Department of Epileptology, University of Bonn Medical Center, Bonn, Germany.
Department of Neurology, University of Münster, Münster, Germany.
Cortex. 2019 Jan;110:58-68. doi: 10.1016/j.cortex.2018.01.003. Epub 2018 Jan 31.
Accelerated long-term forgetting (ALF) is a phenomenon found in late onset epilepsy and in transient epileptic amnesia (TEA). Here we evaluated ALF in patients with focal epilepsies and limbic encephalitis (LE) in particular.
ALF was assessed in 36 patients with focal epilepsy and 154 healthy subjects using an extended version of the Verbal Learning and Memory Test (VLMT), with free recall after 30 min and again after one week. From these patients, 89% had temporal lobe epilepsy; 42% left-lateralized; 39% right; 19% bilateral; 17% were diagnosed with hippocampal sclerosis; 64% displayed features indicating LE; 52% with amygdala pathology, and 61% were antibody positive. ALF was defined as either having unimpaired free recall after 30 min and impaired recall after a week (A) or as a loss in recall exceeding the absolute (B) and percentage loss (C) in the interval of the 30 min and one week recall seen in controls by more than one standard deviation.
Repeated measures analysis revealed an association between LE and ALF. Depending on its definition (A, B, or C), ALF was evident in 31%, 42%, or 67% of the patients. Poor verbal memory and ALF (C) were prominent in left-lateralized epilepsies. ALF (A) appeared more frequently in auto-antibody negative patients with LE, ALF (B) less frequently with hippocampal sclerosis. Seizures during the interval did not explain ALF.
Depending on its definition, ALF is seen in patients with normal or impaired memory at ½ h. ALF seems related to LE but might as well be the first sign of memory impairment in patients with milder epilepsies and not yet definite structural temporal lobe pathology. Longitudinal assessment would be essential for discerning when ALF becomes evident, whether conditions exist in which ALF precedes short-term forgetting, and whether ALF responds to treatment.
加速长期遗忘（ALF）是一种在迟发性癫痫和短暂性癫痫性遗忘（TEA）中发现的现象。在这里，我们评估了局灶性癫痫和边缘性脑炎（LE）患者的 ALF。
使用言语学习和记忆测试（VLMT）的扩展版本评估 36 名局灶性癫痫患者和 154 名健康受试者的 ALF，30 分钟后进行自由回忆，一周后再次进行。这些患者中，89%患有颞叶癫痫；42%为左侧病变；39%为右侧病变；19%为双侧病变；17%被诊断为海马硬化症；64%表现出提示 LE 的特征；52%有杏仁核病变，61%为抗体阳性。将 ALF 定义为 30 分钟后自由回忆未受损但一周后回忆受损（A），或者在 30 分钟和一周回忆的间隔内，与对照组相比，回忆损失超过一个标准差的绝对损失（B）和百分比损失（C）。
重复测量分析显示，LE 和 ALF 之间存在关联。根据其定义（A、B 或 C），31%、42%或 67%的患者存在 ALF。言语记忆和 ALF（C）较差在左侧病变中更为突出。LE 中自身抗体阴性患者中更常出现 ALF（A），海马硬化症患者中 ALF（B）较少。间隔期间的癫痫发作不能解释 ALF。
根据其定义，在记忆在半小时内正常或受损的患者中可见 ALF。ALF 似乎与 LE 有关，但也可能是轻度癫痫且尚未明确存在颞叶结构病理学患者记忆障碍的最初迹象。纵向评估对于确定 ALF 何时变得明显、是否存在 ALF 先于短期遗忘的情况以及 ALF 是否对治疗有反应至关重要。
