外伤后癫痫患者的神经心理学评估

Neuropsychological evaluation of post-traumatic epilepsy

目的探讨外伤后癫痫患者的神经心理损害的范围及程度。方法回顾性分析2016年1月—2018年12月联勤保障部队第904医院神经外科收治的135例患者,其中男94例、女41例,平均年龄(32.94±9.51)岁,外伤后癫痫患者(癫痫组)40例,外伤后无癫痫(外伤组)患者53例及健康体检(对照组)患者42例,采用简明精神状态量表(MMSE)、蒙特利尔认知评估量表-基础版(MoCA-B)、听觉词语记忆测验(AVMT)、Rey-Osterrieth复杂图形回忆及临摹测验(CFT)、连线测验(TMT)、汉密尔顿抑郁量表(HAMD)、日常生活能力量表(ADL)进行神经心理评估。结果单因素方差分析结果显示,所有量表癫痫组和外伤组与对照组对比均具有统计学意义(P<0.01)。①MMSE及MoCA-B评分:癫痫组相对外伤组下降的幅度大,但组间对比无统计学意义(P>0.05);②记忆及空间结构能力:AVMT短/长延迟记忆、CFT回忆及临摹测验的结果显示癫痫组较外伤组下降的更显著,组间对比存在统计学意义(P<0.05);③执行能力:TMT-A及TMT-B显示癫痫组较外伤组所使用的时间更长,组间对比存在统计学意义(P<0.01);④抑郁症状:HAMD量表结果显示癫痫组和外伤组间有统计学意义(P<0.01),而外伤组与对照组间无统计学意义(P>0.05);⑤日常生活能力:ADL量表结果显示癫痫组和外伤组间无统计学意义(P>0.05)。结论外伤后癫痫可加重患者的认知功能损伤,主要表现在记忆、空间结构及执行能力的下降,及易出现抑郁症状。在治疗癫痫发作的同时,对外伤后癫痫患者应早期进行神经心理学的筛查及测评,提高患者的生活质量并早日回归社会。

Objective To analyze of the extent of neuropsychological damage in post-traumatic epilepsy patients.Methods One hundred and thirty-five patients treated at the Department of Neurosurgery,the 904 th Hospital of PLA from January 2016 to December 2018 were analyzed retrospectively,including 94 males and 41 females,with an average age of(32.94±9.51)years.They were divided into 3 groups:40 patients with post-traumatic epilepsy(epilepsy group):53 trauma patients without post-traumatic epilepsy(trauma group)and 42 patients with health examination(control group).Neuropsychological assessment using the following scales:Mini-mental State Examination(MMSE):Montreal Cognitive Assessment-Basic(MoCA-B):Audio Verbal Memory Test(AVMT):Rey-Osterrieth Complex Figure Test(CFT):Trail Making Test(TMT):Hamilton Depression Scale(HAMD):Activity of Daily Living(ADL).Results The results of oneway ANOVA showed that there was significant difference between all scales of epilepsy group,trauma group and control group(P<0.01).①MMSE and MoCA-B scores:Compared with trauma group,epilepsy group decreased significantly,but there was no significant difference between groups(P>0.05);②Memory and spatial structure ability:AVMT short/long delayed memory,CFT recall and copy test results showed that epilepsy group decreased more significantly than trauma group,and there was statistical significance between groups(P<0.05);③Executive ability:TMT-A and TMT-B showed that epilepsy group spent longer time than trauma group,and there was significant difference between groups(P<0.01);④Depressive symptoms:HAMD scale showed significant difference between epilepsy group and trauma group(P<0.01):while there was no statistical difference between trauma group and control group(P>0.05);⑤Activity of daily living:ADL scale results showed that there was no significant difference between epilepsy group and trauma group(P>0.05).Conclusion Post-traumatic epilepsy can aggravate the cognitive impairment of patients,mainly in the decline of memory,spatial structure and executive ability,and prone to depressive symptoms.At the same time of treating epilepsy seizures,patients with post-traumatic epilepsy should be screened and assessed early in neuropsychology to improve their quality of life and return to society as soon as possible.