Conradi Nadine, Behrens Marion, Schuster Annika, Schmitt Sophia, Merkel Nina, Melzer Nico, Elben Saskia, Siebenbrodt Kai, Strzelczyk Adam, Rosenow Felix
Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, University Hospital Frankfurt and Goethe University, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe University, Frankfurt am Main, Germany.
Department of Neurology, University Hospital Frankfurt and Goethe University, Frankfurt am Main, Germany.
Epilepsy Behav. 2021 Oct 26;124:108378. doi: 10.1016/j.yebeh.2021.108378.
Patients with temporal lobe epilepsy caused by autoimmune limbic encephalitis (AI-TLE) clinically resemble patients with temporal lobe epilepsy with non-autoimmune etiologies (NAI-TLE) but have a different prognosis and require specific adjusted therapies. The objective of this study was to investigate whether patients with these forms of TLE can be discerned by means of neuropsychological assessment.
Data from 103 patients with TLE (n = 39 with AI-TLE and n = 64 with NAI-TLE, including n = 39 with hippocampal sclerosis [HS] and n = 25 with low-grade epilepsy-associated tumors [LEAT]) and 25 healthy controls who underwent comprehensive neuropsychological assessments were analyzed retrospectively. The neuropsychological characteristics (mean z-scores) were compared between groups using one-way ANOVA, independent-samples t-tests, and discriminant function analysis (DFA).
The groups of patients with TLE showed significantly lower performance in attentional, visuospatial, verbal memory, and nonverbal memory functions compared to the healthy controls. Solely in the domain of executive functions, patients with AI-TLE showed significantly lower performance compared to patients with NAI-TLE regarding cognitive flexibility (p = 0.002) and verbal fluency (p = 0.018). Moreover, the DFA identified cognitive flexibility to be most appropriate to differentiate between patients with AI-TLE and patients with HS. Group membership was correctly predicted through neuropsychological assessment alone in 66.7% of the patients using cross-validation.
We were able to identify specific neuropsychological features in our sample of patients with AI-TLE. While all groups of patients with TLE showed the expected TLE-typical memory impairments, significant differences between patients with AI-TLE and NAI-TLE were present only in the cognitive domain of executive functions. This finding facilitates the choice of suitable psychometric tests in clinical routine and, thus, the clinical differential diagnosis between these entities.
自身免疫性边缘性脑炎所致颞叶癫痫（AI-TLE）患者在临床上与非自身免疫性病因所致颞叶癫痫（NAI-TLE）患者相似，但预后不同，需要特定的调整治疗。本研究的目的是调查通过神经心理学评估能否区分这两种形式的颞叶癫痫患者。
回顾性分析103例颞叶癫痫患者（39例AI-TLE患者和64例NAI-TLE患者，包括39例海马硬化[HS]患者和25例低级别癫痫相关肿瘤[LEAT]患者）以及25名接受全面神经心理学评估的健康对照者的数据。使用单因素方差分析、独立样本t检验和判别函数分析（DFA）比较各组之间的神经心理学特征（平均z分数）。
与健康对照者相比，颞叶癫痫患者组在注意力、视觉空间、言语记忆和非言语记忆功能方面表现明显较差。仅在执行功能领域，与NAI-TLE患者相比，AI-TLE患者在认知灵活性（p = 0.002）和言语流畅性（p = 0.018）方面表现明显较差。此外，DFA确定认知灵活性最适合区分AI-TLE患者和HS患者。通过交叉验证，仅通过神经心理学评估就能正确预测66.7%患者的组别归属。
我们能够在AI-TLE患者样本中识别出特定的神经心理学特征。虽然所有颞叶癫痫患者组都表现出预期的颞叶癫痫典型记忆障碍，但AI-TLE患者和NAI-TLE患者之间的显著差异仅存在于执行功能的认知领域。这一发现有助于在临床常规中选择合适的心理测量测试，从而有助于这些疾病之间的临床鉴别诊断。
