目的:颞叶癫痫(TLE)和阿尔茨海默病(ad)患者表现出增加的β-淀粉样蛋白和tau沉积,相对于患有TLE或AD的患者。在这两种疾病的患者中,广告的呈现可能是非典型且更快。我们对一名68岁的老人进行了四次连续的神经心理学评估(NPE),有癫痫病史的右撇子女性(治疗难治性),神经外科切除术,以及早发性AD的偶然神经病理学发现。
方法:病史包括青春期全身强直阵挛性发作和许多复杂的部分性发作,在丙戊酸上管理了约20年。在63岁时,她报告了记忆变化。神经生理学检查显示右额颞叶癫痫发作病灶,神经影像学研究显示淀粉样血管病。她接受了右颞叶切除术和杏仁核海马切除术。之后,癫痫发作控制和感知记忆功能改善。术后病理分析检测到神经原纤维缠结,神经炎斑块,血管病变,缺氧变化,和神经胶质增生。稍后,她和家人描述了记忆力下降和行为抑制。后续CSF分析确定p-tau/β-淀粉样蛋白比率与ad一致。
结果:术前NPE基本完整。术后NPE显示稳定/改善的执行功能(EF),视觉空间技能(VS),和记忆,语言的可变性。10个月后的NPE随访确定了总体稳定性和一些变异性(例如,源内存困难)。此后16个月的NPE随访显示几个领域的下降,保留VS和语言。
结论:我们介绍了患有难治性TLE和早发性AD的个体的认知轨迹,并发神经外科切除术的认知/神经精神后遗症。此案例突显了连续重新评估在评估难治性TLE老龄化人群中提示广告的认知变化方面的潜在益处。
OBJECTIVE: Patients with Temporal Lobe Epilepsy (TLE) and Alzheimer\'s Disease (ad) demonstrate increased β-amyloid and tau deposition, relative to patients with either TLE or ad. Presentation of ad may be atypical and more rapid in patients with both disorders. We present four serial neuropsychological evaluations (NPE) of a 68-year-old, right-handed woman with history of epilepsy (which became treatment refractory), neurosurgical resection, and incidental neuropathological findings of early-onset ad.
METHODS: History included generalized tonic-clonic seizure in adolescence and numerous complex partial seizures, managed for ~20 years on valproic acid. At age 63, she reported memory changes. Neurophysiological work-up revealed right frontotemporal seizure foci, and neuroimaging studies revealed amyloid angiopathy. She underwent right anterior temporal lobectomy and amygdalohippocampectomy. Afterwards, seizure control and perceived memory function improved. Post-surgical pathological analysis detected neurofibrillary tangles, neuritic plaques, angiopathy, anoxic changes, and gliosis. Later, she and family described memory decline and behavioral disinhibition. Follow-up CSF analysis identified p-tau/β-amyloid ratio consistent with ad.
RESULTS: Presurgical NPE was largely intact. Post-surgical NPE revealed stable/improved executive functioning (EF), visuospatial skills (VS), and memory, with variability in language. Follow-up NPE 10 months later identified general stability with some variability (e.g., source memory difficulties). Follow-up NPE 16 months after that revealed declines in several domains, with sparing of VS and language.
CONCLUSIONS: We present the cognitive trajectory of an individual with refractory TLE and early-onset ad, complicated by cognitive/neuropsychiatric sequelae of neurosurgical resection. This
case highlights the potential benefits of serial re-evaluation in assessing for cognitive change suggestive of ad in aging populations with refractory TLE.