Examining factors related to accelerated long-term forgetting in epilepsy using ambulatory EEG monitoring
Examining factors related to accelerated long-term forgetting in epilepsy using ambulatory EEG monitoring
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DOI：
10.1111/epi.12090
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发表时间：
2013-05-01
期刊：
影响因子：
5.6
通讯作者：
Miller, Laurie A.
中科院分区：
文献类型：
--
作者：
Fitzgerald, Zoe;Thayer, Zoe;Miller, Laurie A.
一些癫痫患者在相对较短的时间间隔内进行记忆测试时表现出正常的记忆力（例如，30分钟），但是在较长的延迟时间段上的实质性损失（例如，天或周）。这种加速长期遗忘（ALF）模式影响患者的日常生活，但未被标准神经心理学记忆测试检测到，其病理生理基础也知之甚少。通过在一段时间内同时进行动态脑电图（EEG）测试记忆，本研究旨在调查可能导致ALF的因素。方法对39例临床诊断为癫痫或疑似癫痫的患者进行连续5d动态脑电图检查，其中18例脑电图正常，10例有局灶性癫痫放电，5例有全身性癫痫放电，6例有一次或多次癫痫发作。15名匹配的健康对照受试者也参加了研究，但没有进行EEG。受试者被教导13个项目的单词和设计列表的标准，并在30分钟，24小时和4d的回忆进行了测试。受试者还完成了有关日常记忆和情绪的问卷调查。关键发现组分析（不包括在监测期间发生癫痫发作的患者）表明，在24小时至4天延迟间隔期间发生全身放电的患者表现出更高的非语言信息遗忘率。有局灶性放电的患者在30分钟到40天之间的言语信息中出现ALF，而脑电图正常的患者在40天内没有ALF的证据。令人惊讶的是，情绪和癫痫变量（如疾病持续时间或抗惊厥药物的数量）与ALF没有显着相关性。虽然没有发现夜间睡眠结构的任何方面与前24小时后的回忆有关，但白天小睡与更好的保持有关。日常记忆功能的自我报告与较长延迟的回忆有关，但在30分钟时则无关。本研究结果表明，癫痫患者的ALF与亚临床放电有关，而与抗癫痫药物（AEDs）、情绪或睡眠障碍无关。长期回忆的测量可以揭示与主观日常记忆投诉的相关性，当回忆仅在标准（30分钟）延迟间隔下进行测试时，这些相关性并不明显。这些发现有可能改善那些抱怨记忆困难的患者的治疗策略。
Purpose Some patients with epilepsy demonstrate normal memory when this is tested at relatively short intervals (e.g., 30min), but substantial loss over longer delay periods (e.g., days or weeks) when compared to healthy control subjects. This pattern of accelerated long-term forgetting (ALF) affects the everyday lives of patients, yet goes undetected by standard neuropsychological memory tests, and its pathophysiologic basis is poorly understood. By testing memory over a period of concurrent ambulatory electroencephalography (EEG), the current study aimed to investigate possible factors contributing to ALF. Methods Thirty-nine patients diagnosed with epilepsy or probable epilepsy underwent 5days of continuous ambulatory EEG: 18 had normal EEG studies, 10 had focal epileptic discharges, 5 had generalized epileptic discharges, and 6 had one or more seizures. Fifteen matched healthy control subjects also participated, but did not undergo EEG. Subjects were taught 13-item word and design lists to criterion, and recall was tested at 30min, 24h, and 4days. Subjects also completed questionnaires pertaining to everyday memory and mood. Key Findings Group analyses (excluding patients who experienced seizures during monitoring) indicated that patients who experienced generalized discharges during the 24-h to 4-day delay intervals showed higher rates of forgetting for nonverbal information. Those with focal discharges showed ALF between 30min and 4days for verbal information, whereas those with normal EEGs over the 4days recording had no evidence of ALF. Surprisingly, mood and epilepsy variables (such as duration of disease or number of anticonvulsant medications) showed no significant correlation with ALF. Although no aspect of nighttime sleep architecture was found to be related to recall after the first 24h, daytime naps were associated with better retention. Self-report of everyday memory functioning was related to recall at longer delays, but not at 30min. Significance The present findings indicated that ALF in epilepsy is associated with subclinical discharges rather than antiepileptic drugs (AEDs), mood or sleep disturbance. Measures of longer-term recall can reveal correlations with subjective everyday memory complaints that are not evident when recall is only tested at a standard (30min) delay interval. These findings have the potential to improve treatment strategies for patients who complain of memory difficulties.