前颞叶切除术对PET阳性、MRI阴性的颞叶癫痫患者认知功能的影响

Effects of anterior temporal lobectomy on cognitive outcomes in patients with PET-positive MRI-negative temporal lobe epilepsy

目的探讨前颞叶切除术对正电子发射体层显像(positron emission tomography,PET)阳性、MRI阴性的颞叶癫痫患者认知功能的影响。方法回顾性分析福州总医院从2004年4月至2017年4月行前颞叶切除术的115例PET阳性、MRI阴性内侧颞叶癫痫患者的临床资料。在术前及术后3个月、1年时,患者均行详细的神经心理学评估,包括智商、记忆和语言功能测评。结果术后1年81例患者(70. 4%)的Engel分级为Ⅰ级。左侧手术组患者术后3个月的言语智商(70. 1±12. 9)和记忆商(73. 2±15. 8)显著减低(均P <0. 05),术后1年有所恢复(71. 2±14. 5; 75. 3±15. 1),但仍明显低于术前水平(75. 8±12. 1; 81. 9±13. 2)(均P <0. 05)。术后两组操作智商和总智商均有升高。左侧手术组患者术后3个月的言语记忆得分(2. 9±1. 8)明显低于术前(5. 4±1. 7)(P <0. 05),术后1年(3. 3±1. 2)有所改善,但仍显著低于术前(P <0. 05)。两组术前视觉记忆(17. 8±8. 1; 16. 5±7. 3)无明显异常,右侧手术组术后3个月(15. 8±8. 3)及术后1年(15. 9±8. 9)轻度减退,左侧手术组与术前无明显变化。结论 PET阳性、MRI阴性的颞叶癫痫难以用药物控制发作而致痫灶诊断明确者,宜行手术治疗。左侧前颞叶切除后部分患者会出现比较明显的词语记忆、语言功能减低;但相对于癫痫发作的有效控制,患者仍是显著受益的。

Objective To evaluate the neuropsychological outcomes of anterior temporal lobectomy （ATL） for the treatment of medically refractory mesial temporal lobe epilepsy （MTLE） in patients who presented with ipsilateral temporal PET hypometabolism and nonlesional magnetic resonance imaging （PET ＋/MRI-）. Methods The clinical data of 115 patients underwent ATL for PET ＋/MRI-MTLE at Fuzhou General Hospital from April 2004 to April 2017 were analyzed retrospectively. All patients underwent a detailed neuropsychological evaluation including Intelligence Quotient （IQ） testing, memory testing, and language testing before and 3 months and 1 year after surgery. Results 81 （70.4%） patients were classified as Engel class I at 1-year follow-up. The mean scores of VIQ （70.1 ± 12.9）and MQ （73.2 ± 15.8 ）in patients with left-sided brain surgery obviously decreased at 3 months after surgery （ all P 〈 0.05 ） , and then returned to near to the preoperative level at 1 year after surgery（71.2 ± 14.5,75.3 ± 15.1 ）. Scores for both PIQ and FIQ were higher at 3 months and at 1 year after surgery than before surgery on either side of the brain. Verbal memory scores obtained at 3 months （2.9 ± 1.8 ） and at 1 year after surgery （ 3.3±1.2 ）were significantly lower than preoperative scores（5.4 ± 1.7 ） for patients who underwent left-sided surgery （ P 〈 0.05 ） , and remained unchanged after right-sided surgery. The visual memory scores were normal before surgery in both left and right groups （ 17.8 ± 8. 1 ; 16.5 ± 7.3 ）. The visual memory scores decreased after right-sided surgery, and remained unchanged after left-sided surgery. Conclusions The anterior temporal lobectomy is associated with favorable long-term postoperative seizure outcomes in patients with medically intractable mesial temporal lobe epilepsy （MTLE） who presented with ipsilateral temporal PET hypometabolism and nonlesional magnetic resonance imaging,but may have a detrimental effect on verbal memory and language ability after left-sided surgery.