Mezial temporal lob epilepsisi tanısı alan hastalarda lateralizasyonun bellek ve yürütücü işlevler üzerine etkisi

Abstract

Özet:

Amaç: Çalışmamızda sağ ya da sol hipokampal sklerozu (HS) olup mezial temporal lob epilepsisi (MTLE) tanısı alan hastaların bellek ve frontal lob fonksiyonlarını karşılaştırarak, bu fonksiyonların hastalık lateralizasyonu ile ilişkisini araştırmayı amaçladık.

Gereç ve yöntem: Hastalar 2017 ILAE Revize Nöbet Sınıflamasına göre sınıflandırıldı. Mezial temporal lob epilepsisi tanısı almış olan 79 hasta ve 30 benzer yaş, cinsiyet ve eğitim durumuna sahip sağlıklı kontrol çalışmaya dahil edildi.. Çalışmamızda sağ ve sol HS’u olan hastalar, bellek ve frontal lob fonksiyonları yönünden karşılaştırıldı.

Bulgular: MTLE-HS tanısı alan hastaların 49’u (%62) kadın ve 30’u (%38) erkekti. Kontrol grubu 14 (%46,7) kadın ve 16 (%53,3) erkekten oluşmaktaydı. Hastaların ve kontrol grubunun ortalama yaşları sırasıyla; 33,53±9,60 (18-57) ve 35,90±7,98 (18-56) idi. 40 hastada (%50,6) sağ HS, 39 hastada (%49,4) sol HS saptanmıştı. Hem sağ hem de sol HS’lu hastaların bellek, dikkat ve diğer frontal lob fonksiyonları kontrol grubuna göre anlamlı derecede başarısızdı (p<0,05). Sol HS’lu hastaların SBST’de en fazla temsil edici alt test olan geri çağırma skoru, sağ HS’lu hastalara göre anlamlı düzeyde düşük bulundu (p=0,001). Sol HS’u olan olguların SBST tanıma sayıları hastalık lateralizasyonu sağ taraf olan olgulara göre istatistiksel olarak anlamlı düzeyde yüksekti (p=0,001). Görsel bellek açısından değerlendirdiğimizde ise sağ ve sol HS’u olan hastalar arasında görsel bellek performansları açısından anlamlı fark bulunmadı (p>0,05). Sağ ve sol HS’u olan hastalarda dikkat ve diğer frontal lob fonksiyonları açısından anlamlı fark saptanmadı (p>0,05)

Sonuç: Sol HS’lu hastalarda sözel bellek testlerinden geri çağırma skorunu, sağ HS’lu hastalara göre anlamlı düzeyde düşük bulmamız sözel bellek bozukluğunun sola lateralize edilebileceğini ancak görsel bellek açısından fark bulmamamız literatürdeki çelişkili sonuçlara benzer şekilde bu fonksiyonun her zaman sağa lateralize edilemeyeceğini doğrulamıştır. Dikkat ve diğer yürütücü işlev performansları açısından anlamlı fark bulmamamız ise dikkat ve diğer yürütücü işlevlerde bozulmanın hastalık lateralizasyonu ile ilişkisi olmadığını düşündürtmüştür.

Keywords

• mezial temporal lob epilepsisi,hipokampal skleroz,bellek,yürütücü işlevler

Lateralization effect on memory and executive functions in mesial temporal lobe epilepsy

Abstract

Summary:

Purpose: The patients who were diagnosed with mesial temporal lobe epilepsy (MTLE) were included to the study. The aim of this study was to compare patients with right or left hippocampal sclerosis (HS) among memory and executive functions and to search if there is lateralization effect on these functions.

Materials and methods: Patients were classified according to 2017 ILAE Classification of Seizures criteria. 79 patients with MTLE-HS who were diagnosed according to seizure history, EEG, neuropsychological tests and MRI findings and 30 healthy controls were enrolled in the study. The patients with right or left HS were compared in terms of memory and executive functions. Tests evaluating memory and executive functions were performed to all participants.

Results: Forty-nine (62%) female and 30 (38%) male patients with MTLE-HS, and 14 (46.7%) female and 16 (53.3%) male controls participated in the study. The mean age of the patients and controls was 33.53±9.60 (range, 18-57) years and 35.90±7.98 (range, 18-56) years, respectively. 40 patients (50.6%) had right HS while 39 (49.4%) had left HS. When comparing patients with controls, scores of tests evaluating memory, attention and other executive functions were found significantly lower in patients than controls  (p<0,05). Recall score of Verbal Memory-Recall, Recognition, Total Learning-Tests (VMT) was significantly lower while recognition scores were higher in left HS patients than right HS patients (p=0,001). There were no significant differences between right and left HS patients concerning visual memory scores or executive functions (p>0,05).

Conclusion: In our study, the lower recall scores of VMT in left HS suggested us that deficits in verbal memory tests could be lateralized to the left, however finding no difference in visual memory function would not always be lateralized to the right  similar to conflicting results in the literature. There were no significant differences between right and left HS concerning attention and other executive functions. Thus, we suggested that defisits in these functions would not help us to lateralize the disorder.

Keywords

• mesial temporal lobe epilepsy,hipocampal sclerosis,memory,executive functions,epilepsy

References

1. 1-Kneebone AC. Presurgical Neuropsychological Evaluation for Localization of the Epileptogenic Zone. Epilepsisurgery.2.ed.Philadelphia:Lippincott Williams&Wilkins, 2001;487-946.
2. 2-Jokeit H, Seitz RJ, Markowitsch HJ, Neumann N, Witte OW, Ebner A. Prefrontal asymmetric interictal glucose hypometabolism and cognitive impairment in patients with temporal lobe epilepsy. Brain. 1997;120 (Pt 12): 2283-2294.
3. 3-Özkara Ç, Bora İ, Yeni SN, Gürses C. Temporal Lob Epilepsileri 1. basım, İstanbul, Nobel Tıp Kitabevleri; 2008. s. 301-317.
4. 4-Sencer S, Kınay D, Gürses C, Kurt BB, Poyanlı A, Gökyiğit A, Tolun R. Cerrahi uygulanan mezial temporal skleroz olgularında klinik ve MRG bulgular. Tanısal ve Girişimsel Radyoloji. 2003; 9:171-175.
5. 5-Delaney MC, Mattson RH. Memory function in focal epilepsy e comparasion of nonsurgical unilateral temporal lobe and frontal lobe samples 1986; 16:103-117.
6. 6-Helmstaedter C, Wietzke J, Lutz MT. Unique and shared validity of the "Wechsler logical memory test", the "California verbal learning test", and the "verbal learning and memory test" in patients with epilepsy. Epilepsy Res. 2009;87(2-3):203-212.
7. 7-Helmstaedter C, Elger CE. Chronic temporal lobe epilepsy: a neurodevelopmental or progressively dementing disease? Brain. 2009;132 (Pt 10):2822-2830.
8. 8-Helmstaedter C, Kurthen M, Lux S, Reuber M, Elger CE. Chronic epilepsy and cognition: a longitudinal study in temporal lobe epilepsy. Ann Neurol. 2003;54(4):425-432.

9. 9-Baxendale SA, van Paesschen W, Thompson PJ, Connelly A, Duncan JS, Harkness WF, Shorvon SD. The relationship between quantitative MRI and neuropsychological functioning in temporal lobe epilepsy. Epilepsia. 1998; 39(2):158-166.
10. 10-Jokeit H, Ebner A. Long term effects of refractory temporal lobe epilepsy on cognitive abilities: a cross sectional study. J Neurol Neurosurg Psychiatry. 1999;67(1):44-50.
11. 11-Sass KJ, Buchanan CP, Kraemer S, Westerveld M, Kim JH, Spencer DD. Verbal memory impairment resulting from hippocampal neuron loss among epileptic patients with structural lesions. Neurology. 1995;45(12):2154-2158.
12. 12-Wagner DD, Sziklas V, Garver KE, Jones-Gotman M. Material-specific lateralization of working memory in the medial temporal lobe. Neuropsychologia. 2009;47(1):112-122.
13. 13-Glikmann-Johnston Y, Saling MM, Chen J, Cooper KA, Beare RJ, Reutens DC. Structural and functional correlates of unilateral mesial temporal lobe spatial memory impairment. Brain. 2008;131(Pt 11):3006-3018.
14. 14-Hanoğlu et al. Material specific memory impairment as a lateralizing finding in temporal lobe epilepsy. Epilepsi. 2014;20(2):67-74.
15. 15-Bell B, Lin JJ, Seidenberg M, Hermann B. The neurobiology of cognitive disorders in temporal lobe epilepsy. Nat Rev Neurol. 2011;7(3):154-164.
16. 16-Baxendale SA, Van Paesschen W, Thompson PJ, Duncan JS, Harkness WF, Shorvon SD. Hippocampal cell loss and gliosis: relationship to preoperative and postoperative memory function. Neuropsychiatry Neuropsychol Behav Neurol. 1998;11(1):12-21.
17. 17-Saling MM, Wilson SJ. Presurgical diagnostics. In: Helmstaedter C, Hermann B, Arzimanoglu A, editors. Neuropsychology in the care of people with epilepsy. Monseltrouge, France: JhonLibbey; 2011; 191-199.
18. 18-Tudesco Ide S, Vaz LJ, Mantoan MA, Belzunces E, Noffs MH, Caboclo LO, Yacubian EM, Sakamoto AC, Bueno OF. Assessment of working memory in patients with mesial temporal lobe epilepsy associated with unilateral hippocampal sclerosis. Epilepsy Behav. 2010;18(3):223-238.
19. 19-Black LC, Schefft BK, Howe SR, Szaflarski JP, Yeh HS, Privitera MD. The effect of seizures on working memory and executive functioning performance. Epilepsy Behav. 2010;17(3):412-419.
20. 20-Giovagnoli AR. Relation of sorting impairment to hippocampal damage in temporal lobe epilepsy. Neuropsychologia. 2001;39(2):140-50. 21-Corcoran R, Upton D. A role for the hippocampus in card sorting? Cortex. 1993;29(2):293-304.
21. 22-Upton D, Corcoran R. The role of the right temporal lobe in card sorting: a case study. Cortex. 1995;31(2):405-409.
22. 23-Zamarian L, Trinka E, Bonatti E, Kuchukhidze G, Bodner T, Benke T, Koppelstaetter F, Delazer M. Executive functions in chronic mesial temporal lobe epilepsy. Epilepsy Res Treat. 2011;2011:596174.
23. 24-Riley JD, Moore S, Cramer SC, Lin JJ. Caudate atrophy and impaired frontostriatal connections are linked to executive dysfunction in temporal lobe epilepsy. Epilepsy&Behavior. 2011; 21(1):80-87.