- 學位論文
顳葉癲癇患者神經心理功能、社會功能及其關係之研究
Neuropsychological Features, Social Functioning, and Their Relationship in Patients with Temporal Lobe Epilepsy
摘要
背景：過去大量研究已發現顳葉癲癇患者除了常見有記憶力缺損，其智力、語言、執行功能、及心智運作速度表現皆可能較一般健康受試者差。然而在台灣，與該議題相關之研究報告仍相當缺乏。此外，改善癲癇患者社會職業功能一直是病人、家屬、乃至臨床醫療人員努力的目標。然而，由於功能取向之評估工具的缺乏，目前國際上對於癲癇患者的認知功能（抑或社會認知功能）缺損是否直接影響其社會功能表現？影響程度又為何？仍一無所知。方法：本論文由四項子研究組成。研究一主要是以回溯性研究方法，蒐集/建構國內顳葉癲癇患者的神經心理功能特徵，並同時檢視癲癇相關疾病條件對患者神經心理功能的影響。研究二主要目的在發展功能導向之「癲癇患者社會及職業功能評估量表」。研究三則接續以新發展之「癲癇患者社會及職業功能評估量表」探討顳葉患者認知功能缺損、癲癇相關疾病條件與其社會職業功能的關係。最後，研究四則以該量表進一步探究顳葉患者之社會認知功能與其社會職業功能間的關係。結果與結論：研究發現多數顳葉癲癇患者確實併有兩種以上認知功能缺損，其缺損種數則隨癲癇相關疾病條件（包括癲癇發病年齡、患病年數、服用抗癲癇藥物種數、及癲癇發作頻率）之不同而異。此外研究證實新發展之「癲癇患者社會及職業功能評估量表」確實擁有適宜之信、效度計量特性，並可提供臨床使用。藉該量表，研究三發現顳葉癲癇患者之多領域認知功能缺損確實對其社會職業功能障礙有顯著預測力。最後，研究四則發現顳葉癲癇患者的基礎及高階心智推理功能皆較一般健康受試者易有缺損。而高階心智推理功能、患者精神狀態、及語文功能對患者的社會職業功能表現有顯著預測力。上列研究結果對於癲癇患者社會認知功能的瞭解與改善，具臨床參考價值。
並列摘要
Background: A growing body of evidence has suggested that patients with temporal lobe epilepsy (TLE) exhibit not only an impaired memory but also a worse performance across measures of intelligence, language, executive function, and psychomotor speed. Nevertheless, in Taiwan, the literature on this subject is sparse. Moreover, Maintaining or improving social functioning has been a long-standing goal for patients with epilepsy, their families, and clinicians. However, because of the lack of functional-based social functioning scale for epilepsy, to date it is still unclear to what extent cognitive impairment or other relevant factors, such as social cognitive deficit, can have a direct influence on social functioning in patients with TLE. Methods: This dissertation comprises four original studies. The first retrospective study characterized the neuropsychological features in patients with TLE and identified the relative contributions of seizure-related variables on neuropsychological function. The second study aimed to develop a functional-based social functioning scale for epilepsy to test its psychometric properties. The third study was conducted to identify the relative contributions of cognitive function and seizure-related variables on social functioning in TLE patients. Finally, the fourth study in this dissertation was then conducted to explore social cognitive function and its relationship to social functioning in patients with TLE. Results and Conclusions: Cognitive impairments in multiple domains are evident in most patients with TLE and are dependent on age at seizure onset, number of antiepileptic drugs used, frequency of seizures, and duration of epilepsy. Moreover, a new epilepsy-specific social functioning scale, namely, the “Social and Occupational Functioning Scale for Epilepsy (SOFSE),” was developed. It is a brief, psychometrically sound, and easy-to-administer measure of social functioning for use in busy clinical settings. By using the SOFSE, the study 3 showed that cognitive impairment in multiple domains significantly contributed to social dysfunction in patients with TLE. In addition, advanced impairment of theory of mind, psychiatric disturbances, and other cognitive (verbal) impairments can also contribute to social and occupational functioning in TLE patients. These findings have implications for the targeted improvement of complex social cognitive skills in epilepsy, that can lead to enhancement of patients’ social functioning.