药物难治性额叶、颞叶癫痫患者认知功能障碍特点及影响分析

Drug refractory cognitive dysfunction in patients with frontal lobe, temporal lobe epilepsy characteristics and influence factors

目的：探讨药物难治性额叶、颞叶癫痫患者认知功能障碍特点及影响因素。方法：选取2013年2月-2017年1月湛江中心人民医院神经内科收治的55例药物难治性额叶、颞叶癫痫患者（观察组）以及70例药物治疗有效的额叶、颞叶癫痫患者（对照组）作为研究对象，均采用蒙特利尔认知评估量表（MoCA）进行认知功能评分，然后再根据MoCA评分将55例观察组患者进一步分为两个亚组：A组39例，MoCA评分〈18分，B组16例，MoCA评分≥18分。结果：①观察组MoCA视空间与执行能力（t=2．9887，P=0．0034）、命名（t=3．4314，P=0．0008）、注意（t=3．3880，P=0．0009）、语言流畅（t=2．4023，P=0．0178）、抽象思维（t=2．9138，P=0．0042）、延迟记忆（t=2．0736，P=0．0402）、定向力（t=2．1824，P=0．0310）等8个维度评分均显著低于对照组，差异有统计学意义。②观察组A亚组患者与B亚组患者之间性别（χ^2=0．2964，P=0．6097）、发病年龄（t=0．4275，P=0．6708）、病程（t=0．3702，P=0．7127），并发全面性强直阵挛发作（GTCS）患者所占比例（χ^2=0．0388，P=0．8648）相比差异无统计学意义。A亚组患者癫痫发作频率（t=3．3194，P=0．0012）、额叶致痫灶患者所占比例（χ^2=4．4908，P=0．0362）、服用药物种类（t=3．3136，P=0．0017）均显著高于对照组，差异有统计学意义。结论：药物难治性额叶、颞叶癫痫患多存在较严重的认知功能障碍，且与癫痫发作频率、服用药物种类、致痫灶部位密切相关。

Objective： To explore the characteristics and influencing factors of cognitive dysfunction of patients with drug refractory frontal lobe and temporal lobe epilepsy. Methods：55 patients with refractory frontal lobe and temporal lobe epilepsy （the observation group） and 70 cases with frontal lobe and temporal lobe epilepsy treated with drug therapy （ the control group） were selected from the Department of Neurology from February 2013 to January 2017 as the research objects. Their cognitive functions were scored by the Montreal Cognitive Assessment Scale （MoCA）, and then according to the MoCA scores the patients in the observation group were further divided into Group A （39 cases, MoCA scores〈18 points） and Group B （16 cases, MoCA score≥18 points）. Results： （1）of the observe group MoCA The scores of the 8 dimensions including visual space and executive abilities （t = 2. 9887, P = 2. 9887）, naming （t = 3. 4314, P=3. 4314） , attention （t=3. 3880, P=0. 0009）, language fluency （t=2. 4023, P=0. 0178）, abstract thinking （t=2. 9138, P=2. 9138）, delayed memory （t=2. 0736, P=2. 0736） and directional force （t=2. 1824, P=0. 0310） were significantly lower than those of the control group. The difference was statistically significant. （2） The difference in gender （chi-square= 0. 2964, P = 0. 2964）, the onset age （t=0.4275, P=0.6708）, the course of disease （t=0.3702, P=0.3702） and the ratio in patients with concurrent comprehensive stiffness clonus seizures （GTCS） （chi-square= 0. 0388, P= 0. 8648） between Group A and Group B in the observation were no statistically significant. The epileptic seizure fre- quency of Group A （t=3. 3194, P=3. 3194）, the proportion of patients with frontal lobe epilepsy （chi- square=4. 4908, P=4. 4908） and the type of drugs （t=3. 3136, P=3. 3136） were significantly higher than that of the control group, the difference was statistically significant. Conclusion： Severe cognitive dysfunction often occurs in most of patients with drug refractory frontal lobe and temporal lobe epilepsy. with the seizure frequency epileptogenic zone, and is closely related with onset frequency, drug types and position of seizure focus.