Online ISSN : 1687-8329

    




Quick Search 
 
Author  
Year    
Title  
Vol:  

 
 
April2012 Vol.49 Issue:      2 Table of Contents
Full Text
PDF


Cognitive Decline in Patients with Refractory Complex Partial Seizures

Mohamed Youssry A. El-Senousey1, Ashraf A. Aboelsafa1, Tarek M. El-Gammal1,Azza A. Ghali1, Yasser A. El-Heneedy1, Rania E. Mohamed2

Departments of Neuropsychiatry1, Radiology2, Tanta University; Egypt

 



ABSTRACT

Background: Patients with refractory complex partial seizures (CPS) are at a higher risk for mental and cognitive impairments. Objective: To evaluate the cognitive decline in patients with refractory CPS of temporal lobe origin. Methods: This study was carried out on 57 epileptic patients with temporal CPS. They were grouped into the refractory group (32 patients), subdivided into right (17 patients) and left (15 patients) subgroups, and the control group (25 patients) with controlled CPS. All patients were subjected to history taking, clinical neurological examination, electroencephalography (EEG), magnetic resonance imaging (MRI) of the brain, and neuropsychological assessment using:  Wechsler adult intelligence scale-revised (WAIS-R), Trail making test for assessment of attention, Digit span subtest of WAIS for assessment of immediate retention, and Bender Gestalt test for assessment of visual memory. Results: The digit span, Bender Gestalt and WAIS-R tests showed significantly lowered scores in the refractory group when compared to the control group (p<0.05). The mean score of the Trail making test showed a significantly longer time among patients with refractory than that of the control group (p<0.05). The WAIS-R has an inverse correlation with each of the duration of illness and the frequency of seizures. Hippocampal sclerosis ranked the first MRI abnormality. The EEG was concordant to MRI findings in hippocampal sclerosis. Conclusion: Patients with refractory CPS of temporal lobe origin are at higher risk for mental and cognitive impairments. Negative MRI studies in refractory CPS are still a challenge. [Egypt J Neurol Psychiat Neurosurg.  2012; 49(2): 149-156]

Key words: complex partial seizures, cognitive impairment, refractory seizures.

Correspondence to Ashraf A. Aboelsafa, Department of Neurology, Tanta University; Egypt. Tel:+20106622792. E-mail: draboelsafa@hotmail.com





INTRODUCTION

 

Epilepsy is a chronic disorder characterized by a spontaneous tendency for recurrent seizures which are the clinical manifestations of abnormally hyperexcitable cortical neurons.1 The prevalence of active epilepsy is roughly in the range 5–10 per 1000 people. The approximate annual incidence rate of epilepsy is 40–70 per 100,000 in industrialized countries and 100–190 per 100,000 in resource-poor countries.2 About 50 million people worldwide have epilepsy. It becomes more common as people age.3

In one quarter of epileptic patients, seizures may become refractory to medications (intractable or drug-resistant epilepsy). Moreover, up to 1% of patients with intractable epilepsy die per year and the risk of sudden death appears to be twice as high compared with that in the general population.4

Traditionally, patients are drug resistant if they continue to have seizures despite adequate treatment trials. A task force of the International League Against Epilepsy (ILAE) proposed that drug-resistant be defined as the failure of adequate trials of two tolerated, appropriately chosen and administered antiepileptic drugs

 (AEDs), whether as monotherapy or in combination, to achieve seizure freedom.5,6 The prevalence of refractory epilepsy defined by one or more seizures per year is between 2 and 3 per 1000 population.7

Seizures that begin in a focal region of the cerebral cortex, often within one lobe of the brain, are termed partial seizures. The term complex partial seizure refers to a partial onset of seizure with impairment of consciousness.8,9 The site of origin of complex partial seizures is predominantly in the temporal lobe (80%), but frontal, parietal, and occipital lobes may also be involved.10,11

In epilepsy, neuropsychological testing is particularly valuable in the presurgical evaluation of patients with epilepsy who are being considered for temporal lobectomy.12

The aim of this study was to study the cognitive decline in patients with refractory complex partial seizures (CPS) of temporal lobe origin through evaluation of some of the clinical, radiological and neuropsychological aspects in such patients.

 

SUBJECT AND METHODS

 

This study was carried out in the Neuropsychiatry Department, Tanta University Hospitals, on 57 epileptic patients with CPS of temporal lobe origin (with or without secondary generalization) selected according to the electroclinical criteria of the ILAE classification.13

 

The studied groups were:

1. Refractory group (32 patients); falling into 2 subgroups: right (17 patients) and left (15 patients) refractory temporal subgroups, and 2. Controlled group; composed of 25 patients with controlled complex temporal partial seizures. Inclusion criteria for the refractory group included patients with refractory CPS of temporal lobe origin, defined when they had an average frequency of at least one seizure per month for a period of at least 2 years during which at least 3 AEDs had to be used daily either singly or in combination and their doses and/or serum levels were falling within the therapeutic range. The AEDs were considered to be failed if they could not control seizures or if were discontinued because of side effects. A drug used acutely to treat status epilepticus in the emergency room was not counted as one of the 3 AEDs. Patients with sub-therapeutic serum levels of their AEDs and/or poor compliance were excluded.

Inclusion criteria for the controlled epileptic patients were defined when at least one year seizure-free if seizures immediately ceased once treatment began and a two years seizure-free period if remission did not begin immediately after treatment was instituted.

Illiterate patients were excluded for conducting neuropsychological testing and a good reading and writing abilities was a criterion of the studied patients.

 

All patients were subjected to:

1.      History taking from the patients themselves or reliable eye-witness for recording the clinical semiology of seizures.

2.      Clinical general and neurological examination to prove that none of the patients suffer from neurological deficit.

3.      MRI of the brain using 1.5 tesla high speed scanner. The protocol included T1 weighted oblique coronal sequence with 5 mm slice thickness orthogonal perpendicular to the long axis of the hippocampus, T2 weighted fast spin echo, axial and coronal FLAIR sequences with 2 mm slice thickness. Mesial temporal sclerosis criteria were hippocampal atrophy on coronal T1WI, signal hyperintensity within the hippocampus on T2WI or FLAIR, and/or loss of hippocampal internal structure.   

4.      Awake interictal scalp electro-encephalography (EEG) was done for all patients. The device used was Nihon-Kohden Neurofax 10 channels and Medtronic-Dantec PL-270, 32 channels according to the international 10-20 system. Focal seizures were electrographically defined as the regional appearance of sequential epileptiform potentials (spikes, spike-wave, sharp waves, phase reversal or polyspikes).14 Patients with bisynchronous onsets, inadequately recorded seizures or without EEG changes were excluded.

5.      Neuropsychological assessment using: [a] Wechsler adult intelligence scale-revised (WAIS-R) included the verbal intelligence quotient (VIQ), the performance intelligence quotient (PIQ) and the full scale intelligence quotient (FSIQ), [b] Assessment of attention by the Trail making test: the patient had to draw lines in ascending order between numbers and the time taken was scored in seconds by a stopwatch, [c] Digit span subtest of WAIS (forward and backward) for assessment of immediate retention: the patient was asked to learn a series of two to nine digits which were immediately recalled both forward and backward, [d] Bender Gestalt test for assessment of visual memory: the patient was asked to reproduce some card designs after 45 to 60 seconds from visually memorizing them.

6.      Monitoring of serum levels of AEDs to assess compliance of patients and exclude those with subtherapeutic levels.

 

Statistical Analysis:

The data were expressed in mean±SD and statistical analysis was performed using SPSS statistical package for windows version 8. Student’s t-test was used to compare groups. P value of <0.05 was considered significant.

 

RESULTS

 

The mean age of refractory group was non-significantly higher than the controlled group (p>0.05). There was no significant difference in the sex of the studied groups. The age at onset in the studied groups revealed no significant difference between the refractory group and the controlled group (p>0.05), as shown in Table 1.

The mean scores of the digit span (forward and backward), the Bender Gestalt, and the verbal, performance and full scale IQ tests showed a significant lowered scores in the refractory group when compared to the control group (p<0.05). Also, the mean score of the Trail making test among patients with refractory epilepsy showed significantly longer time than that of the controlled group (p<0.05), as shown in Table 2.

The mean score of the verbal IQ of the left temporal was significantly lower than the right temporal group (p<0.05), while performance IQ in the right temporal was significantly lower than the left (p<0.05), as shown in Table 3.

               There was an inverse correlation between each of the VIQ, PIQ, FSIQ, and each of the duration of illness and frequency of seizures (Table 4).

Neuroimaging findings (Table 5 and Figures 1, 2, 3 and 4) showed that, in refractory group, hippocampal sclerosis ranked the first abnormality (53.12%). No MRI abnormalities were detected in 4 (12.5%) patients. In controlled group, the MRI was negative in all cases except in 2 cases when it showed hippocampal sclerosis.

The EEG was concordant to the MRI findings in hippocampal sclerosis, arachnoid cyst, cavernous angioma and posttraumatic encephalomalacia. On the other hand, it was discordant in all cases of cortical dysgenesis, in some cases of hippocampal sclerosis and one patient with posttraumatic encephalomalacia.


 

Table 1. Age distribution (in years) and age at onset (in years) of the studied groups.

 

 

Refractory group (n=32)

Control group

(n=25)

t

p

Age

Range

17 - 44

16 - 38

0.820

0.541

Mean ± SD

30.23 ± 7.45

28.60 ± 7.44

Age at onset

Range

11 - 31

12 - 37

0.550

0.686

Mean ± SD

20.87 ± 4.65

21.76 ± 7.51

 

Table 2. Comparison of the digit span, Bender Gestalt, Trail making and WAIS-R IQ tests between the refractory versus the control group.

 

Test

Refractory group (n=32)

Control group  (n=25)

t

p

Digit span test

Range

3 - 8

5 - 8

2.665

0.011*

Mean±SD

5.67±1.47

6.8±1.73

Bender Gestalt

Range

4 - 19

7 - 21

2.348

0.022 *

Mean±SD

9.7±3.90

12.08±3.66

Trail making test

Range

45 - 125

40 - 85

2.034

0.046 *

Mean±SD

67.82±23.76

56.30±17.40

Verbal IQ

Range

80 - 110

80 - 110

2.907

0.005 **

Mean±SD

88.70±6.39

94.00±7.36

Performance IQ

Range

75 - 110

80 - 110

2.241

0.029 *

Mean±SD

88.92±9.12

94.38±9.14

Full scale IQ

Range

80 - 105

80 - 110

3.635

0.001 **

Mean±SD

89.03±5.55

94.50±5.75

* Significant at p<0.05. ** Significant at p<0.01.

 

Table 3. Comparison between the Digit span, Bender Gestalt and WAIS-R IQ of the refractory right versus left temporal groups.

 

Test

Refractory right temporal group (n=17)

Refractory left temporal group (n=15)

t

p

Digit span test

Range

3 - 8

4 - 8

1.245

0.222

Mean ± SD

5.55±0.52

5.81±0.66

Bender Gestalt

Range

4 - 18

4 - 19

1.145

0.261

Mean ± SD

9.5±4.01

11.1±3.87

Verbal IQ

Range

80 - 100

85 - 110

2.153

0.039 *

Mean ± SD

89.67±8.76

84.33±4.17

Performance IQ

Range

75 - 90

75 - 100

2.638

0.013 *

Mean ± SD

81.00±4.31

87.00±8.19

Full scale IQ

Range

80 - 95

80 - 95

0.490

0.617

Mean ± SD

85.53±4.85

86.33±3.99

* Significant at p<0.05.

 

Table 4. Correlation of neuropsychological tests and age, age at onset, duration of illness and frequency of seizures.

 

Test

Age

Age at onset

Duration                 of illness

Frequency of seizures

r

p

r

p

r

p

r

p

Digital span test

- 0.31

> 0.05

- 0.04

> 0.05

0.06

> 0.05

0.17

> 0.05

Bender Gestalt

- 0.15

> 0.05

- 0.18

> 0.05

- 0.03

> 0.05

0.11

> 0.05

Trail making test

- 0.03

> 0.05

- 0.08

> 0.05

0.90

> 0.05

- 0.02

> 0.05

Verbal IQ

- 0.09

> 0.05

- 0.15

> 0.05

- 0.26

< 0.05 *

- 0.31

< 0.05 *

Performance IQ

- 0.09

> 0.05

- 0.23

> 0.05

- 0.35

< 0.05 *

- 0.27

< 0.05 *

Full scale IQ

- 0.08

> 0.05

- 0.29

> 0.05

- 0.35

< 0.05 *

- 0.41

< 0.05 *

* Significant at p<0.05.

 

Table 5. Magnetic resonance imaging in refractory and control groups.

 

MRI finding

Refractory group

(n=32)

Control group 

(n=25)

Hippocampal sclerosis

17 (53.12%)

2 (8%)

Cortical dysgenesis

5 (15.63%)

0

Arachnoid cyst

3 (9.37%)

0

Posttraumatic encephalomalacia

2 (6.25%)

0

Cavernous angioma

1 (3.13%)

0

Negative MRI

4 (12.50%)

23 (92%)

 

 

 

 

 

 

Figure 1. Coronal 3D spoiled gradient WI shows atrophic right temporal lobe with prominent right hippocampal fissure.

 

Figure 2. Coronal FLAR image shows an area of encephalomalacia of the left temporoparietal region with exvacu-dilatation of the adjacent temporal and frontal horns of ipsilateral lateral ventricle.

 

Figure 3. Axial T2WI shows the characteristic popcorn like appearance of cavernous angioma.

 

Figure 4. Axial T2WI shows a well defined left temporal arachnoid cyst exerting mass effect on temporal lobe.


DISCUSSION

 

Patients with refractory temporal lobe epilepsy (TLE) are at higher risk for mental and cognitive impairments than healthy controls. The assessment of neuropsychological function is now an established part of the evaluation of patients with intractable epileptic seizures. Today a large body of evidence exists on the neuropsychological deficits that regularly accompany TLE.15

In the current study, the neuropsychological test battery showed significantly lower scores in the refractory than the controlled group on the digit span forward and backward, a finding proved in other studies.16,17

Cohen18 revealed that left TLE scored significantly lower than normal control on the digit span forward and backward test. However, there was no significant difference between the right and left TLE groups. This is in agreement with the present study that showed no significant difference between the left and right temporal groups.

In the current study, the refractory group showed a significantly slower time than the controlled epileptic group in the Trail making test, a finding that is similar to other studies.16,19

In the present study, as seen also by others,19 Bender Gestalt test, for assessment of short term visual memory, was significantly reduced in the refractory group than the controlled epilepsy group. Also, Cohen18 studied the visual memory in adults with TLE versus normal control and revealed that right TLE scored significantly lower on visual memory. However, there was no significant difference between right and left TLE group, a finding that is consistent with that obtained from the current study. But, in Cohen18 study, children with right TLE scored lower than left TLE on visual memory testing.

The non-dominant temporal lobe has been shown in many studies to mediate visuospatial perceptual function. Consequently, mild but significant deficit on visuospatial tests can be found in such patients.20

In the present study, the refractory group performed significantly lower scores compared to the controlled group on different variables of WAIS-R. In a prospective study, Bjornaes et al21 found that in children there was a decline in the mean IQ scores while these scores increased in adults. So, recurrent seizures may represent a considerable risk for intellectual decline in children, while intellectual functioning seems to be less vulnerable in adults with early onset of epilepsy.

Rodin et al.22 revealed that those whose seizures remained uncontrolled had a statistically significant decrease in performance IQ. So, they concluded that decreased IQ indicated slower mental growth rather than loss of previously acquired function. Also, Maestu et al.23 found similar results of the present study as they concluded that the longer duration of seizures the lower the IQ and also the same regarding the frequency.

The present study also, revealed that the VIQ of left sided focus was significantly lower than right sided one but the PIQ of the right sided was significantly lower than the left sided one. In a trial to elucidate the effect of duration on refractory TLE, Jokeit and Ebner24 revealed that cognitive abilities of patients did not deteriorate with increasing duration of intractable epilepsy less than two decades. But, duration of chronic epilepsy exceeding two decades is associated with worse cognitive abilities. Consequently, refractory TLE seems to induce a very slow but ongoing cognitive deterioration. It is assumed that epilepsy-related noxious events and agents exhaust the compensatory capacity of brain functions. A high cognitive reserve capacity, however, might delay the onset of deterioration. The duration of epilepsy contributes to the explanation of interindividual variability in IQ measures of adult TLE patients to a higher degree than age and age of epilepsy onset.

In the present study, results of the digit span forward and backward test showed no correlation with either the frequency or the duration of seizures. In contrary to this, Riva et al25 found that frequency of seizures correlated with attention difficulties digit span forward and backward test, but they attributed this to the AEDs and not to the epileptic process. Also the subjects of the study of Riva et al25 were children while patients of the present study were adults.

Magnetic resonance imaging is the most sensitive and specific structural neuroimaging procedure for use in refractory epilepsy. It may reliably indicate the pathologic findings underlying the epileptogenic zone and indirectly suggest localization of the epileptic brain tissue. The most common abnormalities identified are hippocampal sclerosis, cortical dysgenesis, vascular malformations, tumors and other pathologies as atrophy, cysts, ischemic lesions as well as traumatic injuries26.

In the present study, hippocampal sclerosis ranked the first MRI abnormality being present in 53.12% of TLE patients.  This is going with the study of Garcia et al.27, who concluded that hippocampal sclerosis is the most common cause of TLE. On the other hand, 12.5% of TLE showed negative MRI that is similar to other work.28 Cortical dysgenesis can be presented by any form of epilepsy29 and may be seen in up to 14% in children with refractory epilepsy.30 Arachnoid cyst was present in 10% of TLE patients of the present study. However, the relationship between arachnoid cyst and epilepsy is controversial.31 One of the possible mechanisms is a mass effect of the cyst with subsequent irritation of the surrounding cortex.32 In the current work, hippocampal sclerosis was present in 8% of the controlled TLE group. This finding could be attributed to either turn of controlled seizures to refractory type or it could be an incidental MRI finding.

The EEG is the most frequently performed neurodiagnostic study in patients with a seizure disorder.33 Most patients with partial epilepsy experience complex partial seizures, with onset in the anterior temporal region, emanating from the medial temporal lobe (amygdala or hippocampus) or the lateral temporal neocortex.34 Anterior temporal spikes are highly epileptogenic and represent the most common interictal EEG alteration in adults with partial epilepsy.

Negative MRI studies in refractory complex partial seizures are still a challenge. In most of the MRI abnormalities, scalp EEG is concordant to MRI except in cortical dysgenesis. In some cases of hippocampal sclerosis, scalp EEG is not concordant to MRI especially in those with bilateral interictal epileptiform discharges and/or bilateral hippocampal sclerosis.

   

Conclusion

The cognitive functions in patients with CPS of temporal lobe origin tend to decline with increased duration of illness and frequency of seizures. Each of the illness duration and the frequency is inversely correlated to the subtests of IQ. The findings underline the importance of earlier neuropsychological interventions as well as follow-up assessments at regular intervals during the course of the disease. Moreover, Negative MRI studies in refractory CPS are still a challenge.  

 

[Disclosure: Authors report no conflict of interest]

 

REFERENCES

 

1.      Hui ACF, Yeung HM. Avoiding pitfalls in the management of epilepsy. The Hong Kong Practitioner. 2001; 23: 246-50.

2.      Sander JW. The epidemiology of epilepsy revisited. Curr Opin Neurol. 2003; 16 (2): 165–70.

3.      Brodie MJ, Elder AT, Kwan P. Epilepsy in later life. Lancet neurology. 2009; 8 (11): 1019-30.

4.      Klennerman P, Sander JW, Shorvon SD. Mortality in patients with epilepsy: a study of patients in long term residential care. J Neurol Neurosurg Psychiatry. 1993; 56: 149-52.

5.      Kwan P, Arzimanoglou A, Berg AT, Brodie MJ, Allen Hauser W, Mathern G, et al.. Definition of drug resistant epilepsy: consensus proposal by the ad hoc Task Force of the ILAE Commission on Therapeutic Strategies. Epilepsia. 2010; 51: 1069-77.

6.      Leppik IE. Intractable epilepsy in adults. Epilepsy Res. 1992; 5: 7-11.

7.      Hauser WA, Annegers JF, Kurland LT. Prevalence of epilepsy in Rochester, Minnesota: 1940-1980. Epilepsia. 1991; 32: 429-45.

8.      Dreifuss FE. Classification of epileptic seizures. In: Engel J Jr and Pedley TA, editors. Epilepsy: A comprehensive textbook. Philadelphia: Lippincott-Raven Publishers; 1997. pp.517-24.

9.      Kramer U, Riviello JJ Jr, Carmant L, Black PM, Madsen J, Holmes GL. Clinical characteristics of complex partial seizure: a temporal versus a frontal onset. Seizures. 1997; 6: 57-61.

10.    Cascino GD. Intractable partial epilepsy: evaluation and treatment. Mayo Clinic Proceedings. 1990; 65: 1578-86.

11.    Chabolla DR. Characteristics of the epilepsies. Mayo Clinic Proceedings. 2002; 77: 981-990.

12.    Loring DW. Neuropsychological evaluation in epilepsy surgery. Epilepsia. 1997; 38 suppl 4: s18-s24.

13.    Commission on classification and terminology of the international league against epilepsy (ILAE). Proposal for a revised classification of the epilepsies and epileptic syndromes. Epilepsia. 1989; 30: 389-99.

14.    Ebersole JS, Wade PB. Spike voltage topography identifies two types of fronto-temporal epileptic foci. Neurology. 1991; 41: 1425-33.

15.    Hermann BP, Seidenberg M, Schoenfeld J, Davies K. Neuropsychological characteristics of the syndrome of mesial temporal epilepsy. Arch Neurol. 1997; 54: 369-76.

16.    Exner C, Boucsein K, Lange C, Winter H, Weniger G, Steinhoff BJ, et al. Neuropsychological performance in frontal lobe epilepsy. Seizure. 2002; 11: 20-32.

17.    Baglietto MG, Battaglia FM, Nobili L, Tortorelli S, De Negri E, Calevo MG, et al. Neuropsychological disorders related to interictal epileptic discharges during sleep in benign epilepsy of childhood with centrotemporal or Rolandic spikes. Dev Med Child Neurol. 2001; 43: 407-412.

18.    Cohen M. Auditory-verbal and visuo-spatial memory in children with complex partial epilepsy of temporal lobe origin. Brain Cogn. 1992; 20: 315-26. 

19.    Smith ML, Elliot IM,Lach L. Cognitive skills in children with intractable epilepsy: comparison of surgical and nonsurgical candidates. Epilepsia. 2002; 43: 631-637.

20.    Smith ML, Milner B. Estimation of frequency of occurrence of abstract designs after frontal or temporal lobectomy. Neuropsychologia. 1988; 26: 297-306.

21.    Bjornaes H, Stabell K, Henriksen O, Loyning Y. The effects of refractory epilepsy on intellectual functioning in children and adults. A longitudinal study. Seizures. 2001; 10: 250-9. 

22.    Rodin EA, Schmaltz S, Twitty G. Intellectual functions in childhood onset epilepsy. Dev Med Child Neurol. 1986; 28: 25-33.

23.    Maestú F, Martín P, de Sola RG, Obregón MC, Gómez-Utrero E, Fernandez A, et al. Neuropsychology of temporal partial epilepsy: a comparison of drug resistant and pharmacologically controlled patients. Rev Neurol. 2002; 31: 817-21.

24.    Jokeit AKP, Ebner A. Effects of chronic epilepsy on intellectual functions. Prog Brain Res. 2002; 135: 455-63.

25.    Riva D, Saletti V, Nichelli F, Bulgheroni S. Neuropsychologic effects of frontal lobe epilepsy in children. J Child Neurol. 2002; 17: 661-7.

26.    Heinz ER, Crain BJ, Radtke RA, Burger PC, Friedman AH, Djang WT, et al. MR imaging in patients with temporal lobe seizures: correlation of results with pathologic findings. AJNR. 1990; 11: 827-32.

27.    Garcia PA, Laxer KD, Barbaro NM, Dillon WP. Prognostic value of qualitative magnetic resonance imaging hippocampal abnormalities in patients undergoing temporal lobectomy for medically refractory seizures. Epilepsia. 1994; 35: 520-4.

28.    Scott CA, Fish DR, Smith SJ, Free SL, Stevens JM, Thompson PJ Duncan JS, Shorvon SD and Harkness WF. Presurgical evaluation of patients with epilepsy and normal MRI: role of scalp video-EEG telemetry. J Neuro Neurosurg Psychiatry. 1999; 66: 69-71.

29.    Li LM, Fish DR, Sisodiya SM, Shorvon SD, Alsanjari N, Stevens JM. High resolution magnetic resonance imaging in adults with partial or secondary generalized epilepsy attending a tertiary referral unit. J Neuro Neurosurg Psychiatry. 1995; 59: 384-7. 

30.    Steffenburg U, Hedstrom A, Lindroth A, Wiklund LM, Hagberg G, Kyllerman M. Intractable epilepsy in a population based series of mentally retarded children. Epilepsia. 1998; 39: 767-75. 

31.    Arroyo S, Santamaria J. What is the relationship between arachnoid cysts and seizure foci? Epilepsia. 1997; 38: 1098-102.

32.    Koch CA, Moore JL, Voth D. Arachnoid cyst: how do postsurgical cyst size and seizure outcome correlate? Neurosurgical Review. 1998; 21: 14-22.

33.    Daly DD. Epilepsy and syncope. In: Pedley TA, Daly DD, editors. Current practice in electroencephalography. New York NY: Raven Press; 1990. pp.269-344.

34.    Williamson PD, Spencer SS. Clinical and EEG features of complex partial seizures of extratemporal origin. Epilepsia. 1986; 27 (suppl. 2): s46-63.


 

 

 

 

 

الملخص العربى

 

التدهور الإدراكي في مرضى الصرع الجزئي المركب العاصى

 

يعتبر الصرع من أكثر الأمراض العصبية شيوعا كما يعتبر الصرع الجزئي المركب من أكثر أنواع الصرع شيوعا وأصعبها في علاجه، وترجع أسبابه إلى خلل في الفص الصدغي للمخ. يهدف هذا البحث إلى دراسة الهبوط الأدراكى أو المعرفي في مرضى الصرع الجزئي المركب العاصي في الفص الصدغي للمخ، وقد تم إجراء هذه الدراسة على 57 مريض بهد النوع من الصرع حيث تم عمل رسم مخ للمرضى وعلى أساسه تم تقسيم المرضى إلى مجموعتين رئيسيتين: (1) مجموعة الصرع الجزئي المركب العاص (32 مريضا) وتم تقسيمهم إلى مجموعتين فرعيتين وهى مجموعة صرع الفص الصدغي الأيمن (17 مريضا) والأيسر (15 مريضا)، و(2) المجموعة الضابطة وهى مجموعة الصرع الجزئي المركب تحت السيطرة (25 مريضا). وتم عمل أشعة بالرنين المغناطيسي على المخ للمرضى كما خضع المرضى للدراسة بالقياسات النفسية وهى: مقياس ويكسل للراشدين، اختبار السعة الرقمية، قياس درجة الانتباه باختبار توصيل الدوائر، واختبار "بيندر-جيشتلت" للذاكرة البصرية. تبين من البحث أن كلا من اختبار السعة الرقمية وإختبار "بيندر-جيشتلت" واختبار توصيل الدوائر (الذاكرة الشفهية القصيرة)  أحرز مرضى الصرع الجزئى العاص نقاطا أقل من مرضى الصرع الجزئى تحت السيطرة وكان ذو دلالة إحصائية، اما فى كل اختبار "ويكسلر" للراشدين المنقح فكما بين حصول مرضى الصرع الجزئى العاص على نقاط أقل من مرضى الصرع الجزئى تحت السيطرة وكان ذو دلالة إحصائية بين أيضا انحسارا ذا دلالة إحصائية للمعامل الشفهى فى الفص الأيسر مقابل الأيمن وعلى النقيض بالنسبة للمعامل. كما لم يتضح أى علاقة بين هذه القياسات وكل من عمر المريض أو عمره عند بداية المرض أو مدة المرض أو معدل حدوث النوبات الصرعية.  أما عن نتائج دراسة الرنين المغناطيسى فقد وجد أن تصلب قرن آمون هو الأكثر شيوعا (53.12% فى المجموعة الأولى وفى 8% من المجموعة الثانية) وقد كان الرنين المغناطيسى طبيعيا فى 12.5% فى المجموعة الأولى. أما عن نتائج تخطيط المخ الكهربائى فقد جاءت متطابقة مع الرنين المغناطيسى فى 88.2% من مرضى تصلب قرن آمون. ومن هذا يتضح أنه يلزم عمل هذه القياسات لدراسة هناك ثمة تدهور حاصل فى القدرات المعرفية والإدراكية  لهذه النوعية من مرضى الصرع وعلاقتها بتصوير المخ بأشعة الرنين المغناطيسى وتخطيط الدماغ الكهربائى.



2008 � Copyright The Egyptian Journal of Neurology,
Psychiatry and Neurosurgery. All rights reserved.

Powered By DOT IT