Janecek Julie K, Binder Jeffrey R, Mueller Wade M, Swanson Sara J
Department of Neurology, Medical College of Wisconsin, 8701 W. Watertown Plank Rd., Milwaukee, WI 53226, USA.
Department of Neurosurgery, Medical College of Wisconsin, 8701 W. Watertown Plank Rd., Milwaukee, WI 53226, USA.
Epilepsy Behav Rep. 2021 Sep 15;16:100482. doi: 10.1016/j.ebr.2021.100482. eCollection 2021.
Anterior temporal lobectomy (ATL) is an effective treatment for drug-resistant epilepsy, and risk for post-surgical naming and verbal memory decline after dominant hemisphere ATL is well-established. However, less is known about later life cognitive and functional outcomes following ATL performed in early or mid-life, as there are few studies that report very long-term outcomes, and the intersection of epilepsy and the aging process is not well-understood. Factors that may promote healthy cognitive aging or confer increased risk for cognitive decline in late life for those with seizure onset in early or mid-life have yet to be determined. This case report describes an individual with drug-resistant epilepsy who was treated with left ATL in mid-life, and then subsequently sustained a moderate traumatic brain injury 22 years later. The excellent recovery and remarkable stability of cognitive performance over time may be associated with several protective factors such as favorable seizure outcome, high cognitive reserve, and the absence of co-occurring medical conditions. This case also highlights the clinical utility of serial neuropsychological testing at multiple timepoints across the lifespan for those with epilepsy, and the importance of considering the clinical significance, or functional impact, of cognitive deficits in this population.
颞叶前部切除术（ATL）是治疗耐药性癫痫的有效方法，并且优势半球ATL术后命名和言语记忆衰退的风险已得到充分证实。然而，对于在早年或中年进行ATL后的晚年认知和功能结局知之甚少，因为很少有研究报告非常长期的结局，而且癫痫与衰老过程之间的交叉关系尚未得到很好的理解。对于那些在早年或中年发病的癫痫患者，可能促进健康认知衰老或增加晚年认知衰退风险的因素尚未确定。本病例报告描述了一名耐药性癫痫患者，中年时接受了左侧ATL治疗，22年后又遭受了中度创伤性脑损伤。随着时间推移，认知表现的出色恢复和显著稳定性可能与多种保护因素有关，如良好的癫痫发作结局、高认知储备以及无并发疾病。本病例还强调了对癫痫患者在整个生命周期的多个时间点进行系列神经心理测试的临床实用性，以及考虑该人群认知缺陷的临床意义或功能影响的重要性。
