John Carroll University, Cleveland, OH, USA.
Department of Psychology and Psychiatry, Cleveland Clinic, Cleveland, OH, USA.
Epilepsia. 2018 Apr;59(4):825-833. doi: 10.1111/epi.14036. Epub 2018 Mar 14.
The International League Against Epilepsy (ILAE) proposed a classification system for hippocampal sclerosis (HS) based on location and extent of hippocampal neuron loss. The literature debates the usefulness of this classification system when studying memory in people with temporal lobe epilepsy (TLE) and determining memory outcome after temporal lobe resection (TLR). This study further explores the relationship between HS ILAE subtypes and episodic memory performance in patients with TLE and examines memory outcomes after TLR.
This retrospective study identified 213 patients with TLE who underwent TLR and had histopathological evidence of HS (HS ILAE type 1a = 92; type 1b = 103; type 2 = 18). Patients completed the Wechsler Memory Scale-3rd Edition prior to surgery, and 78% of patients had postoperative scores available. Linear regressions examined differences in preoperative memory scores as a function of pathology classification, controlling for potential confounders. Fisher's exact tests were used to compare pathology subtypes on the magnitude of preoperative memory impairment and the proportion of patients who experienced clinically meaningful postoperative memory decline.
Individuals with HS ILAE type 2 demonstrated better preoperative verbal memory performance than patients with HS ILAE type 1; however, individual data revealed verbal and visual episodic memory impairments in many patients with HS ILAE type 2. The base rate of postoperative memory decline was similar among all 3 pathology groups.
This is the largest reported overall sample and the largest subset of patients with HS ILAE type 2. Group data suggest that patients with HS ILAE type 2 perform better on preoperative memory measures, but individually there were no differences in the magnitude of memory impairment. Following surgery, there were no statistically significant differences between groups in the proportion of patients who declined. Future research should focus on quantitative measurements of hippocampal neuronal loss, and multicenter collaboration is encouraged.
国际抗癫痫联盟（ILAE）提出了一种基于海马神经元丢失位置和程度的海马硬化（HS）分类系统。文献就该分类系统在研究颞叶癫痫（TLE）患者的记忆以及确定颞叶切除（TLR）后的记忆结果的有用性展开了争论。本研究进一步探讨了 TLE 患者 HS ILAE 亚型与情景记忆表现之间的关系，并检查了 TLR 后的记忆结果。
本回顾性研究纳入了 213 例接受 TLR 且具有 HS 组织病理学证据的 TLE 患者（HS ILAE 1a 型=92 例；1b 型=103 例；2 型=18 例）。患者在手术前完成了韦氏记忆量表第三版测试，78%的患者有术后评分。线性回归分析了术前记忆评分与病理分类之间的差异，同时控制了潜在的混杂因素。Fisher 精确检验用于比较病理亚型在术前记忆损伤程度和经历临床显著术后记忆下降的患者比例方面的差异。
HS ILAE 2 型个体的术前言语记忆表现优于 HS ILAE 1 型患者；然而，个体数据显示，许多 HS ILAE 2 型患者存在言语和视觉情景记忆障碍。所有 3 个病理组的术后记忆下降发生率相似。
这是迄今为止报道的最大总体样本和最大的 HS ILAE 2 型患者亚组。组数据表明，HS ILAE 2 型患者在术前记忆测试中表现更好，但在记忆损伤程度方面，个体之间没有差异。手术后，各组之间在记忆下降患者的比例上没有统计学上的显著差异。未来的研究应侧重于对海马神经元丢失的定量测量，并鼓励开展多中心合作。
