Szabó C A, Wyllie E, Stanford L D, Geckler C, Kotagal P, Comair Y G, Thornton A E
Department of Neurology, The Cleveland Clinic Foundation, Ohio 44195, USA.
Epilepsia. 1998 Aug;39(8):814-9. doi: 10.1111/j.1528-1157.1998.tb01174.x.
Numerous studies have demonstrated changes in cognitive, memory, and language functioning in adults and adolescents after temporal lobectomy, yet little information is available regarding neuropsychological outcome in preadolescent children.
We studied pre- and postoperative neuropsychological test results from 14 children who underwent temporal lobe resection for intractable epilepsy at age 7-12 years (mean 9.4 years).
Thirteen patients (93%) had no seizures or less than one seizure a year at follow-up 23-48 months (mean 34 months) after operation. Postoperative neuropsychological testing was performed 6-9 months (mean 7 months) after surgery in 13 patients and 36 months after the first operation in 1 patient who underwent two-stage resection of a tumor. Verbal, Performance, and Full Scale IQ were initially in the low-average range, with no significant change across the pre- and postoperative evaluations. Immediate verbal memory performance decreased significantly in children who initially performed above the median preoperatively and tended to decrease in children who had left rather than right temporal lobe resection. Significant postoperative decreases in delayed memory scores were independent of preoperative ability or side of resection.
Our small study suggests vulnerability to postoperative decline in immediate verbal memory scores in preadolescent children who have higher baseline immediate memory function or undergo left rather than right temporal lobe resection, similar to that observed in adolescents in adults. The entire group exhibited a statistically significant decrease in delayed verbal memory. Study of larger series of patients will be important to clarify further the short- and long-term risks and benefits of temporal lobe resection in childhood.
众多研究已证实，成人和青少年在颞叶切除术后认知、记忆和语言功能会发生变化，但关于青春期前儿童的神经心理学结果的信息却很少。
我们研究了14名7至12岁（平均9.4岁）因顽固性癫痫接受颞叶切除术的儿童术前和术后的神经心理学测试结果。
13名患者（93%）在术后23至48个月（平均34个月）的随访中无癫痫发作或每年发作少于一次。13名患者在术后6至9个月（平均7个月）进行了术后神经心理学测试，1名接受肿瘤两阶段切除的患者在首次手术后36个月进行了测试。言语、操作和全量表智商最初处于低平均范围，术前和术后评估之间无显著变化。术前表现高于中位数的儿童术后即刻言语记忆表现显著下降，而接受左颞叶而非右颞叶切除的儿童术后即刻言语记忆表现有下降趋势。术后延迟记忆分数显著下降与术前能力或切除侧无关。
我们的小型研究表明，青春期前儿童若基线即刻记忆功能较高或接受左颞叶而非右颞叶切除，术后即刻言语记忆分数易下降，这与在青少年和成人中观察到的情况类似。整个组在延迟言语记忆方面有统计学显著下降。对更多患者系列的研究对于进一步阐明儿童期颞叶切除的短期和长期风险及益处很重要。
