Zalonis Ioannis, Christidi Foteini, Artemiadis Artemios, Psarros Constantinos, Papadopoulos George, Tsivgoulis George, Gatzonis Stergios, Siatouni Anna, Velonakis Georgios, Karavasilis Efstratios, Kararizou Evangelia, Triantafyllou Nikolaos
*Neuropsychological Laboratory, 1st Department of Neurology †1st Department of Neurology; and ‡1st Department of Psychiatry, Aeginition Hospital §2nd Department of Neurology and ¶2nd Department of Radiology, Attikon Hospital ∥1st Department of Neurosurgery, Evangelismos Hospital; Medical School, National & Kapodistrian University, Athens, Greece.
Cogn Behav Neurol. 2017 Jun;30(2):48-56. doi: 10.1097/WNN.0000000000000123.
Clinicians commonly use verbal and nonverbal measures to test fluency in patients with epilepsy, either during routine cognitive assessment or as part of pre- and postsurgical evaluation. We hypothesized that patients with mesial temporal lobe epilepsy (TLE) with hippocampal sclerosis would perform worse than patients with lateral TLE in both verbal and design fluency.
We assessed semantic, phonemic, and nonverbal fluency in 49 patients with TLE: 31 with lateral TLE and 18 with mesial TLE plus hippocampal sclerosis. We also gave non-fluency cognitive measures: psychomotor speed, attentional set shifting, selective attention, abstract reasoning, verbal and visual episodic memory, and incidental memory.
Patients with mesial TLE performed significantly worse on figural fluency than patients with lateral TLE. Even though group differences on verbal fluency measures were not significant, the patients with mesial TLE had a pattern of poorer performance. The patients with mesial TLE scored significantly worse on measures of selective attention, verbal episodic memory, and incidental memory.
Our study underlines differences in cognitive function between patients with mesial and lateral TLE, particularly in figural fluency. Although we cannot directly assess the role of the hippocampus in cognitive aspects of creative and divergent thinking related to figural fluency, the cognitive discrepancies between these two TLE groups could be ascribed to the mesial TLE hippocampal pathology shown in our study and addressed in the literature on hippocampal involvement in divergent thinking. Our findings could benefit cognitive rehabilitation programs tailored to the needs of patients with TLE.
临床医生通常在对癫痫患者进行常规认知评估时，或作为术前和术后评估的一部分，使用言语和非言语测量方法来测试其流畅性。我们假设，患有海马硬化的内侧颞叶癫痫（TLE）患者在言语和设计流畅性方面的表现会比外侧TLE患者更差。
我们评估了49例TLE患者的语义、音素和非言语流畅性：31例为外侧TLE患者，18例为内侧TLE合并海马硬化患者。我们还进行了非流畅性认知测量：心理运动速度、注意力转换、选择性注意力、抽象推理、言语和视觉情景记忆以及偶发记忆。
内侧TLE患者在图形流畅性方面的表现明显比外侧TLE患者差。尽管言语流畅性测量的组间差异不显著，但内侧TLE患者的表现模式较差。内侧TLE患者在选择性注意力、言语情景记忆和偶发记忆测量中的得分明显更低。
我们的研究强调了内侧和外侧TLE患者在认知功能上的差异，尤其是在图形流畅性方面。尽管我们无法直接评估海马体在与图形流畅性相关的创造性和发散性思维的认知方面所起的作用，但这两组TLE患者之间的认知差异可能归因于我们研究中显示的内侧TLE海马体病变，并且在关于海马体参与发散性思维的文献中也有提及。我们的研究结果可能会使针对TLE患者需求的认知康复计划受益。
