头颅MRI海马像异常与难治性内侧颞叶癫癎患者近期记忆损害

Recent memory consequences of drug-resistant medial temporal lobe epilepsy and MRI-positive hippocampns

目的探讨难治性内侧颞叶癫癎（MTLE）患者影像学异常及发作间期放电（IEDs）优势侧对近期记忆损害的影响。方法纳入2006年9月至2007年4月我院癫癎中心门诊就诊的难治性MTLE患者50例，根据MRI海马像检查将其分为左侧MRI（＋）组、右侧MRI（＋）组、MRI（-）组及双侧MRI（＋）组。综合多次IEDs结果进行评定，若一侧独立IEDs≥75％，则判为IEDs优势侧。采用临床记忆量表（CMS）对患者进行记忆评定。结果年龄、性别、职业、文化程度、是否来自农村、病程、发作情况、药物治疗各因素在4组间的分布相匹配。各组记忆商（MQ）及分量表的年龄量表分比CMS正常均数差（P〈0．05）。右侧MRI（＋）组无意义图形再认得分（9．42±7．46）相对于左侧MRI（＋）组（16．26±4．43）和MRI（-）组（18．26±5．49）低（F=4．281，P〈0．05）。MRI（-）者中左侧IEDs、右侧IEDs、双侧IEDs 3组间MQ及各分量表的年龄量表分值均无统计学意义。结论右侧MRI（＋）MTLE患者在空间图形记忆方面的损害更加显著，无意义图形再认对于非语言记忆的评价有较高的特异性。

Objective To assess the effects of MRI-positive and interictal epileptic charges （IEDs） dominance on the memory of the patients with drug-resistant medial temporal lobe epilepsy （ MTLE ）. Methods Fifty right-handed patients （age ranging from 16 to 60 years old） diagnosed as drug-resistant MTLE in our hospital with normal intelligence between September 2006 and April 2007 were investigated. All patients were classified as left MRI-positive （ MRI （ ＋ ） ）, right MRI （ ＋ ）, MRI （ - ）, bilateral MRI （ ＋ ） by high-quality MRI protocol. The EEG was defined as dominant IEDs if ≥75% independent IEDs was confined to one temporal lobe in all EEG recordings. Clinical memory scale was administered as memory assessment of MTLE. ANOVA and non-parametric statistics were used to analyze the data in SPSS 12.0. Results The distribution of age, sex, education, occupation, living condition, course, seizure and treat among left MRI （ ＋ ）, right MRI （ ＋ ）, MRI （ - ）, bilateral MRI （ ＋ ） groups was similar. All scores in the patients with MTLE was significantly lower than normal （P 〈 0.05）. Right MRI （ ＋ ） MTLE patients had deficits in nonsense graphics recognition （9.42 ± 7. 46） compared to left MRI （ ＋ ） and MRI （ - ） groups （ （ 16. 26 ± 4. 43 ） and （ 18. 26 ± 5.49）, F = 4.281, P 〈 0.05 ）. Among MRI （ - ） patients, left IEDs, right IEDs and bilateral IEDs groups displayed not significantly different impairment in memory. Conclusion Right MRI （ ＋ ） MTLE has more severe impairment in non-verbal memory, and nonsense graphics recognition can be used to detect the deficit.