Long term effects of refractory temporal lobe epilepsy on cognitive abilities: a cross sectional study
Long term effects of refractory temporal lobe epilepsy on cognitive abilities: a cross sectional study
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DOI：
10.1136/jnnp.67.1.44
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发表时间：
1999-07-01
影响因子：
11
通讯作者：
Ebner, A
中科院分区：
文献类型：
--
作者：
Jokeit, H;Ebner, A
目的：顽固性癫痫与各种短暂和慢性的脑电和神经化学障碍有关。越来越多的证据表明，慢性癫痫会导致继发性神经元代谢和结构衰退。方法：为探讨难治性颞叶癫痫(TLE)的病程与全身性认知功能障碍的关系，对209例单侧TLE患者进行了基于全量表智商(FSIQ，WAIS-R)的智力测试。方差分析(ANOVA)将患者分为三类：30年难治性TLE。结果：单因素方差分析和多元回归分析显示TLE持续时间影响FSIQ。患有30年TLE的患者比患有15年或30年TLE的患者表现更差。发作侧因素、发作起因、病变类型、MRI检查均无显着性差异。第二个包括教育因素的方差分析显示，在受教育程度较高的患者中，与受教育程度较低的患者相比，平均FSIQ在TLE持续时间内保持稳定。前额叶切除术后6个月复查，无癫痫发作的患者(n=85)FSIQ较高，但前额叶切除术前后的持续效应相似。对癫痫起病年龄、文化程度、发作间期癫痫样放电频率、习惯性发作和全身性发作、抗癫痫药物血药浓度、综合用药等变量进行统计学控制。结论：难治性TLE患者的心理测量智力受损最严重。因此，难治性TLE似乎与缓慢但持续的认知退化有关。据推测，癫痫相关的有害事件和药物耗尽了大脑功能的代偿能力。然而，就像痴呆症和阿尔茨海默病一样，更高的教育程度作为大脑储备更高的指标可能会延缓认知能力的下降。
Objective-Intractable epilepsy is related to various transient and chronic brain electric and neurochemical disturbances. There is increasing evidence that chronic epilepsy induces secondary neuronal metabolic and structural decline. However, there is no convincing evidence that the cognitive abilities of patients deteriorate with increasing duration of intractable epilepsy.Methods-To examine whether duration of refractory temporal lobe epilepsy (TLE) is related to generalised cognitive impairment, psychometric intelligence based on the full scale intelligence quotient (FSIQ, WAIS-R) was determined in 209 patients with unilateral TLE. For analyses of variance (ANOVA) patients were grouped into three categories: 30 years of refractory TLE.Results-An ANOVA and a multiple regression analysis showed that duration of TLE affects FSIQ. Patients with >30 years of TLE performed worse than patients with 15 or 30 years of TLE. The factors side of seizure origin and type of lesion an MRI did not reach significance. A second ANOVA including education as factor showed that in patients with higher educational attainment, the mean FSIQ was stable for a longer duration of TLE than in less educated patients. Retesting 6 months after anterior temporal lobectomy seizure free patients (n=85 of 127) had an higher FSIQ but showed a similar duration effect before and after anterior temporal lobectomy. The variables age at epilepsy onset, education, frequency of interictal epileptiform discharges, frequency of habitual and generalised seizures, serum concentration of anti-epileptic drugs, and polypharmacy were statistically controlled.Conclusions-Psychometric intelligence of patients with a longer duration of refractory TLE were most severely impaired. Consequently, refractory TLE seems to be associated with slow but ongoing cognitive deterioration. It is assumed that epilepsy related noxious events and agents exhaust the compensatory capacity of brain functions. However, as in dementia and Alzheimer's disease, higher educational attainment as an indicator of higher brain reserve might delay the cognitive decline.