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目的探讨发作间期海马放电对于颞叶癫痫(temporal lobe epilepsy,TLE)患者手术前后言语智商(verbal intelligence quotient,v IQ)的影响。方法收集我院2011年1月至2015年1月48例TLE患者临床资料,行韦氏智力量表评分。头皮脑电及术中植入深部电极,探测发作间期海马放电情况。将患者性别、起病年龄、病程、颞叶癫痫类型、发作形式、发作频率、发作间期海马放电、病理类型、教育程度等因素进行分层后就术前v IQ受损进行单因素比较和多因素Logistic回归分析。分析患者术后1年v IQ变化情况。结果发作间期海马放电(P=0.030,OR=11.341)、低年龄起病(P=0.045,OR=7.567)、高发作频率(P=0.023,OR=6.241)是TLE患者术前v IQ受损的危险因素,伴有发作间期海马放电者出现v IQ受损的风险最高,而与海马硬化、颞叶癫痫类型、病程、病灶侧及病理类型等无关(P>0.05)。伴发作间期海马放电组术前v IQ明显低于无海马放电组及健康对照组。无海马放电患者术后v IQ与术前相比无明显变化(P>0.05)。在有发作间期海马放电的患者中,病灶位于右侧者术后v IQ有明显改善。术后疗效达到EngelⅠ~Ⅱ级者v IQ有明显改善,而EngelⅢ~Ⅳ级者会出现言语功能的恶化(P<0.05)。结论伴有发作间期海马放电,尤其是低年龄起病及发作频率高的颞叶癫痫患者,出现语言障碍的风险更大。
Objective To investigate the effect of interictal hippocampal discharge on verbal intelligence quotient (v IQ) in patients with temporal lobe epilepsy (TLE) before and after surgery. Methods The clinical data of 48 TLE patients from January 2011 to January 2015 in our hospital were collected. Wechsler’s mental rating scale was used. Scalp EEG and intraoperative implantation of deep electrodes to detect seizure hippocampal discharge situation. Patients were stratified by gender, age of onset, duration of disease, type of temporal lobe epilepsy, seizure pattern, frequency of seizure, hippocampal discharge in the interictal period, pathological type, education level and other factors. Single factor comparison Multivariate logistic regression analysis. Analysis of patients after 1 year of v IQ changes. Results The interictal hippocampal discharge (P = 0.030, OR = 11.341), onset at lower age (P = 0.045, OR = 7.567), high seizure frequency (P = 0.023, OR = 6.241) However, there was no correlation between hippocampal sclerosis, temporal lobe epilepsy, duration of disease, lesion side and pathological type (P> 0.05). Preoperative v IQ was significantly lower in hippocampal discharge group than in non-hippocampal discharge group and healthy control group. No postoperative hippocampal discharge in patients with v IQ compared with preoperative no significant change (P> 0.05). In patients with interictal hippocampus discharges, there was a significant improvement in v IQ after the lesion was located on the right side. Postoperative efficacy of Engel Ⅰ ~ Ⅱ grade v IQ significantly improved, while Engel Ⅲ ~ Ⅳ grade speech function deterioration (P <0.05). Conclusions Patients with temporal lobe epilepsy accompanied by interictal hippocampal discharge, especially those with low age onset and high frequency of seizures, have a greater risk of speech impairment.