以丙泊酚作替代的Wada试验对颞叶癫痫手术患者记忆优势半球判定价值分析

Analysis of the value of memory predominant hemisphere in patients undergoing temporal lobe epilepsy surgery by using propofol as an alternative Wada test

目的评估以丙泊酚作替代的Wada试验对记忆优势半球的判定价值。方法选择2012年2月—2016年12月于河北省人民医院功能神经外科顺利完成Wada试验,并进行手术治疗的颞叶癫痫患者64例。应用中国修订版韦氏记忆量表测定颞叶癫痫患者手术前后记忆商(MQ),比较患者手术治疗前1周与手术后6个月记忆功能的差异。结果所有患者均配合完成测验,MQ平均(96.06±5.54)分,其中长时记忆平均(29.28±2.92)分,短时记忆平均(57.12±4.25)分,瞬时记忆平均(9.65±1.49)分。颞叶癫痫患者MQ和分测验中短时记忆较正常常模(分别为100和60)低,差异有统计学意义(P<0.05)。确定记忆优势半球患者47例,术后6个月再次进行韦氏记忆测验,术前与术后相比较MQ(95.94±5.83 vs. 95.45±5.78)差异无统计学意义,其中长时记忆(29.04±3.19 vs. 28.45±2.83),短时记忆(57.28±4.26 vs. 57.55±4.10),瞬时记忆(9.62±1.54 vs. 9.45±1.56)比较差异均无统计学意义(P>0.05)。结论应用丙泊酚替代的Wada试验对于颞叶癫痫患者的记忆优势半球具有判定作用,可以作为颞叶癫痫患者术前评估的方法。

Objective To evaluate the value of propofol as an alternative to the Wada test for memory dominance hemisphere.Methods From February2012to December2016,the Wada test was successfully completed in the Department of Functional Neurosurgery of Hebei People’s Hospital,and64patients with temporal lobe epilepsy were treated surgically.The memory quotient(MQ)of patients with temporal lobe epilepsy was measured by the revised Wechsler Memory Scale of China before and after operation.The difference of memory function was compared between one week before operation and six months after operation.Results All patients completed the test with an average MQ of96.06±5.54,including average long-term memory(29.28±2.92),average short-term memory(57.12±4.25)and average instantaneous memory(9.65±1.49).Compared with the normal norm,the MQ(81.04±7.29vs.100)and short-term memory(48.18±7.56vs.60)were lower in patients with temporal lobe epilepsy(P<0.05).Forty-seven patients with hemispheric dominance of memory were treated surgically.Wechsler’s memory test was performed again6months after operation.There was no significant difference in MQ before and after operation(95.94±5.83vs.95.45±5.78)between the two groups(P>0.05).There were also no significant differences in long-term memory(29.04±3.19vs.28.45±2.83),short-term memory(57.28±4.26vs.57.55±4.10)and instantaneous memory(9.62±1.54vs.9.45±1.56)before and after operation between the two groups(P>0.05).Conclusion The study confirms that the Wada test with propofol substitution could be used to determine the dominant hemisphere of memory in patients with temporal lobe epilepsy and could be used as a method for preoperative evaluation of temporal lobe epilepsy.