Interaction of cognitive aging and memory deficits related to epilepsy surgery
Interaction of cognitive aging and memory deficits related to epilepsy surgery
复制标题
DOI：
10.1002/ana.10260
复制
发表时间：
2002-07-01
影响因子：
11.2
通讯作者：
Elger, CCE
中科院分区：
文献类型：
--
作者：
Helmstaedter, C;Reuber, M;Elger, CCE
颞叶癫痫手术会导致严重的记忆障碍。这项研究的目的是检查手术是否也会影响老年记忆的预后。对187例患者（左颞叶手术前和手术后1年）和264名健康对照者进行了言语记忆的年龄回归研究。80例行选择性杏仁核切除术，107例行前三分之二颞叶切除术。杏仁核切除术患者有近中颞叶癫痫;前三分之二颞叶切除术患者有更多的近中外或弥漫性癫痫发作区。记忆评估的单词列表学习更近中（巩固/检索）和更多的新皮层（学习）方面。患者表现出明显的术前记忆障碍。独立于癫痫发作的结果和手术方法，手术对学习和巩固/检索有显着的负面影响。在杏仁核campectomy组，术前和术后的学习和巩固/检索的年龄回归与对照组没有差异。在前三分之二颞叶切除术组中，语言学习的年龄回归在手术后变得更陡峭，并且巩固/检索与年龄较大和癫痫发作较晚（甚至在手术前）呈负相关。这些数据证实了左颞叶癫痫患者的言语记忆的年龄回归与健康对照相似。左前三分之二颞叶切除术和杏仁核切除术都使患者的语言学习和记忆恶化，使患者更接近认知障碍。特别是在前三分之二颞叶切除术的患者中，手术和代偿能力的降低导致终身记忆衰退的加速。研究结果支持早期和定制的癫痫手术，并建议在老年记忆预后应考虑，如果更广泛的颞叶切除术将是不可避免的。
Temporal lobe epilepsy surgery can cause significant memory impairment. This study was intended to examine whether surgery also could affect prognosis of memory in older age. Age regression of verbal memory was examined in 187 patients (before and 1 year after left temporal lobe surgery) and 264 healthy controls. Eighty patients underwent selective amygdalohippocampectomy, and 107 patients underwent anterior two-thirds temporal lobectomy. Amygdalohippocampectomy patients had mesiotemporal epilepsy; anterior two-thirds temporal lobectomy patients had more extramesial or diffuse seizure onset zones. Memory was assessed by word list learning for its more mesial (consolidation/retrieval) and more neocortical (learning) aspects. Patients showed significant preoperative memory impairment. Independent of seizure outcome and surgical approach, surgery had significant negative effects on learning and consolidation/retrieval. In the amygdalohippocampectomy group, preoperative and postoperative age regressions of learning and consolidation/retrieval were not different from those of controls. In the anterior two-thirds temporal lobectomy group, age regression of verbal learning became steeper after surgery, and consolidation/retrieval was negatively correlated with older age and later onset of epilepsy even before surgery. The data confirm that age regression of verbal memory in left temporal lobe epilepsy is similar to that in healthy controls. Both left anterior two-thirds temporal lobectomy and amygdalohippocampectomy worsen verbal learning and memory and bring patients closer to cognitive disability. Particularly in anterior two-thirds temporal lobectomy patients, surgery and reduced capacities for compensation cause acceleration of lifetime memory decline. The results support earlier and tailored epilepsy surgery and suggest that memory prognosis in older age should be considered if more extensive temporal resections would be inevitable.