顳葉癲癇病患手術前後之神經心理與社會功能追蹤研究

Neuropsychological Performance and Social Functioning in Patients with Temporal Lobe Epilepsy Who Underwent Surgical Treatment: A Retrospective Longitudinal Study

洪瑋璘(Wei-Lin Hung)

指導教授 ： 何明洲

共同指導教授 ： 王瑋瀚(Wei-Han Wang)

中山醫學大學/醫學院/心理學系暨臨床心理學碩士班/碩士(2021年)

https://doi.org/10.6834/csmu202100095

摘要

背景：回顧文獻可發現，國內關於顳葉癲癇患者接受神經外科手術治療前後的神經心理功能表現和社會功能的研究，目前仍然相當缺乏。在此背景下，本研究旨在探討顳葉癲癇患者在接受癲癇手術治療後的病況（例如癲癇發作頻率）、認知功能和社會功能的變化。研究方法：回顧2014年1月至2019年5月在台北榮民總醫院一般神經外科接受癲癇手術的49例顳葉癲癇患者（男26例，女23例），所有研究對象在癲癇手術前、後均完成全套神經心理功能評估，並使用「癲癇患者社會及職業功能評估量表」評估其社會功能。結果與結論：研究結果顯示：（1）癲癇手術可明顯減少癲癇發作頻率和抗癲癇藥物種類的使用；（2）在語言優勢半腦進行手術後，語文記憶沒有明顯下降；（3）接受語言優勢半腦癲癇手術的病人，其術後作業智商、視覺記憶、執行功能和視空間知覺皆有顯著改善；（4）接受非語言優勢半腦癲癇手術的病人，其術後作業智商、語文記憶和視空間知覺能力皆有明顯進步，其中視空間知覺功能的改善尤為顯著；（5）儘管兩種手術方法之間的差異不明顯，但整體結果顯示，接受選擇性杏仁核海馬切除術的患者，其術後語文記憶和執行功能有較佳之趨勢；（6）術後一年內，社會功能即有明顯改善。

關鍵字

顳葉癲癇 ； 顳葉癲癇手術 ； 神經心理功能 ； 社會功能

並列摘要

Background: In Taiwan, the literature on neuropsychological performance and social functioning in patients with temporal lobe epilepsy (TLE) who underwent epilepsy surgery is still limited. On this background, this study aimed to figure out the medical (such as seizure frequency), cognitive, and social functional outcomes of epilepsy surgery in patients with TLE.
Research Method: A total of 49 patients (26 males and 23 females) with TLE who underwent epilepsy surgery at the Division of General Neurosurgery of Taipei Veteran General Hospital from January 2014 to May 2019 were included by reviewing the medical record. All participants completed a comprehensive neuropsychological assessment and an evaluation of social functioning, measured by the Social and Occupational Functioning Scale for Epilepsy, before and after epilepsy operation.
Results Conclusion: The results showed that (1) epilepsy surgery elicits a statistically significant reduction in seizure frequency and the number of antiepileptic drugs usage; (2) verbal memory did not significantly decline when the surgery was administered in the language-dominant hemisphere; (3) Performance Scale IQ (PIQ), visual memory, executive function, and visuospatial perception showed improvement after resective surgery to the language-dominant hemisphere; (4) when the surgery was applied in the nonlanguage-dominant hemisphere, the neuropsychological performance of PIQ, verbal memory, especially visuospatial perception were improved; (5) Despite the insignificant differences between the two surgical approaches, the tendency of selective amygdalohippocampectomy results in better verbal memory and executive function was observed; (6) social functioning was significantly improved within the first year after the epilepsy surgery.

並列關鍵字

Temporal lobe epilepsy ； Temporal lobe epilepsy surgery ； neuropsychological function ； social functioning

參考文獻

Barr, W. B. (2008). Neuropsychological outcome. In H. O. Lüders (Eds)., Textbook of Epilepsy Surgery (pp. 1277–1287). Informa healthcare.

Barr, W. B. (2015). Neuropsychological Assessment of Patients with Epilepsy. In W. B. Barr C. Morrison (Eds.), Handbook on the Neuropsychology of Epilepsy (pp. 1–36). Springer. https://doi.org/10.1007/978-0-387-92826-5_1

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Bell, B., Lin, J. J., Seidenberg, M., Hermann, B. (2011). The neurobiology of cognitive disorders in temporal lobe epilepsy. Nature Reviews. Neurology, 7(3), 154–164. https://doi.org/10.1038/nrneurol.2011.3