Miller L A, McLachlan R S, Bouwer M S, Hudson L P, Munoz D G
Department of Clinical Neurological Sciences, University of Western Ontario, London, Canada.
J Neurol Neurosurg Psychiatry. 1994 Sep;57(9):1099-105. doi: 10.1136/jnnp.57.9.1099.
Isolated amygdalar sclerosis (AS) in the presence of an intact hippocampus has been described in a subset of patients who have undergone a temporal lobectomy for the relief of seizures. Clinical observation suggested that these patients might be distinguishable, before and after operation, from those with typical mesial temporal sclerosis, which implies combined amygdalar and hippocampal sclerosis (AHS). From a three year series, all 11 patients classified as having AS were included in this study. These patients were compared with a group of 20 randomly chosen patients with AHS. The groups were found to be well matched in duration of ongoing seizures, full scale IQ, and duration of follow up (mean 19 months). Compared with patients with AHS, patients in the AS group were less likely to have had a seizure in early childhood, a variety of auras, EEG abnormalities localised to one temporal lobe, or an abnormal MRI before operation. They also performed better on preoperative memory tests. At follow up, patients in the AS group were less likely to be seizure free and more likely to have a deterioration in memory after undergoing anterior temporal lobectomy, including part of the hippocampus. The results show that there are preoperative indicators of mesial temporal pathology that are also of prognostic importance given the differences in outcome between the two pathological groups.
在部分因缓解癫痫发作而接受颞叶切除术的患者中，已发现存在孤立性杏仁核硬化（AS）且海马体完整的情况。临床观察表明，这些患者在手术前后可能与典型的内侧颞叶硬化患者有所不同，后者意味着合并杏仁核和海马体硬化（AHS）。在一项为期三年的研究系列中，本研究纳入了所有被归类为患有AS的11名患者。将这些患者与一组随机选取的20名患有AHS的患者进行比较。发现两组在癫痫持续时间、全量表智商和随访时间（平均19个月）方面匹配良好。与患有AHS的患者相比，AS组患者在幼儿期出现癫痫发作、多种先兆、脑电图异常局限于一个颞叶或术前MRI异常的可能性较小。他们在术前记忆测试中的表现也更好。在随访中，AS组患者在接受包括部分海马体的前颞叶切除术后，无癫痫发作的可能性较小，且记忆恶化的可能性较大。结果表明，内侧颞叶病变存在术前指标，鉴于两个病理组的结局差异，这些指标也具有预后重要性。
