發(fā)布時(shí)間：2018-02-24 19:15

  本文關(guān)鍵詞： 顳葉癲癇 認(rèn)知功能 事件相關(guān)電位 P300 N400　出處：《安徽醫(yī)科大學(xué)》2016年碩士論文　論文類(lèi)型：學(xué)位論文

【摘要】：目的運(yùn)用事件相關(guān)技術(shù)(ERPs),采用P300實(shí)驗(yàn)范式、N400實(shí)驗(yàn)范式,評(píng)估藥物難治性顳葉癲癇(RTLE)患者行裁剪式前顳葉切除術(shù)術(shù)前、術(shù)后的認(rèn)知功能：①分析術(shù)前、手術(shù)后的P300及N400的變化特點(diǎn)：②初步探討藥物難治性TLE患者存在認(rèn)知功能障礙；③進(jìn)一步探討前顳葉切除術(shù)對(duì)藥物難治性TLE患者認(rèn)知功能的影響。方法連續(xù)收集2014年12月至2015年12月,于廈門(mén)市解放軍第174醫(yī)院神經(jīng)醫(yī)學(xué)中心行裁剪式前顥葉切除術(shù)治療的10例顳葉癲癇患者。所有患者均在術(shù)前進(jìn)行嚴(yán)密的術(shù)前評(píng)估：①無(wú)創(chuàng)術(shù)前評(píng)估：錄像腦電圖(video electroencephalography, VEEG)、3.0T MRI、正電子發(fā)射斷層顯像(positron emission computerized tomography,PET),其中有6例患者經(jīng)過(guò)上述檢查后可明確致癇灶范圍及側(cè)別；②有創(chuàng)術(shù)前評(píng)估：顱內(nèi)電極埋藏以及丙泊酚Wada試驗(yàn),另4例患者在進(jìn)一步的有創(chuàng)評(píng)估后確定致癇灶范圍及側(cè)別：③神經(jīng)心理學(xué)評(píng)估：所有患者均進(jìn)行韋氏智力及記憶量表測(cè)量；④P300、N400檢查：所有患者在術(shù)前均采用德國(guó)品牌Brain Products (BP)的64導(dǎo)聯(lián)ERP記錄與分析軟件進(jìn)行檢測(cè)。經(jīng)過(guò)上述評(píng)估后在持續(xù)腦電圖(electrocorticogram, ECoG)監(jiān)測(cè)下實(shí)施裁剪式前顳葉切除術(shù)。在手術(shù)后的1個(gè)月、3個(gè)月及6個(gè)月進(jìn)行隨訪,再次對(duì)每個(gè)患者進(jìn)行P300、N400的檢測(cè),最后匯總數(shù)據(jù)分別對(duì)術(shù)前和術(shù)后的P300及N400進(jìn)行比較。結(jié)果①癲癇組與正常對(duì)照的P300潛伏期比較,分別從兩組中獲得均數(shù)及標(biāo)準(zhǔn)差,使用獨(dú)立樣本t檢驗(yàn),結(jié)果顯示癲癇組的CZ、PZ的P300潛伏期較對(duì)照組分別延長(zhǎng)42.54ms、46.53ms,差異具有顯著性,P0.05；②術(shù)前與術(shù)后P300潛伏期及波幅比較：術(shù)后第1個(gè)月、3個(gè)月、6個(gè)月CZ的P300潛伏期分別較術(shù)前縮短24ms,27.4ms、25.4ms,差異具有顯著性,以術(shù)后3個(gè)月及6個(gè)月差異具有極顯著性P0.01,術(shù)后第1個(gè)月差異具有顯著性,P0.05；而PZ的潛伏期在術(shù)后第1個(gè)月、第3個(gè)月差異不明顯,在術(shù)后第6個(gè)月潛伏期較術(shù)前縮短36.2ms,差異具有顯著性,P0.05。而術(shù)前和術(shù)后的CZ、PZ的P300波幅差異不明顯,無(wú)顯著性；③術(shù)前與術(shù)后N400潛伏期及波幅比較：術(shù)后1個(gè)月、3個(gè)月及6個(gè)月PZ的N400潛伏期與術(shù)前相比較,無(wú)顯著性意義。術(shù)后與術(shù)前的N400波幅相比較,也無(wú)顯著性意義。結(jié)論藥物難治性TLE患者均存在認(rèn)知功能障礙,行裁剪式前顳葉切除術(shù)之后,在隨訪的6個(gè)月期間未再出現(xiàn)發(fā)作,TLE患者的臨床發(fā)作得到控制,同時(shí)在隨訪期間對(duì)P300的潛伏期與術(shù)前比較,結(jié)果顯示潛伏期縮短,P300的潛伏期縮短說(shuō)明TLE患者的認(rèn)知功能得到一定程度改善；對(duì)于N400的潛伏期較術(shù)前相比無(wú)明顯變化,可見(jiàn)TLE患者的語(yǔ)言功能恢復(fù)緩慢。
[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.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類(lèi)號(hào)】：R651.1

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