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

Year 2019, , 289 - 296, 28.05.2019

Burcu Yüksel , Sibel Çeliker Uslu

https://doi.org/10.31362/patd.500457

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

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