Chronic epilepsy and cognition: A longitudinal study in temporal lobe epilepsy
Chronic epilepsy and cognition: A longitudinal study in temporal lobe epilepsy
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DOI：
10.1002/ana.10692
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发表时间：
2003-10-01
影响因子：
11.2
通讯作者：
Elger, CE
中科院分区：
文献类型：
--
作者：
Helmstaedter, C;Kurthen, M;Elger, CE
目前尚不清楚不受控制的癫痫是否会导致智力下降。这项纵向研究对比了 147 名接受手术治疗的颞叶癫痫患者和 102 名接受药物治疗的颞叶癫痫患者的记忆功能和非记忆功能的变化。所有参与者均在基线 (T1) 和 2 至 10 年后 (T3) 进行评估。手术患者术后一年接受额外检查（T2）。在个人和团体层面上分析数据。 63% 的手术患者和 12% 的药物治疗患者在 T3 时没有癫痫发作。 50% 的药物治疗患者和 60% 的手术患者在 T3 时表现出显着的记忆力下降，非记忆功能几乎没有变化（差异不显着）。手术预期了药物治疗组中出现的下降，并且在左侧手术时或术后癫痫持续发作时超过了下降。无癫痫发作的手术患者在 T2 时表现出非记忆功能恢复（p < 0.001），在 T3 时表现出记忆功能恢复（T3，p = 0.03）。多元回归表明重测间隔、癫痫控制和心理储备能力是表现变化的预测因素。此外，当癫痫发作得到控制时，心理社会结果会更好。总之，慢性颞叶癫痫与进行性记忆障碍有关。手术，尤其是不成功的手术，会加速这种衰退。然而，如果癫痫发作得到完全控制，记忆力下降可能会停止甚至逆转。
it remains unclear whether uncontrolled epilepsy causes mental decline. This longitudinal study contrasts change of memory and nonmemory functions in 147 surgically and 102 medically treated patients with temporal lobe epilepsy. All participants were evaluated at baseline (T1) and after 2 to 10 years (T3). Surgical patients underwent additional testing I year postoperatively (T2). Data were analyzed on an individual and group level. Sixty-three percent of the surgical and 12% of the medically treated patients were seizure-free at T3. Fifty percent of the medically treated and 60% of the surgical patients showed significant memory decline at T3 with little change in nonmemory functions (difference not significant). Surgery anticipated the decline seen in the medically treated group and exceeded it when surgery was performed on the left, or if seizures continued postoperatively. Seizure-free surgical patients showed recovery of nonmemory functions at T2 (p < 0.001) and of memory functions at T3 (T3, p = 0.03). Multiple regression indicated retest interval, seizure control, and mental reserve capacity as predictors of performance changes. In addition, psychosocial outcome was better when seizures were controlled. In conclusion, chronic temporal lobe epilepsy is associated with progressive memory impairment. Surgery, particularly if unsuccessful, accelerates this decline. However, memory decline may be stopped and even reversed if seizures are fully controlled.