颞叶癫痫患者执行功能损害及其与P300的相关性分析  

Executive dysfunction in patients with temporal lobe epilepsy and its correlation with P300

作　　者：姚晓娟[1] 毓青[3] 杨二娟[2] 欧阳慧[2] 陈英[3] 杨卫东[1] 陈旨娟[3] 王增光[1] 

机构地区：[1]天津医科大学总医院神经外科,300052 [2]天津医科大学总医院神经内科,300052 [3]天津市神经病学研究所

出　　处：《中华医学杂志》2014年第7期521-524,共4页National Medical Journal of China

基　　金：天津市科委科学基金（12JCYBJC16900）

摘　　要：目的探讨颞叶癫痫（TLE）患者执行功能的改变及其与事件相关电位P300的相关性。方法对天津医科大学总医院50例TLE患者和30名与其年龄、性别、文化程度相匹配的健康志愿者进行神经心理学检查，包括蒙特利尔认知评估（MoCA）、工作记忆、语义流畅性试验、连线试验、数字广度测验、数字符号测验、Stroop色词测验及事件相关电位P300检测。结果TLE组MoCA、语言及非语言工作记忆、语义流畅性、数字广度、数字符号及Stroop试验评分低于正常对照组，TLE组连线A、连线B时间延长，差异均有统计学意义（均P〈0．05）。和正常对照组相比，TLE组P300潜伏期[（332±33）ms]延长，P300波幅[（10±8）μV]降低，差异有统计学意义（P〈0．05）。左侧致痫灶组与右侧相比，语言工作记忆差异有统计学意义（P〈0．05）。P300潜伏期和MoCA、非语言工作记忆、数字广度测验、数字符号测验评分存在负相关（r=-0．29～-0．45，P〈0．05）；P300波幅和MoCA、非语言工作记忆、数字符号、Stroop色词测验评分存在正相关（r=0．37～0．47，P〈0．05）。其中P300波幅与总体认知水平和执行功能相关性更大。结论颞叶参与了执行功能的调控，TLE患者除存在广泛的认知损害外，尚存在多项执行功能损害包括：工作记忆、认知灵活性、注意力和抑制控制能力，其中左侧TLE患者语言工作记忆损害明显。TLE患者常存在P300潜伏期延长和波幅下降，其与执行功能测试存在相关性，P300潜伏期和波幅的检测有可能成为评价TLE患者认知功能损害的客观指标。Objective To explore the changes of executive function in patients with temporal lobe epilepsy and analyze its correlation with P300 event-related potentials. Methods Fifty patients with temporal lobe epilepsy and 30 age, gender and education-matched healthy control subjects were assessed by neuropsychological tests, including Montreal cognitive assessment （MoCA）, working memory, verbal fluency, trail making, digit span, digit symbol and Stroop color-word interference to detect P300 event related potentials. Results In temporal lobe epilepsy group, the scores in MoCA, verbal and non-verbal working memory, verbal fluency, digit span, digit symbol and Stroop test were lower than those of the normal control group. And trail making tests A and B became prolonged （ P 〈 0. 05 ） . Comparing with normal control group, temporal lobe epilepsy patients had prolonged latency [ （ 332 ± 33 ） ms ] and decreased P300 amplitude[ （10 ± 8 ）μV] （P 〈 0. 05 ）. Comparing epileptogenic focus group on the left and right sides, there was statistically significant difference in verbal working memory （ P 〈 0. 05 ）. There was a negative correlation of P300 latency and MoCA, non-verbal working memory, digit span and digit symbol test scores （r = - 0. 29 ± 0. 45, P 〈 0. 05 ）. And a positive correlation of P300 amplitude and MoCA, non-verbal working memory, digit symbol conversion and Stroop scores was also found （ r = 0. 37 - 0.47, P 〈 0. 05 ）. P300 amplitude was more relevant to overall cognitive level and executive functions. Conclusion Temporal lobe is involved in the regulation of executive functions. Besides a wide range of cognitive impairment, temporal lobe epilepsy patients have a number of executive dysfunctions, including working memory, cognitive flexibility, attention and inhibitory control ability. And an impairment of verbal working memory is evident in left-sided lesion. Their manifestations include decreased latency arid amplitude of P300 onexecutive function tests. Therefore these

关 键 词：癫痫 颞叶 执行功能 神经心理学 事件相关电位 

分 类 号：R742.1[医药卫生—神经病学与精神病学]