Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia.
Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia.
Epilepsia. 2021 Dec;62(12):3058-3067. doi: 10.1111/epi.17086. Epub 2021 Sep 30.
Cognitive impairment is common in patients with chronic drug-resistant temporal lobe epilepsy (TLE). Hyperphosphorylated tau (pTau) and amyloid-β (Aβ) plaques, pathological hallmarks of Alzheimer disease, have been hypothesized to play a mechanistic role. We investigated Aβ plaques and pTau prevalence in TLE patients who underwent resective surgery and correlated their presence with preoperative psychometric test scores and clinical factors.
Patients were retrospectively selected from the epilepsy surgery register of the Royal Melbourne Hospital, Australia. Sections from the resected temporal lobe were immunostained for pTau and Aβ plaques (antibodies: AT8, 1E8). The presence and severity of pathology were correlated with clinical characteristics, and verbal and visual learning functions as measured by the Verbal Pair Associates (VPA) test and Rey Complex Figure Test.
Fifty-six patients (55% female) aged 20-68 years (median = 34 years) at surgery were included. Aβ plaques were detected in four patients (7%), all at the moderate level. There was no difference in duration, age at onset of epilepsy, or side of resection between patients with and without Aβ plaques. Sparse pTau was found in two patients (3.5%). Both had moderate Aβ plaques and were >50 years of age. Patients with Aβ plaques had a lower median score for the VPA hard assessment compared to those without (0 vs. 4; p = .02). There was otherwise no correlation between pathology and psychometric test scores.
Aβ plaques and pTau were uncommon in the resected brain tissue of patients who have undergone temporal lobectomy, and did not correlate with clinical characteristics or preoperative psychometric test scores, except for a lower VPA median score in patients with Aβ plaques. Therefore, considering the low prevalence of Aβ plaques and pTau herein observed, it is unlikely that cognitive impairment in TLE is driven by the same mechanisms as in Alzheimer disease.
认知障碍在慢性耐药性颞叶癫痫（TLE）患者中很常见。阿尔茨海默病的病理标志物包括过度磷酸化的tau（pTau）和淀粉样β（Aβ）斑块，它们被假设在发病机制中起作用。我们研究了接受切除术的 TLE 患者中 Aβ斑块和 pTau 的患病率，并将其与术前心理测量测试评分和临床因素相关联。
从澳大利亚皇家墨尔本医院的癫痫手术登记处回顾性选择患者。用 pTau 和 Aβ斑块（抗体：AT8、1E8）对切除的颞叶组织切片进行免疫染色。将病理学的存在和严重程度与临床特征以及言语和视觉学习功能（通过言语对联想测验和 Rey 复杂图形测验测量）相关联。
56 名患者（55%为女性）年龄 20-68 岁（中位数=34 岁），接受手术。四名患者（7%）检测到 Aβ斑块，均为中度水平。有和没有 Aβ斑块的患者之间在癫痫持续时间、癫痫发作年龄或切除侧方面没有差异。两名患者（3.5%）发现稀疏的 pTau。两者均有中度 Aβ斑块且年龄>50 岁。与没有 Aβ斑块的患者相比，有 Aβ斑块的患者的言语对联想测验 hard 评估中位数得分较低（0 分与 4 分；p=0.02）。但是，病理学与心理测量测试评分之间没有其他相关性。
在接受颞叶切除术的患者切除的脑组织中，Aβ斑块和 pTau 并不常见，与临床特征或术前心理测量测试评分无关，除了有 Aβ斑块的患者的言语对联想测验中位数得分较低。因此，考虑到本文观察到的 Aβ斑块和 pTau 的低患病率，TLE 中的认知障碍不太可能由与阿尔茨海默病相同的机制引起。
