Schwarz Michael, Geismar Lisa, Schneider Katrin, Kasper Burkhard S, Walther Katrin, Hamer Hajo
Department of Neurology, University Hospital Erlangen, Erlangen, Germany.
Br J Occup Ther. 2022 Aug;85(8):617-624. doi: 10.1177/03080226211067430. Epub 2022 Feb 7.
There is a relevant risk of psychosocial as well as cognitive impairments in epilepsy patients with resective surgery in the left temporal lobe. Surgery in the speech-dominant hemisphere can be associated with deterioration of speech related functions including verbal memory. There are only limited studies addressing the impact of occupational therapy in postoperative rehabilitation of epilepsy patients.
In this study, a mixed-methods design based on the grounded theory concept was administered. Seven patients with left temporal lobe epilepsy and a risk profile for postoperative cognitive decline were investigated over various time points. Neuropsychological assessments occurred before surgery, 1 week, 3 months, and 6 months postoperatively. According to our rehabilitation concept, every patient started occupational therapy 1 month before surgery. Therapy lasted for at least 6 months after surgery. For all patients, extensive qualitative interviews with the occupational therapists and anamnestic data were analyzed.
In all patients, postoperative psychosocial difficulties emerged. Language and memory tests showed a decline after 6 months specifically for name retrieval. Occupational therapy was adapted to find individual solutions for the patients problems and to implement effective coping strategies.
Cognitive training lead to consistent improvements over time. The results show that occupational therapy can be an efficient tool in the treatment of psychosocial and cognitive impairments after epilepsy surgery.
接受左颞叶切除手术的癫痫患者存在心理社会和认知障碍的相关风险。在语言优势半球进行手术可能会导致包括言语记忆在内的与言语相关功能的恶化。关于职业治疗对癫痫患者术后康复影响的研究非常有限。
在本研究中,采用了基于扎根理论概念的混合方法设计。对7例左颞叶癫痫且有术后认知下降风险的患者在不同时间点进行了调查。在手术前、术后1周、3个月和6个月进行了神经心理学评估。根据我们的康复理念,每位患者在手术前1个月开始接受职业治疗。治疗在术后至少持续6个月。对所有患者,分析了与职业治疗师的广泛定性访谈和记忆数据。
所有患者术后都出现了心理社会方面的困难。语言和记忆测试显示,6个月后特别是在命名回忆方面有所下降。职业治疗进行了调整,以找到针对患者问题的个性化解决方案并实施有效的应对策略。
随着时间的推移,认知训练带来了持续的改善。结果表明,职业治疗可以成为治疗癫痫手术后心理社会和认知障碍的有效工具。