Law Nicole, Benifla Mony, Rutka James, Smith Mary Lou
Department of Psychology, University of Toronto, Toronto, Ontario, Canada.
Department of Psychology, Hospital for Sick Children, Toronto, Ontario, Canada.
Epilepsia. 2017 Feb;58(2):291-299. doi: 10.1111/epi.13635. Epub 2016 Dec 24.
Previous findings have been mixed regarding verbal memory outcome after left temporal lobectomy in children, and there are few studies comparing verbal memory change after lateral versus mesial temporal lobe resections. We compared verbal memory outcome associated with sparing or including the mesial structures in children who underwent left or right temporal lobe resection. We also investigated predictors of postsurgical verbal memory change.
We retrospectively assessed verbal memory change approximately 1 year after unilateral temporal lobe epilepsy surgery using a list learning task. Participants included 23 children who underwent temporal lobe surgery with sparing of the mesial structures (13 left), and 40 children who had a temporal lobectomy that included resection of mesial structures (22 left).
Children who underwent resection from the left lateral and mesial temporal lobe were the only group to show decline in verbal memory. Furthermore, when we considered language representation in the left temporal resection group, patients with left language representation and spared mesial structures showed essentially no change in verbal memory from preoperative to follow-up, whereas those with left language representation and excised mesial structures showed a decline. Postoperative seizure status had no effect on verbal memory change in children after left temporal lobe surgery. Finally, we found that patients with intact preoperative verbal memory experienced a significant decline compared to those with below average preoperative verbal memory.
Our findings provide evidence of significant risk factors for verbal memory decline in children, specific to left mesial temporal lobe epilepsy. Children who undergo left temporal lobe surgery that includes mesial structures may be most vulnerable for verbal memory decline, especially when language representation is localized to the left hemisphere and when preoperative verbal memory is intact.
既往关于儿童左颞叶切除术后言语记忆结果的研究结果不一，且很少有研究比较外侧与内侧颞叶切除术后言语记忆的变化。我们比较了接受左或右颞叶切除术的儿童中，保留或切除内侧结构与言语记忆结果之间的关系。我们还研究了术后言语记忆变化的预测因素。
我们使用列表学习任务，对单侧颞叶癫痫手术后约1年的言语记忆变化进行了回顾性评估。参与者包括23名接受颞叶手术且保留内侧结构的儿童（13名左侧），以及40名接受颞叶切除术且包括切除内侧结构的儿童（22名左侧）。
接受左侧外侧和内侧颞叶切除术的儿童是唯一显示言语记忆下降的组。此外，当我们考虑左颞叶切除组中的语言表征时，具有左侧语言表征且保留内侧结构的患者从术前到随访时言语记忆基本没有变化，而具有左侧语言表征且切除内侧结构的患者则出现了下降。术后癫痫状态对左颞叶手术后儿童的言语记忆变化没有影响。最后，我们发现术前言语记忆完好的患者与术前言语记忆低于平均水平的患者相比，经历了显著的下降。
我们的研究结果提供了证据，表明儿童言语记忆下降存在显著风险因素，特别是对于左侧内侧颞叶癫痫。接受包括内侧结构的左颞叶手术的儿童可能最容易出现言语记忆下降，尤其是当语言表征定位于左半球且术前言语记忆完好时。
