Martin R C, Sawrie S M, Roth D L, Gilliam F G, Faught E, Morawetz R B, Kuzniecky R
University of Alabama at Birmingham, School of Medicine, Department of Neurology, Epilepsy Center, 35294-0021, USA.
Epilepsia. 1998 Oct;39(10):1075-82. doi: 10.1111/j.1528-1157.1998.tb01293.x.
To characterize patterns of base rate change on measures of verbal and visual memory after anterior temporal lobectomy (ATL) using a newly developed regression-based outcome methodology that accounts for effects of practice and regression towards the mean, and to comment on the predictive utility of baseline memory measures on postoperative memory outcome.
Memory change was operationalized using regression-based change norms in a group of left (n = 53) and right (n = 48) ATL patients. All patients were administered tests of episodic verbal (prose recall, list learning) and visual (figure reproduction) memory, and semantic memory before and after ATL.
ATL patients displayed a wide range of memory outcome across verbal and visual memory domains. Significant performance declines were noted for 25-50% of left ATL patients on verbal semantic and episodic memory tasks, while one-third of right ATL patients displayed significant declines in immediate and delayed episodic prose recall. Significant performance improvement was noted in an additional one-third of right ATL patients on delayed prose recall. Base rate change was similar between the two ATL groups across immediate and delayed visual memory. Approximately one-fourth of all patients displayed clinically meaningful losses on the visual memory task following surgery. Robust relationships between preoperative memory measures and nonstandardized change scores were attenuated or reversed using standardized memory outcome techniques.
Our results demonstrated substantial group variability in memory outcome for ATL patients. These results extend previous research by incorporating known effects of practice and regression to the mean when addressing meaningful neuropsychological change following epilepsy surgery. Our findings also suggest that future neuropsychological outcome studies should take steps towards controlling for regression-to-the-mean before drawing predictive conclusions.
使用一种新开发的基于回归的结果方法来描述前颞叶切除术（ATL）后言语和视觉记忆测量中基础率变化的模式，该方法考虑了练习效应和向均值回归的影响，并对基线记忆测量对术后记忆结果的预测效用进行评论。
在一组左（n = 53）右（n = 48）ATL患者中，使用基于回归的变化规范来操作记忆变化。所有患者在ATL前后均接受了情景言语（散文回忆、列表学习）和视觉（图形复制）记忆以及语义记忆测试。
ATL患者在言语和视觉记忆领域表现出广泛的记忆结果。25% - 50%的左ATL患者在言语语义和情景记忆任务上表现出显著下降，而三分之一的右ATL患者在即时和延迟情景散文回忆方面表现出显著下降。另外三分之一的右ATL患者在延迟散文回忆方面表现出显著改善。在即时和延迟视觉记忆方面，两个ATL组之间的基础率变化相似。大约四分之一的患者在术后视觉记忆任务上出现了具有临床意义的损失。使用标准化记忆结果技术时，术前记忆测量与非标准化变化分数之间的稳健关系减弱或反转。
我们的结果表明ATL患者在记忆结果方面存在很大的组间差异。这些结果通过在解决癫痫手术后有意义的神经心理学变化时纳入已知的练习效应和向均值回归的影响，扩展了先前的研究。我们的发现还表明，未来的神经心理学结果研究在得出预测性结论之前应采取措施控制向均值回归的影响。
