例接受SAH手术的患者与26例接受ATL手术的患者术前与术后的记忆表现，两组患者在手术侧、智商、癫痫发作起始年龄和手术年龄方面相匹配。使用韦氏记忆量表第三版（LM-WMS）的逻辑记忆子测试、雷伊听觉词语学习测试（RAVLT）、韦氏成人智力量表的数字广度子测试以及雷伊-奥斯特里赫复杂图形测试来评估记忆功能。重复测量方差分析显示，SAH和ATL对两项言语学习记忆测试产生了相反的影响。在LM-WMS的即时回忆试验中，与SAH术后相比，ATL术后的表现有所下降。相比之下，在RAVLT的延迟识别试验中，与ATL术后相比，SAH术后的表现有所下降。然而，进一步分析发现，只有在右侧半球进行手术时才会出现后一种情况。在其他记忆结果方面未发现交互作用。这些结果与以下观点一致，即与内侧颞叶切除相比，涉及丰富语义内容和句法结构的任务对颞叶外侧皮质切除的影响更敏感。这些发现突出了任务选择在评估TLE手术患者记忆中的重要性。
