Sepeta Leigh N, Casaletto Kaitlin Blackstone, Terwilliger Virginia, Facella-Ervolini Joy, Sady Maegan, Mayo Jessica, Gaillard William D, Berl Madison M
Department of Neurosciences, Children's National Health System, Washington, District of Columbia, U.S.A.
NINDS Clinical Epilepsy Section, NIH, Bethesda, Maryland, U.S.A.
Epilepsia. 2017 Feb;58(2):300-310. doi: 10.1111/epi.13637. Epub 2017 Jan 23.
Learning and memory are essential for academic success and everyday functioning, but the pattern of memory skills and its relationship to executive functioning in children with focal epilepsy is not fully delineated. We address a gap in the literature by examining the relationship between memory and executive functioning in a pediatric focal epilepsy population.
Seventy children with focal epilepsy and 70 typically developing children matched on age, intellectual functioning, and gender underwent neuropsychological assessment, including measures of intelligence (Wechsler Abbreviated Scale of Intelligence [WASI]/Differential Ability Scales [DAS]), as well as visual Children's Memory Scale (CMS Dot Locations) and verbal episodic memory (Wide Range Assessment of Memory and Learning [WRAML] Story Memory and California Verbal Learning Test for Children [CVLT-C]). Executive functioning was measured directly (WISC-IV Digit Span Backward; Clinical Evaluation of Language Fundamentals, Fourth Edition (CELF-IV) Recalling Sentences) and by parent report (Behavior Rating Inventory of Executive Function [BRIEF]).
Children with focal epilepsy had lower delayed free-recall scores than controls across visual and verbal memory tasks (p = 0.02; partial η = 0.12). In contrast, recognition memory performance was similar for patients and controls (p = 0.36; partial η = 0.03). Children with focal epilepsy demonstrated difficulties in working memory (p = 0.02; partial η = 0.08) and planning/organization (p = 0.02) compared to controls. Working memory predicted 9-19% of the variance in delayed free recall for verbal and visual memory; organization predicted 9-10% of the variance in verbal memory. Patients with both left and right focal epilepsy demonstrated more difficulty on verbal versus visual tasks (p = 0.002). Memory performance did not differ by location of seizure foci (temporal vs. extratemporal, frontal vs. extrafrontal).
Children with focal epilepsy demonstrated memory ability within age-level expectations, but delayed free recall was inefficient compared to typically developing controls. Memory difficulties were not related to general cognitive impairment or seizure localization. Executive functioning accounted for significant variance in memory performance, suggesting that poor executive control negatively influences memory retrieval.
学习和记忆对学业成功及日常功能至关重要，但局灶性癫痫患儿的记忆技能模式及其与执行功能的关系尚未完全明确。我们通过研究儿科局灶性癫痫群体中记忆与执行功能之间的关系来填补文献中的空白。
70名局灶性癫痫患儿和70名年龄、智力功能及性别相匹配的正常发育儿童接受了神经心理学评估，包括智力测量（韦氏儿童智力量表简式版[WASI]/差异能力量表[DAS]），以及视觉儿童记忆量表（CMS点位置）和言语情景记忆（广泛记忆与学习评估[WRAML]故事记忆及儿童加利福尼亚言语学习测验[CVLT-C]）。执行功能通过直接测量（韦氏儿童智力量表第四版数字广度倒背；语言基本能力临床评估第四版[CELF-IV]句子回忆）和家长报告（执行功能行为评定量表[BRIEF]）进行评估。
在视觉和言语记忆任务中，局灶性癫痫患儿的延迟自由回忆得分低于对照组（p = 0.02；偏η = 0.12）。相比之下，患者和对照组的识别记忆表现相似（p = 0.36；偏η = 0.03）。与对照组相比，局灶性癫痫患儿在工作记忆（p = 0.02；偏η = 0.08）和计划/组织方面存在困难（p = 0.02）。工作记忆预测了言语和视觉记忆中延迟自由回忆变异的9 - 19%；组织预测了言语记忆中变异的9 - 10%。左、右局灶性癫痫患者在言语任务上比视觉任务表现出更多困难（p = 0.002）。记忆表现不因癫痫病灶位置（颞叶与颞外、额叶与额外）而有所不同。
局灶性癫痫患儿的记忆能力在年龄预期范围内，但与正常发育的对照组相比，延迟自由回忆效率较低。记忆困难与一般认知障碍或癫痫定位无关。执行功能在记忆表现中占显著变异，表明执行控制不佳对记忆检索有负面影响。
