癫癎患者记忆障碍与癎灶部位、神经电生理的临床对比及相关性研究
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摘要
目的：探讨不同大脑半球的癎灶对癫癎患者记忆功能影响的特点以及癫癎患者的事件相关电位(P_(300))、脑干诱发电位(BAEP)变化情况及其与记忆障碍之间的相关性。方法：选择年龄、性别、文化程度相匹配的51例癫癎患者和22例健康正常人，由专人进行记忆测评，根据脑电图检查结果将癫癎患者分为左侧癎灶组、右侧癎灶组、双侧癎灶组，对比各癫癎组和正常对照组的测验结果，并对癫癎患者与健康正常人进行P_(300)、BAEP检查，分析其与记忆测评之间的相关性。结果：1、各癫癎组的总量表分、记忆商数均显著低于正常对照组。2、左侧癎灶组的视空间记忆保持相对较好。右侧癎灶组记忆功能的损害程度较轻，言语记忆保持相对较好，视空间记忆则相对较差。双侧癎灶组各分项的成绩及全量表分、记忆商数均较其余各组降低。3、癫癎组P_(300)测试结果显示癫癎组与对照组相比潜伏期明显延长，波幅显著降低。4、癫癎组记忆测试结果和P_(300)之间存在负相关。5、癫癎组BAEP检查结果显示癫癎组与对照组相比潜伏期、波峰间期明显延长，两组的Ⅴ／Ⅰ波幅比无统计学差异，癫癎组波形分化异常率高。癫癎组记忆测试结果和BAEP无相关性。结论：1、癫癎患者存在明显的记忆功能障碍，不同部位癎灶引起的记忆障碍的特点不同，为患者记忆障碍的合理化康复治疗提供指导。2、P_(300)可以作为评价癫癎患者的认知损害程度的灵敏而客观的指标，与神经心理学检查结合可以很好地对癫癎患者的记忆障碍进行正确的评价。3、BAEP可以帮助评价癫癎患者的脑损伤范围，但与记忆功能之间无相关性。
Objective: To investigate the characteristics in memory impairment with different epileptogenic focus. To explore the alteration and the correlation between memory impairment and event-related potential (ERP) P300 and brainstem auditory evoked potential (BAEP). Methods: We select 51 epilepsy patients and 22 healthy control subjects matched with age, sex, education level and handedness. All subjects were examined with Wechsler Memory Scale (WMS) by one observer. Epilepsy patients were divided into three groups (focus in left cerebral hemisphere, focus in right cerebral hemisphere, focus in bilateral cerebral hemispheres) according to the electroencephalography (EEG). Then we contrasted their memory scores with control subjects. Epilepsy patients and healthy control subjects were examined with P300 and BAEP. Results: The memory scores of epilepsy patients were significantly lower than that of control group. Left focus group kept relative intact visualspatial memory, but worse visual memory. Right focus group k
ept relative intact visual memory, but worse visualspatial memory. Bilateral focus group gained the lowest score than the rest patients and healthy controls. As compared with control group, the peak latencies of P300 and BAEP and the interspike intervals of BAEP were significantly delayed in epilepsy patients. And the amplitude of P300 was decreased in epilepsy patients. And more abnormal differentiation of undulate forms of BAEP was in epilepsy patients. There was no significantly different rate of V /1 wave amplitude between epilepsy patients and healthy controls. There was a negative correlation between memory score and P300, but no correlation between memory score and BAEP. Conclusions: 1. Epilepsy patients can induce memory impairment. And different epileptogenic focus produces different types of memory impairment. These can help to work rational plan of therapy and rehabilitation. 2. P300 can be used to achieve greater precision and sensitivity in cognitive evaluation in patients of epilepsy. If we com
bine P300 with the neuropsychological test maybe valuable in the evolutional assessment of memory impairment in patients of epilepsy. 3. BAEP can be used to help to evaluate the brain lesion extent in patients of epilepsy. But there is no correlation between memory and BAEP.
Objective: To investigate the characteristics in memory impairment with different epileptogenic focus. To explore the alteration and the correlation between memory impairment and event-related potential (ERP) P300 and brainstem auditory evoked potential (BAEP). Methods: We select 51 epilepsy patients and 22 healthy control subjects matched with age, sex, education level and handedness. All subjects were examined with Wechsler Memory Scale (WMS) by one observer. Epilepsy patients were divided into three groups (focus in left cerebral hemisphere, focus in right cerebral hemisphere, focus in bilateral cerebral hemispheres) according to the electroencephalography (EEG). Then we contrasted their memory scores with control subjects. Epilepsy patients and healthy control subjects were examined with P300 and BAEP. Results: The memory scores of epilepsy patients were significantly lower than that of control group. Left focus group kept relative intact visualspatial memory, but worse visual memory. Right focus group k
ept relative intact visual memory, but worse visualspatial memory. Bilateral focus group gained the lowest score than the rest patients and healthy controls. As compared with control group, the peak latencies of P300 and BAEP and the interspike intervals of BAEP were significantly delayed in epilepsy patients. And the amplitude of P300 was decreased in epilepsy patients. And more abnormal differentiation of undulate forms of BAEP was in epilepsy patients. There was no significantly different rate of V /1 wave amplitude between epilepsy patients and healthy controls. There was a negative correlation between memory score and P300, but no correlation between memory score and BAEP. Conclusions: 1. Epilepsy patients can induce memory impairment. And different epileptogenic focus produces different types of memory impairment. These can help to work rational plan of therapy and rehabilitation. 2. P300 can be used to achieve greater precision and sensitivity in cognitive evaluation in patients of epilepsy. If we com
bine P300 with the neuropsychological test maybe valuable in the evolutional assessment of memory impairment in patients of epilepsy. 3. BAEP can be used to help to evaluate the brain lesion extent in patients of epilepsy. But there is no correlation between memory and BAEP.
引文
1. Bulteau C, Jambaque I, Viguier D, et al. Epileptic syndromes, cognitive assessment and school placement: a study of 251 children. Dev Med Child Neurol, 2000, 42 (2): 319～327.
2. Kwan P, Brodie MJ. Neuropsychological effects of eoilepsy and antiepileptic drugs. Lancet, 2001, 35(7): 216-222.
3. Helmstraedter, C. Effects of chronic epilepsy on declarative memory systems. Progress Brain Research, 2002, 13(5): 439～453.
4．洪震，黄茂盛，王蓓．癫癇患者的认知功能状况分析．临床神经电生理学杂志，2002，11(2)：88～90．
5. Sangal RB, Sangal JM. Obstructive sleep and abnormal P3 latency topography. Clinical Electroencephalogr, 1997,28 (1):. 14～21.
6．彭斌，李舜伟，汤晓芙等．事件相关电位(P3)与记忆功能关系初探．中国神经精神疾病杂志，2000，26(5)：305～306．
7．龚耀先等．修订《韦氏成人记忆量表手册》，湖南医学院出版社，1981．
8. Perani D, Bress S, Cappa SF, et al. Evidence of multiple memory system in human brain. Brain, 1993, 11(1):903.
9. Etchepareborda MC. Epilepsy and learning: a neuropsychological approach. Rev Neurol, 1999, 8 (suppl 2) : S142～149.
10．郭瑞友，史庭慧，唐荣华．不同发作类型癫癇患者的记忆障碍研究．临床神经病学杂志，2000，13(1)：48～49．
11. Moscovitch M. Memory and working with memory: evaluation of a component process model and comparision with other models. In: Schacter DL, Tulving E, eds. Memory systems. Cambridge:MIT Press, 1999. 269～310.
12. Peredery O, Persinger MA, Parker G; et al. Temperal changes in neuronal dropout following inductings of lithium/pilocarpine seizures in the rat. Brain Res, 2000, 881 (1):9～17.
13. Grattan-Smith P, Hopkins I, Shield L, et al. Status epilepticus-induced brain damage and opercular syndrome in childhood. Dev Med Child Neurol, 2000,42 (6):428～429.
14. Jokeit H, Daamen M, Zang H, et al. Seizures accelerate forgetting in patients with left-sided temporal lobe epilepsy. Neurology, 2001, 57(3):125～126.
15. David A M, Mary P M. Material-specific deficits in "remembering" in patients with unilateral temporal lobe epilepsy and excisions. Neuropsychologia, 2002, 40: 1335～1342.
16. Burgess PW, Veitch E, de Lacy Costello A, et al. The cognitive and neuroanatomical correlates of multitasking. Neuropsychologia, 2000, 38: 848～863.
17. Koivisto M, Hamalainen H. Hemispheric semantic priming in the single word presentation task. Neuropsychologia, 2002.40: 978-985.
18. Baxendale SA, Thompson P J, Paesschen WV. A test of spatial memory and its clinical utility in pre-surgical investigation of temporal lobe epilepsy patients. Neuropsychologia, 1998, 36 (7): 591～602.
19. Lee TM, Yip JT, Jones-Gotman M. Memory deficits after resection from left or right anterior temporal lobe in humans: a meta-analytic review. Epilepsia, 2002, 43: 283～291.
20. Giovagnoli AR, Avanzini G. Learning and. memory impatirment in patients with temporal lobe epilepsy: Relation to the presence, type and location of brain lesion. Epilepsia, 1999, 40 (7): 904～911.
21. Blaxton TA, Theodore WH. The role of the temporal in recognizing visuospatial materials: remembering versus knowing. Brain and Cognition, 1997, 35: 5～25.
22. Sophie D, Yves S, Pierre-Franc-ois V, et al. Delayed verbal memory retrieval: afunctional MRI study in epileptic patients with structural lesions of the left medial temporal lobe. Neuroimage, 2001, 14: 995-1003.
23. Anna R, Giuliano A. Learning and memory impairment in patients and tempotal lobe epilepsy: relation to the presence, type, and location of brain lesion. Epilepsia, 1999, 40 (7): 904～911.
24. Ulrike G, Christoph H, Christian E. Memory recorganization in adult brain: observation in three patients with temporal lobe epilepsy. 2002, 48: 229～234.
25．许虹，任惠，刘磊，等．脑损害患者的事件相关电位研究．脑与神经疾病杂志，2000，8(2)：80～82．
26. Geisler MW, Morgan CD, Covington JW, et al. Neuropsychological performance and cognitive olfactory event-related brain potentials in young and elderly adults. J Clin Exp Neuropsychol, 1999, 21: 108～126.
27．潘映辐，周立春．癫癇患者智商和P300测试分析．中华神经科杂志，1998，31：11～12．
28．姚静，孙学礼，刘涛生，等．健康成人事件相关电位与神经心理学测验的相关性研究．中华精神科杂志，2003，36：167～170．
29. Umbricht D, Javitt D, Novak G, et al. Effects of contralateral speech competition on anditory event-related potentials in schizophrenia. Biol Psychiatry, 1998, 44: 716～725.
30．潘映辐．临床诱发电位学．第二版．北京：人民卫生出版社，2000．350～351，356～357．
2. Kwan P, Brodie MJ. Neuropsychological effects of eoilepsy and antiepileptic drugs. Lancet, 2001, 35(7): 216-222.
3. Helmstraedter, C. Effects of chronic epilepsy on declarative memory systems. Progress Brain Research, 2002, 13(5): 439～453.
4．洪震，黄茂盛，王蓓．癫癇患者的认知功能状况分析．临床神经电生理学杂志，2002，11(2)：88～90．
5. Sangal RB, Sangal JM. Obstructive sleep and abnormal P3 latency topography. Clinical Electroencephalogr, 1997,28 (1):. 14～21.
6．彭斌，李舜伟，汤晓芙等．事件相关电位(P3)与记忆功能关系初探．中国神经精神疾病杂志，2000，26(5)：305～306．
7．龚耀先等．修订《韦氏成人记忆量表手册》，湖南医学院出版社，1981．
8. Perani D, Bress S, Cappa SF, et al. Evidence of multiple memory system in human brain. Brain, 1993, 11(1):903.
9. Etchepareborda MC. Epilepsy and learning: a neuropsychological approach. Rev Neurol, 1999, 8 (suppl 2) : S142～149.
10．郭瑞友，史庭慧，唐荣华．不同发作类型癫癇患者的记忆障碍研究．临床神经病学杂志，2000，13(1)：48～49．
11. Moscovitch M. Memory and working with memory: evaluation of a component process model and comparision with other models. In: Schacter DL, Tulving E, eds. Memory systems. Cambridge:MIT Press, 1999. 269～310.
12. Peredery O, Persinger MA, Parker G; et al. Temperal changes in neuronal dropout following inductings of lithium/pilocarpine seizures in the rat. Brain Res, 2000, 881 (1):9～17.
13. Grattan-Smith P, Hopkins I, Shield L, et al. Status epilepticus-induced brain damage and opercular syndrome in childhood. Dev Med Child Neurol, 2000,42 (6):428～429.
14. Jokeit H, Daamen M, Zang H, et al. Seizures accelerate forgetting in patients with left-sided temporal lobe epilepsy. Neurology, 2001, 57(3):125～126.
15. David A M, Mary P M. Material-specific deficits in "remembering" in patients with unilateral temporal lobe epilepsy and excisions. Neuropsychologia, 2002, 40: 1335～1342.
16. Burgess PW, Veitch E, de Lacy Costello A, et al. The cognitive and neuroanatomical correlates of multitasking. Neuropsychologia, 2000, 38: 848～863.
17. Koivisto M, Hamalainen H. Hemispheric semantic priming in the single word presentation task. Neuropsychologia, 2002.40: 978-985.
18. Baxendale SA, Thompson P J, Paesschen WV. A test of spatial memory and its clinical utility in pre-surgical investigation of temporal lobe epilepsy patients. Neuropsychologia, 1998, 36 (7): 591～602.
19. Lee TM, Yip JT, Jones-Gotman M. Memory deficits after resection from left or right anterior temporal lobe in humans: a meta-analytic review. Epilepsia, 2002, 43: 283～291.
20. Giovagnoli AR, Avanzini G. Learning and. memory impatirment in patients with temporal lobe epilepsy: Relation to the presence, type and location of brain lesion. Epilepsia, 1999, 40 (7): 904～911.
21. Blaxton TA, Theodore WH. The role of the temporal in recognizing visuospatial materials: remembering versus knowing. Brain and Cognition, 1997, 35: 5～25.
22. Sophie D, Yves S, Pierre-Franc-ois V, et al. Delayed verbal memory retrieval: afunctional MRI study in epileptic patients with structural lesions of the left medial temporal lobe. Neuroimage, 2001, 14: 995-1003.
23. Anna R, Giuliano A. Learning and memory impairment in patients and tempotal lobe epilepsy: relation to the presence, type, and location of brain lesion. Epilepsia, 1999, 40 (7): 904～911.
24. Ulrike G, Christoph H, Christian E. Memory recorganization in adult brain: observation in three patients with temporal lobe epilepsy. 2002, 48: 229～234.
25．许虹，任惠，刘磊，等．脑损害患者的事件相关电位研究．脑与神经疾病杂志，2000，8(2)：80～82．
26. Geisler MW, Morgan CD, Covington JW, et al. Neuropsychological performance and cognitive olfactory event-related brain potentials in young and elderly adults. J Clin Exp Neuropsychol, 1999, 21: 108～126.
27．潘映辐，周立春．癫癇患者智商和P300测试分析．中华神经科杂志，1998，31：11～12．
28．姚静，孙学礼，刘涛生，等．健康成人事件相关电位与神经心理学测验的相关性研究．中华精神科杂志，2003，36：167～170．
29. Umbricht D, Javitt D, Novak G, et al. Effects of contralateral speech competition on anditory event-related potentials in schizophrenia. Biol Psychiatry, 1998, 44: 716～725.
30．潘映辐．临床诱发电位学．第二版．北京：人民卫生出版社，2000．350～351，356～357．