手术对难治性癫痫患者认知功能影响的临床分析

关键词：难治性癫痫  手术  认知功能  瑞文标准推理能力测验

Keywords:intractable epilepsy  surgery  cognitive function  Raven′s standard progressive matrices

摘要：

      摘要 目的：探讨手术对难治性癫痫患者认知功能的影响。 方法：选取30例手术治疗的难治性癫痫患者，采用瑞文标准推理能力测验（SPM）对患者手术前后的认知状况进行评测，分析不同术前IQ分值、手术侧别、部位、手术预后等因素对患者术后认知功能的影响。 结果：30例难治性癫痫患者，随访10—24个月，手术总有效率达86.67%；术后认知功能较术前得到改善者占33.33%，下降者占43.33%；颞叶及非颞叶手术均可导致术后认知障碍；术前智商（IQ）≥70的患者术后认知下降率（60%）明显高于术前IQ＜70者（26.67%）（P<0.05）；左侧手术患者术后认知下降率（50%）明显高于右侧手术患者（35.71%）（P<0.05）；预后EngelⅠ—Ⅱ级的患者术后认知改善率（38.46%）明显高于预后Engel Ⅲ—Ⅳ级的患者（0%），并随着术后病程时间的延长，患者认知功能可得到逐步改善。 结论：部分癫痫患者手术后认知功能得以改善，但仍有不少比例的患者术后认知功能受损。左侧手术、术前IQ分值较高、术后发作控制不佳的患者术后更易出现认知功能障碍。

Abstract:

      Abstract Objective: To investigate the effects of surgery on cognitive functions of patients with intractable epilepsy. Method: Thirty patients with intractable epilepsy were chosen in the study. Raven′s standard progressive matrices（SPM） was used to evaluate patients′ intelligence pre-operation and post-operation, and then the effects of various factors on cognitive functions, including different preoperative IQ, operation sides, operation site, surgery effect, postoperative course were further analyzed. Result: Thirty patients were followed up for 10 to 24 months. The total effective rate of surgery was 86.67%. The cognitive function of 10 cases (33.33%) improved significantly after operation, and that of 13 cases (43.33%) declined. Further analysis showed that, temporal lobe and non-temporal lobe operations could both lead to cognitive disorders; the cognition decline rate of patients with preoperative intelligence quotient(IQ)≥70 (60%) was significantly higher than those with IQ＜70 (26.67%) before operation, and that with left side operation (50%) was higher than that with right side operation (35.71%) (P<0.05). The cognition improve rate of patients with prognosis EngelⅠ—Ⅱ(38.46%) was higher than those with Engel Ⅲ—Ⅳ(0%).With the prolongation of postoperation course, patients′ cognitive function improved gradually. Conclusion: The cognitive function of some patients after surgery improved, but many patients still suffered cognition impairment. The patients who received left side operation, had higher preoperative IQ and whose postoperation attack did not controlled well, occurred more cognitive disorders after operation.