中国版神经心理评估在癫痫外科术前评估中的应用

The application of neuropsychological assessment-Chinese version to presurgical evaluation in epilepsy surgery

目的神经心理评估能够对癫痫患者认知及心理功能做出客观的评价,同时也可以作为一种诊断方法,通过评价认知功能及行为的损害来为癫痫术前评估提供定位及定测信息。探讨中国版神经心理评估在癫痫外科术前评估中的致痫灶定位价值。方法本研究回顾性总结分析了自2016年8月至2017年3月在深圳大学第一附属医院完成全套神经心理评估,并进行了癫痫手术且术后6个月以上无发作的患者资料。根据致痫灶部位将所有患者分为三组,即左颞内侧结构起源组5例(Left Mesial Temporal,LMT)、右颞内侧结构起源组4例(Right Mesial Temporal,RMT)和左侧半球其他部位起源组5例(Left hemisphere,LH)。中国版神经心理评估内容主要包括:利手测试、IQ测试、Rey复杂图形测试、抽象图形测试(Aggi Figure Learning Test,AFLT)、Token测试、人脸识别测试、抽象词语记忆测试(Abstract Verbal Learning Test,AVLT)、条件联系学习测试、BEM抽象图形再识测试等。结果在AFLT测试中,LMT及LH组学习曲线形成较好,而RMT组患者AFTL的学习曲线形成显著欠佳,三组患者在即刻回忆及延迟回忆时均未见明显丢失。在AVLT测试中,所有颞叶内侧癫痫患者(LMT和RMT)完成情况均较LH组差(LH> RMT> LMT),三组患者在即刻回忆和延迟回忆时均有所丢失,丢失程度趋势为LMT> RMT> LH。BEM测试结果显示所有RMT组结果均显著异常,而LH组和LMT组患者,只有AFLT结果中最好回忆结果小于10的患者才有BEM结果的显著异常。结论神经心理评估方法能够很好的评估人脑各脑区的功能,评测结果与神经影像学和/或者术后结果一致性较高。中国改良版AFLT vs. AWLT在左侧颞叶内侧癫痫患者有较好的定位价值,但须在其他测试结果均正常的基础上。右侧颞叶内侧癫痫患者中,两者结果均有所下降,但与BEM结果和其他测试联合分析,有助于致痫灶定位。

Objective The role of a neuropsychological assessment is to provide a comprehensive and objective assessment of an individual's cognitive and psychological functioning.The impairments in cognition or behavior can provide clues to the lateralization or localization of the seizure network,or the nature of the epilepsy syndrome.This study analyzed a series of cases to explore the role of Neuropsychological Testing Battery-Chinese version in presurgical evaluation for refractory epilepsy patients.Methods This article analyzed the postoperative epilepsy patients from August 2016 to March 2017 in the First Affiliated Hospital of Shenzhen Univeristy who completed a full set of neuropsychological assessments and have seizui'e free for more than 6 months.According to epileptogenic zone (EOZ),all of the patients were divided into three groups,left mesial temporal group (LMT),right mesial temporal group (RMT)and other origins within left hemisphere (LH).The Chinese version of the neuropsychological Test Battery mainly includes:Handedness Testing,IQ Testing,Rey Complex Figure Testing,Aggi Figure Learning Testing (AFLT),Token Testing,Face recognition memory Testing,Abstract Verbal Learning Testing (AVLT),Conditions Associated Learning Test (CALT),BEM Testing.Results In AFLT test,LH and LMT group had normal learning curve.The RMT group had significant poor performance in the AFLT.However,None of the three groups had significant loss in the immediate recall and delayed recall testing.In AVLT test,the scores of the LH group were better than the patients with mesial temporal epilepsy (including LMT&RMT),however,the difference among three groups was not significant probably due to the limited number of the patients.All groups had various degree of words loss in the immediate recall and delayed recall testing (LMT>RMT>LH).The results of the BEM test showed that the score of RMT group were significantly abnormal,while it was normal in the LH and the LMT group,except for the patients with declined function of the right temporal (AFLTmax<10).Conclusion Neuropsychological assessment can be used to evaluate the function of the different brain areas,and the results of the evaluation are consistent with the imaging and/or postoperative results.Chinese modified AFLT vs. AWLT has better evaluation value in the patients with left mesial temporal lobe epilepsy,whose performance in the other tests was usually normal.The scores of the Chinese modified AFLT and AWLT in the right mesial temporal lobe epilepsy patients were lower than the LH.The difference between AFLT and AVLT was not significant,probably due to t the Chinese characters in the AVLT which may have figure properties.But,combination with BEM test and the other tests could be helpful to lateralize and/or localize the EOZ.