颞叶癫痫发作间期海马放电对患者言语智商的影响

Impact of interictal discharge in hippocampus on verbal intelligence quotient of patients with temporal lobe epilepsy

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 discharge in hippocampus on verbal intelligence quotient （vIQ） of patients with temporal lobe epilepsy （TLE） before and after operative treatment. Methods Clinical data of 48 patients with refractory TLE receiving surgical treatment from January 2011 to January 2015 in our hospital were collected. The patients were assessed with the Wechsler Adult Intelligence Scale （WAIS-RC）, and intraoperatively implanted with electrodes for detecting the hippocampal discharge. Univariate analysis and logistic regression analysis were used to reveal the relationship between the impairment of vlQ and related factors, such as gender and education, age at seizure onset, duration of epilepsy, types and frequency of the TLE, pathology, and hippocampal abnormalities. The change of vIQ was comparatively studied after 1-year operation. Results Interictal discharge in hippocampus （P =0. 030, OR = 11. 341 ）, earlier age of seizure onset （P =0. 045, OR =7. 567） and high frequency of seizure （P=0. 023, OR = 6. 241 ） were the risk factors of pre-operative vIQ impairment. Of these, the interictal discharge in hippocampus was the most dangerous one, whereas hippocampal sclerosis, type and duration of the TLE, lesion side and pathological types were not closely related. Before the operation, the vIQ was significant lower in patients with interictal discharge in hippocampus compared to those of the patients without hippoeampal discharge and the health control （ P 〈 0. 05 ）. No significant difference of vIQ was found in patients without interictal discharge in hippocampus between pre-operation and post-operation （P 〉 0. 05 ）. By contrast, the vIQ of patients with interictal discharge in hippocampus and lesion occurred in the fight side was significantly improved after the operation. Additionally, patients with curative level of Engel I -Ⅱ had a higher vIQ after the operation, but the patients with level of Engel Ill-IV suffered a significant decline of the vlQ （p 〈 0. 05 ）. Conclusion The patients with the interictal discharge in the hippocampus, particularly with the earlier age of seizure onset and high frequency of seizure, would have worse linguistic function.