运用事件相关电位法探索前颞叶切除术对颞叶癫痫患者认知功能影响的研究

发布时间：2018-02-24 19:15

本文关键词： 颞叶癫痫认知功能事件相关电位 P300 N400　出处：《安徽医科大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的运用事件相关技术(ERPs),采用P300实验范式、N400实验范式,评估药物难治性颞叶癫痫(RTLE)患者行裁剪式前颞叶切除术术前、术后的认知功能：①分析术前、手术后的P300及N400的变化特点：②初步探讨药物难治性TLE患者存在认知功能障碍；③进一步探讨前颞叶切除术对药物难治性TLE患者认知功能的影响。方法连续收集2014年12月至2015年12月,于厦门市解放军第174医院神经医学中心行裁剪式前颢叶切除术治疗的10例颞叶癫痫患者。所有患者均在术前进行严密的术前评估：①无创术前评估：录像脑电图(video electroencephalography, VEEG)、3.0T MRI、正电子发射断层显像(positron emission computerized tomography,PET),其中有6例患者经过上述检查后可明确致痫灶范围及侧别；②有创术前评估：颅内电极埋藏以及丙泊酚Wada试验,另4例患者在进一步的有创评估后确定致痫灶范围及侧别：③神经心理学评估：所有患者均进行韦氏智力及记忆量表测量；④P300、N400检查：所有患者在术前均采用德国品牌Brain Products (BP)的64导联ERP记录与分析软件进行检测。经过上述评估后在持续脑电图(electrocorticogram, ECoG)监测下实施裁剪式前颞叶切除术。在手术后的1个月、3个月及6个月进行随访,再次对每个患者进行P300、N400的检测,最后汇总数据分别对术前和术后的P300及N400进行比较。结果①癫痫组与正常对照的P300潜伏期比较,分别从两组中获得均数及标准差,使用独立样本t检验,结果显示癫痫组的CZ、PZ的P300潜伏期较对照组分别延长42.54ms、46.53ms,差异具有显著性,P0.05；②术前与术后P300潜伏期及波幅比较：术后第1个月、3个月、6个月CZ的P300潜伏期分别较术前缩短24ms,27.4ms、25.4ms,差异具有显著性,以术后3个月及6个月差异具有极显著性P0.01,术后第1个月差异具有显著性,P0.05；而PZ的潜伏期在术后第1个月、第3个月差异不明显,在术后第6个月潜伏期较术前缩短36.2ms,差异具有显著性,P0.05。而术前和术后的CZ、PZ的P300波幅差异不明显,无显著性；③术前与术后N400潜伏期及波幅比较：术后1个月、3个月及6个月PZ的N400潜伏期与术前相比较,无显著性意义。术后与术前的N400波幅相比较,也无显著性意义。结论药物难治性TLE患者均存在认知功能障碍,行裁剪式前颞叶切除术之后,在随访的6个月期间未再出现发作,TLE患者的临床发作得到控制,同时在随访期间对P300的潜伏期与术前比较,结果显示潜伏期缩短,P300的潜伏期缩短说明TLE患者的认知功能得到一定程度改善；对于N400的潜伏期较术前相比无明显变化,可见TLE患者的语言功能恢复缓慢。
[Abstract]:Objective to evaluate the cognitive function of patients with drug refractory temporal lobe epilepsy (RTLEL) before clipping anterior temporal lobectomy, using event-related technique and P300 / N400 paradigm. Changes of P300 and N400 after surgery: 2 preliminary study on cognitive dysfunction in patients with drug-resistant TLE further study of the effect of anterior temporal lobectomy on cognitive function in patients with drug-resistant TLE methods 2014. From December to December 2015, Ten patients with temporal lobe epilepsy were treated by cutting anterior temporal lobe lobectomy at the Neuromedical Center of the 174 Hospital of Xiamen people's Liberation Army. All the patients underwent a rigorous preoperative evaluation: 1: 1 noninvasive preoperative evaluation: video EEG video. Electroencephalography (VEEGG) 3.0T MRI, positron emission computerized tomographygraphy (PETX) were performed in 6 patients. The range of epileptogenic foci and the preoperative evaluation of lateral eclampsia were determined in 6 patients: intracranial electrode implantation and propofol Wada test. In another 4 patients, after further invasive evaluation, the range of epileptogenic foci and the side of the epileptogenic foci were determined. Neuropsychological assessment: all patients were assessed with Wechsler Intelligence and memory scale 4P300N400: all patients were treated with German brand before operation. The 64-lead ERP recording and analysis software of Brain Products was tested. After the above evaluation, the anterior temporal lobectomy was performed with continuous electroencephalography (EEG) monitoring. The patients were followed up 1 month, 3 months and 6 months after the operation. The P300 and N400 were compared before and after operation. Results 1the latency of P300 in the epileptic group was compared with that in the normal control group, and the mean and standard deviation were obtained from the two groups, respectively. Using an independent sample t-test, The results showed that the P300 latency of CZP PZ in the epileptic group was 42.54 Ms / 46.53 mslonger than that in the control group, respectively. There was a significant difference between the P300 latency and the amplitude of P300 before and after the operation. The P300 latency of CZ in the 1st, 3rd and 6th month after operation was significantly shorter than that in the control group. The difference was significant. There was a significant difference in the latency of PZ between the first month and the first month, but the latency of PZ was not significantly different in the first month and the third month after operation, but the difference was significant at the 3rd month and the 3rd month after the operation, but there was no significant difference in the latency of PZ in the first month and the third month after the operation. The latency at the 6th month after operation was 36.2 Ms shorter than that before operation, and the difference was significant (P 0.05). However, there was no significant difference in P300 amplitude between preoperative and postoperative CZP Z. There was no significant difference in N400 latency and amplitude between preoperative and postoperative N400: the N400 latency of PZ at 1 month, 3 months and 6 months after operation was not significantly different from that before operation, but the amplitude of N400 was compared with that before operation. Conclusion there is cognitive impairment in all patients with drug-resistant TLE. After cutting anterior temporal lobectomy, no further seizures occurred during the 6-month follow-up period, and the clinical seizures of the patients were controlled. At the same time, the latency of P300 during the follow-up period was compared with that before operation. The results showed that the shortened latency of P300 indicated that the cognitive function of patients with TLE was improved to some extent, but the latency of N400 had no significant change compared with that of pre-operation. It can be seen that the recovery of language function in TLE patients is slow.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R651.1

【相似文献】