Gül Günay, Yandim Kuşcu Demet, Özerden Mesude, Kandemir Melek, Eren Fulya, Tuğcu Bekir, Keskinkiliç Cahit, Kayrak Nalan, Kirbaş Dursun
Clinic of 3 Neurology, Bakırköy Psychiatric and Neurological Diseases Training and Research Hospital, İstanbul, Turkey.
Department of Neurology, MedAmerican Policlinics, İstanbul, Turkey.
Noro Psikiyatr Ars. 2017 Mar;54(1):43-48. doi: 10.5152/npa.2016.13802. Epub 2016 Mar 28.
The aim of the present study was to evaluate the neuropsychological outcomes of patients with medically intractable unilateral mesial temporal lobe epilepsy (MTLE) due to hippocampal sclerosis (HS) treated either by anterior temporal lobectomy (ATL) or selective amygdalohippocampectomy (SAH).
This was a retrospective study where 67 patients who had undergone surgery for MTLE were evaluated. Thirty-two patients underwent ATL and 35 underwent SAH. All patients underwent a detailed neuropsychological evaluation before and 1 year after surgery.
The verbal memory outcome was unchanged after left-sided surgery, whereas learning capacity increased after right-sided surgery (p=0.038). The visual memory outcome improved after right-sided surgery. Improvement of executive functions, particularly in the resistance of interference pattern in the Stroop Test, shortened 5th card time (p=0.000), and decreased corrections (p=0.003), after right-sided surgery and increased attention (p=0.027) after left-sided surgery were observed. After both surgery types, although statistically insignificant, there was a marked decrease in incorrect answers in the Stroop Test, which also showed an improvement in the resistance of interference pattern. Moreover, there was a significant decrease in switching errors with word pairs in the Verbal Fluency Test (p=0.008) after right-sided surgery. When the two sides were compared, we observed that the recall phase of the verbal memory worsened (p=0.018); however, the recognition phase improved (p=0.015) after left-sided surgery. Additionally, the short-term visual memory was better for both sides (p=0.035).
Our results showed that patients with left MTLE were not worsened in verbal memory, but despite improved recognition, they have some problems in recalling information and only a minor improvement in attention. Patients with right MTLE improved in their verbal learning capacity, visual memory, and resistance of interference pattern 1 year after surgery. It was thus shown that while epilepsy surgery is associated with some negative cognitive changes, it may also improve some cognitive functions.
本研究的目的是评估因海马硬化（HS）导致的药物难治性单侧内侧颞叶癫痫（MTLE）患者，接受前颞叶切除术（ATL）或选择性杏仁核海马切除术（SAH）后的神经心理学结果。
这是一项回顾性研究，对67例接受MTLE手术的患者进行了评估。32例患者接受了ATL，35例接受了SAH。所有患者在手术前和手术后1年都接受了详细的神经心理学评估。
左侧手术后言语记忆结果未变，而右侧手术后学习能力增强（p = 0.038）。右侧手术后视觉记忆结果改善。观察到右侧手术后执行功能改善，特别是在Stroop测试中的干扰模式抗性方面，缩短了第5张卡片时间（p = 0.000），减少了校正次数（p = 0.003），左侧手术后注意力增强（p = 0.027）。两种手术类型后，尽管在统计学上不显著，但Stroop测试中的错误答案有明显减少，干扰模式抗性也有所改善。此外，右侧手术后言语流畅性测试中单词对的转换错误显著减少（p = 0.008）。当比较两侧时，我们观察到左侧手术后言语记忆的回忆阶段变差（p = 0.018）；然而，识别阶段有所改善（p = 0.015）。此外，两侧的短期视觉记忆都更好（p = 0.035）。
我们的结果表明，左侧MTLE患者的言语记忆没有恶化，但尽管识别能力有所改善，他们在回忆信息方面存在一些问题，注意力仅略有改善。右侧MTLE患者在手术后1年，言语学习能力、视觉记忆和干扰模式抗性有所改善。因此表明，虽然癫痫手术与一些负面认知变化有关，但它也可能改善一些认知功能。
