前颞叶切除术对癫痫患者临床记忆商的影响

Effect of Anterior Temporal Lobectomy on Clinical Memory Quotient in Patients with Epilepsy

目的探讨前颞叶切除术前后癫痫患者临床记忆力的变化。方法58例颞叶癫痫患者均经前颞叶切除手术治疗,其中左侧手术者27例,右侧手术者31例。在手术治疗前后对其记忆商(MQ)进行测定,并比较分析手术预后、术前MQ与术后MQ的关系。结果51例预后EngleⅠ-Ⅱ级,其中术后MQ改善16例(31.4%),无变化30例,下降5例;7例预后Ⅲ-Ⅳ级,其中术后MQ无变化1例,下降6例;两组术后MQ改善率相差显著(P<0.01)。右侧手术者术后MQ评分均值显著高于术前(P<0.01),但左侧手术者手术前后MQ评分均值没有显著差异(P>0.05)。右侧手术组术后MQ改善率(35.5%,11/31)明显高于左侧手术组(18.5%,5/27)。术前MQ障碍者术后MQ改善率(38.5%,10/26)明显高于术前MQ优秀(0.0%,0/5)和中等者(22.2%,6/27)。结论经受了右侧前颞叶手术切除的癫痫病人术后MQ有明显改善,左侧手术者则无明显变化;颞叶癫痫患者的手术预后和术前MQ是影响其术后MQ变化的重要因素。

Objective To explore the effect of anterior temporal lobectomy （ATL） on clinical memory quotient （MQ） in the patients with epilepsy, Methods Of 58 patients with intractable temporal lobe epilepsy undergoing ATL, 27 received the left ATL and 31 the right ATL. MQ was determined in all the patients before and after the operation. The relationship of the postoperative MQ with the operative outcome and preoperative MQ was analyzed. Results Of 51 patients with Engle grades Ⅰ -Ⅱ, 16 improved in the postoperative MQ, 30 had unchanged MQ after the operation, and 5 suffered from a decrease in the postoperative MQ. Of 7 patients with Engle grades Ⅲ-Ⅳ, l had unchanged MQ after the operation, and 6 suffered from a decrease in the postoperative MQ, There was a significant difference in the improving rate of postoperatively MQ between both the groups （P〈0.01）. In the patients undergoing the right ATL, the MQ was significantly higher after the operation than that before the operation （P〈0.05）. In the patients undergoing the left ATL, MQ was insignificantly higher after the operation than that before the operation （P〉0.05）. The improving rate of postoperative MQ in the patients undergoing the right ATL （35.5%, 11/31） was significant higher than that in the patients undergoing the left ATL （18.5%, 5/27; P〈0.05）. The improving rate of MQ after the operation in the patients with preoperative disturbance of MQ （38.5%, 10/ 26） was significant higher than that in the patients with good （0.0%, 0/5） and middle （22.2%, 6/27） preoperative MQ （P〈0.05）, Conclusions The MQ in the patients undergoing right, not left ATL, after the operation was significantly improved compared to that before the operation. The operative outcome and preoperative MQ are closely related to the postoperative MQ in the patients with epilepsy undergoing ATL.