From the Florey Institute of Neuroscience and Mental Health (G.R., C.T., G.J., S.W.), and Comprehensive Epilepsy Programme, Austin Health (G.J., S.W.), Melbourne Brain Centre, Heidelberg; Melbourne School of Psychological Sciences (G.R., S.W.), the University of Melbourne, Parkville; and Institute for Social Neuroscience (C.T.), Heidelberg, Australia.
Neurology. 2019 Feb 12;92(7):e680-e689. doi: 10.1212/WNL.0000000000006905. Epub 2019 Jan 11.
Patients with temporal lobe epilepsy (TLE) are similar in their epileptology regardless of whether they have a lesion evident on MRI; this study aims to prospectively clarify whether they are also similar in their neuropsychological profiles.
Participants comprised 152 adults: 79 patients with TLE and 73 healthy controls. Patients and controls did not differ in age, sex, or education ( > 0.05). Sixty-two percent of patients had an MRI-resolvable lesion (39% with presumed hippocampal sclerosis [HS-TLE], 61% with a lesion other than HS [MRI-positive TLE]); the remaining 38% of patients were lesion-negative. Psychometric measures well established in epilepsy were used.
Relative to controls, all 3 patient subgroups showed significantly impaired autobiographical, verbal, and visual memory ( < 0.05-0.001) and significantly more depression and anxiety ( < 0.05-0.01). Yet, contrary to expectations, the 3 TLE subgroups did not differ in their severity of memory or mood impairment ( > 0.05). Lower Full-Scale IQ predicted memory impairments across all TLE subtypes, with early age at seizure onset a predictor unique to MRI-negative TLE.
MRI-negative TLE is associated with memory and mood dysfunction equivalent to that seen in patients with hippocampal sclerosis and other MRI-resolvable pathologies. As such, neuropsychological impairments in TLE are not contingent on a macroscopic lesion and might be an intrinsic property of the underlying network disease.
颞叶癫痫（TLE）患者无论是否存在 MRI 可见病变，其癫痫学特征均相似；本研究旨在前瞻性明确其神经心理学特征是否也相似。
参与者包括 152 名成年人：79 名 TLE 患者和 73 名健康对照。患者和对照组在年龄、性别和教育程度上无差异（>0.05）。62%的患者存在 MRI 可识别的病变（39%为推测性海马硬化[HS-TLE]，61%为除 HS 以外的病变[MRI 阳性 TLE]）；其余 38%的患者为病变阴性。使用了在癫痫中广泛应用的心理测量方法。
与对照组相比，所有 3 个患者亚组的自传体、言语和视觉记忆明显受损（<0.05-0.001），抑郁和焦虑明显更多（<0.05-0.01）。然而，出乎意料的是，3 个 TLE 亚组在记忆和情绪损害的严重程度上没有差异（>0.05）。全量表智商降低预测了所有 TLE 亚型的记忆障碍，而发病年龄较早是 MRI 阴性 TLE 的独特预测因素。
MRI 阴性 TLE 与海马硬化和其他 MRI 可识别的病变患者相似，存在记忆和情绪功能障碍。因此，TLE 的神经心理学损伤不依赖于宏观病变，可能是潜在网络疾病的内在特征。
