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
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摘要
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 February 2012 to December 2016, the Wada test was successfully completed in the Department of Functional Neurosurgery of Hebei People's Hospital, and 64 patients 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 of 96.06 ± 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±7.29 vs. 100) and short-term memory(48.18 ±7.56 vs.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 again 6 months after operation. There was no significant difference in MQ before and after operation(95.94±5.83 vs. 95.45±5.78) between the two groups(P>0.05). There were also no significant differences in long-term memory(29.04±3.19 vs. 28.45±2.83), short-term memory(57.28±4.26 vs.57.55±4.10) and instantaneous memory(9.62±1.54 vs. 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.
Objective To evaluate the value of propofol as an alternative to the Wada test for memory dominance hemisphere.Methods From February 2012 to December 2016, the Wada test was successfully completed in the Department of Functional Neurosurgery of Hebei People's Hospital, and 64 patients 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 of 96.06 ± 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±7.29 vs. 100) and short-term memory(48.18 ±7.56 vs.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 again 6 months after operation. There was no significant difference in MQ before and after operation(95.94±5.83 vs. 95.45±5.78) between the two groups(P>0.05). There were also no significant differences in long-term memory(29.04±3.19 vs. 28.45±2.83), short-term memory(57.28±4.26 vs.57.55±4.10) and instantaneous memory(9.62±1.54 vs. 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.
引文
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[9]Persike DS,Marques-Carneiro JE,Stein MLL,et al.Altered proteins in the hippocampus of patients with mesial temporal lobe epilepsy[J].Pharmaceuticals(Basel),2018,11(4).pii:E95.doi:10.3390/ph11040095.
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[11]Bogaarts G,Gommer E,Hilkman D,et al.An improved q EEGindex for asymmetry detection during the Wada test[J].Epilepsy Behav,2016,62:40-46.doi:10.1016/j.yebeh.2016.06.009.
[12]Jain P,Tomlinson G,Snead C,et al.Systematic review and network meta-analysis of resective surgery for mesial temporal lobe epilepsy[J].J Neurol Neurosurg Psychiatry,2018,89(11):1138-1144.doi:10.1136/jnnp-2017-317783.
[13]武江,李文玲,岳向勇,等.以丙泊酚作替代的Wada试验不良反应的多因素分析[J].中国神经精神疾病杂志,2014,40(9):551-554.Wu J,Li WL,Yue XY,et al.The analysis of adverse reactions with propofol as alternative for Wada test[J].Chin J Nerv Ment Dis,2014,40(9):551-554.doi:10.3936/j.issn.1002-0152.2014.09.009.
[14]武江,李文玲,岳向勇,等.应用丙泊酚作替代的Wada试验临床分析[J].第三军医大学学报,2015,37(5):470-473.Wu J,Li WL,Yue XY,et al.Clinical analysis of Wada test with propofol as sodium pentobarbital substitute[J].J Third Mil Med Univ,2015,37(5):470-473.doi:10.16016/j.1000-5404.201409148.
[15]Ding K,Gong Y,Modur PN,et al.Temporal lobe volume predicts Wada memory test performance in patients with mesial temporal sclerosis[J].Epilepsy Res,2016,120:25-30.doi:10.1016/j.eplepsyres.2015.11.018.
[16]Chen DQ,Strauss I,Hayes DJ,et al.Age-related changes in diffusion tensor imaging metrics of fornix subregions in healthy humans[J].Stereotact Funct Neurosurg,2015,93(3):151-159.doi:10.1159/000368442.
[17]Uda S,Matsui M,Tanaka C,et al.Normal development of human brain white matter from infancy to early adulthood:a diffusion tensor imaging study[J].Dev Neurosci,2015,37(2):182-194.doi:10.1159/000373885.
[18]Markoula S,Chaudhary UJ,Perani S,et al.The impact of mapping interictal discharges using EEG-fMRI on the epilepsy presurgical clinical decision making process:A prospective study[J].Seizure,2018,61:30-37.doi:10.1016/j.seizure.2018.07.016.
[19]Mani J,Busch R,Kubu C,et al.Wada memory asymmetry scores and postoperative memory outcome in left temporal epilepsy[J].Seizure,2008,17(8):691-698.doi:10.1016/j.seizure.2008.04.009S1059-1311(08)00097-6.
[2]Bharadwaj S,Venkatraghavan L.Dexmedetomidine sedation for WADA test with intracarotid propofol in pediatric patients[J].JNeurosurg Anesthesiol,2015,27(4):352-353.doi:10.1097/ANA.0000000000000165.
[3]祁文静,于瑶,刘献增,等.经颈内动脉注射异丙酚行Wada试验的初步研究[J].山东医药,2012,52(8):25-28.Qi WJ,Yu Y,Liu XZ,et al.Preliminary study on Wada test with bolus injection of propofol into intracarotid artery[J].Shandong Medical Journal,2012,52(8):25-28.doi:10.3969/j.issn.1002-266X.2012.08.009.
[4]Helmes E,Miller M.A comparison of MicroCog and the Wechsler Memory Scale(3rd ed.)in older adults[J].Appl Neuropsychol,2006,13(1):28-33.doi:10.1207/s15324826an1301-4.
[5]Takayama M,Miyamoto S,Ikeda A,et al.Intracarotid propofol test for speech and memory dominance in man[J].Neurology,2004,63(3):510-515.
[6]Quigg M.Taking sides:physician's perceptions on the use of the Wada test in epilepsy surgery-Q-PULSE survey commentary[J].Epilepsy Curr,2015,15(4):225.doi:10.5698/1535-7511-15.4.225.
[7]Audrain S,Barnett AJ,McAndrews MP.Language network measures at rest indicate individual differences in naming decline after anterior temporal lobe resection[J].Hum Brain Mapp,2018,39(11):4404-4419.doi:10.1002/hbm.24281.
[8]武江,何利兵,岳向勇,等.颞叶结合型局灶性脑皮质发育不良超微结构分析[J].中华神经外科疾病研究杂志,2014,13(2):165-166.Wu J,He LB,Yue XY,et al.Ultrastructural analysis of temporal lobe associated focal cortical dysplasia[J].Chin JNeurosurg Dis Res,2014,13(2):165-166.
[9]Persike DS,Marques-Carneiro JE,Stein MLL,et al.Altered proteins in the hippocampus of patients with mesial temporal lobe epilepsy[J].Pharmaceuticals(Basel),2018,11(4).pii:E95.doi:10.3390/ph11040095.
[10]Wu J,Li W,Chen Y,et al.Clinical characteristics of 92 patients with temporal lobe focal cortical dysplasia identified by pathological examination[J].J Clin Neurosci,2014,21(12):2170-2174.doi:10.1016/j.jocn.2014.04.022.
[11]Bogaarts G,Gommer E,Hilkman D,et al.An improved q EEGindex for asymmetry detection during the Wada test[J].Epilepsy Behav,2016,62:40-46.doi:10.1016/j.yebeh.2016.06.009.
[12]Jain P,Tomlinson G,Snead C,et al.Systematic review and network meta-analysis of resective surgery for mesial temporal lobe epilepsy[J].J Neurol Neurosurg Psychiatry,2018,89(11):1138-1144.doi:10.1136/jnnp-2017-317783.
[13]武江,李文玲,岳向勇,等.以丙泊酚作替代的Wada试验不良反应的多因素分析[J].中国神经精神疾病杂志,2014,40(9):551-554.Wu J,Li WL,Yue XY,et al.The analysis of adverse reactions with propofol as alternative for Wada test[J].Chin J Nerv Ment Dis,2014,40(9):551-554.doi:10.3936/j.issn.1002-0152.2014.09.009.
[14]武江,李文玲,岳向勇,等.应用丙泊酚作替代的Wada试验临床分析[J].第三军医大学学报,2015,37(5):470-473.Wu J,Li WL,Yue XY,et al.Clinical analysis of Wada test with propofol as sodium pentobarbital substitute[J].J Third Mil Med Univ,2015,37(5):470-473.doi:10.16016/j.1000-5404.201409148.
[15]Ding K,Gong Y,Modur PN,et al.Temporal lobe volume predicts Wada memory test performance in patients with mesial temporal sclerosis[J].Epilepsy Res,2016,120:25-30.doi:10.1016/j.eplepsyres.2015.11.018.
[16]Chen DQ,Strauss I,Hayes DJ,et al.Age-related changes in diffusion tensor imaging metrics of fornix subregions in healthy humans[J].Stereotact Funct Neurosurg,2015,93(3):151-159.doi:10.1159/000368442.
[17]Uda S,Matsui M,Tanaka C,et al.Normal development of human brain white matter from infancy to early adulthood:a diffusion tensor imaging study[J].Dev Neurosci,2015,37(2):182-194.doi:10.1159/000373885.
[18]Markoula S,Chaudhary UJ,Perani S,et al.The impact of mapping interictal discharges using EEG-fMRI on the epilepsy presurgical clinical decision making process:A prospective study[J].Seizure,2018,61:30-37.doi:10.1016/j.seizure.2018.07.016.
[19]Mani J,Busch R,Kubu C,et al.Wada memory asymmetry scores and postoperative memory outcome in left temporal epilepsy[J].Seizure,2008,17(8):691-698.doi:10.1016/j.seizure.2008.04.009S1059-1311(08)00097-6.