背景:内侧颞叶癫痫中,仅有胶质增生(GO)和海马硬化(HS)是不同的组织病理学实体。这项研究探讨了在评估术前和术后记忆时,这种区别是否也存在于功能水平上。
方法:使用回顾性匹配的病例对照研究设计,我们分析了49例GO患者和49例HS患者择期手术前后的言语和视觉记忆表现.
结果:临床差异明显,癫痫发作年龄越晚(18±12vs12±9岁),术后无癫痫发作的患者越少(63%vs82%)。术前,群体和个体水平的数据表明,记忆障碍的频率较低,与HS相比,GO患者的严重程度较低且相对非特异性。术后,两组的言语记忆力都下降了,尤其是在左侧切除后,GO患者的损失更大。考虑地板效果,GO还与更显著的视觉记忆丧失有关,特别是在左切除后。
结论:与HS相比,GO的特点是(1)癫痫发作较晚,(2)手术前不太明显和更多的非特异性记忆障碍,(3)手术效果较差,(4)术后记忆力下降更明显。总的来说,我们关于认知的结果提供了进一步的证据,证明GO和HS是不同的临床实体.海马的功能完整性在GO中表现得更高,术前记忆表现更好,术后记忆结果更差。术前患者咨询期间应考虑不同的风险收益比。
BACKGROUND: Gliosis only (GO) and hippocampal sclerosis (HS) are distinct histopathological entities in mesial temporal lobe epilepsy. This study explores whether this distinction also exists on a functional level when evaluating pre- and postoperative memory.
METHODS: Using a retrospective matched
case-control study design, we analysed verbal and visual memory performance in 49 patients with GO and 49 patients with HS before and one year after elective surgery.
RESULTS: Clinical differences were evident with a later age at seizure onset (18±12 vs 12±9 years) and fewer postoperative seizure-free patients in the GO group (63% vs 82%). Preoperatively, group and individual-level data demonstrated that memory impairments were less frequent, less severe and relatively non-specific in patients with GO compared with HS. Postoperatively, verbal memory declined in both groups, particularly after left-sided resections, with more significant losses in patients with GO. Factoring in floor effects, GO was also associated with more significant visual memory loss, particularly after left resections.
CONCLUSIONS: Compared with HS, GO is characterised by (1) a later onset of epilepsy, (2) less pronounced and more non-specific memory impairments before surgery, (3) a less successful surgical outcome and (4) a more significant memory decline after surgery. Overall, our results regarding cognition provide further evidence that GO and HS are distinct clinical entities. Functional integrity of the hippocampus appears higher in GO, as indicated by a better preoperative memory performance and worse memory outcome after surgery. The different risk-benefit ratios should be considered during presurgical patient counselling.