Intracarotid amobarbital procedure and prediction of postoperative memory in patients with left temporal lobe epilepsy and hippocampal sclerosis
Intracarotid amobarbital procedure and prediction of postoperative memory in patients with left temporal lobe epilepsy and hippocampal sclerosis
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DOI：
10.1111/j.1528-1157.2000.tb00284.x
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发表时间：
2000-08-01
期刊：
影响因子：
5.6
通讯作者：
Walters, GL
中科院分区：
文献类型：
--
作者：
Bell, BD;Davies, KG;Walters, GL
目的：虽然颞叶癫痫（TLE）患者的优势半球海马硬化通常有良好的认知结果后，前颞叶切除术（ATL），少数患者的经验，至少轻微的ATL后下降的一个或多个标准化措施的情节和语义记忆。本调查的目的是确定是否在这组记忆的结果可以预测术前颈动脉内异戊巴比妥酸程序（IAP）识别记忆scores.Methods：从22例左颞叶癫痫患者的数据进行了回顾性研究。所有患者均为左半球语言优势型，每个半球均有IAP评分，病理学证实左海马硬化（HS+）程度显著，除萎缩外无阳性MRI结果。认知结果状态的数量前到后ATL下降跨越三个测试，定义由第90百分位可靠的变化指数（RCI）criteria.Results：只有14%的样本表现出下降一个以上的记忆测试。右下IAP（左半球注射）评分和相对较高的术前认知能力和手术年龄预测ATL后记忆衰退的风险更大。少数左侧TLE HS+患者在ATL后经历至少轻度的情景或语义记忆的RCI定义的下降。右半球IAP记忆评分，其反映了对侧半球的功能储备，可以帮助预测TLE患者术后记忆力下降的风险，其中HS+可能基于MRI上海马萎缩的存在或癫痫发作的早期年龄。
Purpose: Although temporal lobe epilepsy (TLE) patients with dominant hemisphere hippocampal sclerosis generally have good cognitive outcome after anterior temporal lobectomy (ATL), a minority of patients experience at least mild post-ATL decline on one or more standardized measures of episodic and semantic memory. The goal of this investigation was to determine whether memory outcome in this group could be predicted from preoperative intracarotid amobarbital procedure (IAP) recognition memory scores.Methods: Data from 22 left TLE patients were studied retrospectively. All were left hemisphere language dominant and had IAP scores for each hemisphere, a significant degree of pathology-confirmed left hippocampal sclerosis (HS+), and no positive MRI findings other than atrophy. Cognitive outcome status was represented by the number of pre- to post-ATL declines across three tests, as defined by 90th percentile Reliable Change Index (RCI) criteria.Results: Only 14% of the sample exhibited decline on more than one memory test. Low right IAP (left hemisphere injection) scores and relatively high preoperative cognitive ability and age at surgery predicted a greater risk of post-ATL memory decline.Conclusions: A minority of left TLE HS+ patients experience at least a mild degree of RCI-defined decline in episodic or semantic memory after ATL, The right hemisphere IAP memory score, which reflects the functional reserve of the contralateral hemisphere, can help predict the risk of postoperative memory decline for TLE patients in whom HS+ is likely based on the presence of hippocampal atrophy on MRI or early age of seizure onset.