JNNP:前颞叶切除术与选择性杏仁核-海马切除术命名测试结果的随机对照试验

2021-01-21 MedSci原创 MedSci原创

难治性颞叶癫痫(TLE)的手术治疗已经很成熟,在癫痫控制、患者生活质量(QOL)和治疗费用方面都取得了良好的效果。 然而,术后认知能力下降是一个值得关注的问题。在占优势的大脑半球,有25%-60%的患

难治性颞叶癫痫(TLE)的手术治疗已经很成熟,在癫痫控制、患者生活质量(QOL)和治疗费用方面都取得了良好的效果。 然而,术后认知能力下降是一个值得关注的问题。在占优势的大脑半球,有25%-60%的患者在前颞叶切除术(ATL)后出现发音障碍。 选择性杏仁核-海马切除术(SAH)是一种替代方法,在这种方法中,为减少功能损伤,颞叶新皮质被保留。目前没有进行对照研究来证明这两种方法的结果。有必要确定蛛网膜下腔出血是否能更好地保留神经心理功能。本研究旨在通过随机对照试验(RCT)设计确定SAH和ATL的不同临床结果。

2012年至2018年间,在一家三级医疗机构进行了一项平行的单中心随机对照试验。由于招募率下降,试验中止。没有进行中期分析。使用波士顿命名测试(BNT)进行测量。该仪器是癫痫患者最常用的命名评估方法,该仪器已被证明能可靠地检测术后发音障碍。将听觉命名、生活质量和抑郁症状作为次要结果进行测量。患者由外部管理人员采用封闭随机模型随机分配到ATL或SAH组。手术在入组后1周内完成,所有手术均由同一神经外科医生完成。术前和术后1年对患者进行检测。采用T检验比较命名、生活质量和情绪的平均变化得分与RCIs和最小临床重要差异(mcid)之间的差异。进行二级相关分析,以评估颞叶内侧硬化症(MTS)与癫痫发病年龄和术后预后之间的关系。所有数据均用SPSS统计。

34名患者同意参加试验。在32名数据完整的随机患者中,SAH和ATL组的MRI表现比例如下:MTS 12:11,正常3:3,海马海绵状细胞瘤1:1,局灶性杏仁核发育不良0:1。蛛网膜下腔出血组中女性明显增多,但手术后男性和女性的命名变化得分无显著差异。在联合队列中,术前视觉命名受损(43.8±11;平均值±标准差),术后进一步下降,50%的患者的变化得分超过RCI。19%的患者术后视觉命名有明显改善,其中13%的患者的变化评分超过RCI。

两组之间的视觉命名变化得分没有显著差异(95%CI−4.8至6.4,p=0.4)。6%的SAH患者和13%的ATL患者的改善程度超过RCI,56%的SAH患者和44%的ATL患者的下降程度超过RCI。在合并队列中,BNT的视觉命名平均下降了5.9±9.1(95%CI−9.2至−2.6,p=0.001),SAH组的平均下降为−6.3±8(95%CI−9.9至–2.8,p=0.0035),ATL组的平均下降为−5.5±9.7(95%CI−9.6至−0.98,p=0.002)。无MTS证据的患者视觉命名下降明显更大(p=0.05)。相比之下,两组在术后听觉命名方面存在显著差异(95%CI−9.1至–0.9,−5,p=0.025)。听觉命名使用听觉命名测试(ANT)进行评估,SAH组63%的患者改善超过4分的RCI,ATL组6%的患者改善。联合组在听觉命名方面提高了2.7±7.2分(95%ci0.54~4.9,p=0.021),超过RCI下降了13%。手术后联合组患者的生活质量显著改善(95%CI 11.2至21.4,p<0.001)和抑郁症状减少(95%CI−7.98至–0.83,p=0.017),分别有72%和22%的患者有临床意义的改善。18例术后1年无癫痫发作。

随机对照试验的结果显示:术后1年接受ATL和SAH的患者视觉命名下降无显著性差异(95%CI<RCI),而术后两组患者的听觉命名有显著性差异,63%的SAH患者的视觉命名改善超过ANT RCI,而6%的SAH患者的视觉命名改善超过ANT RCIATL组。 联合组患者术后视觉命名显著下降,而听觉记忆没有下降。 两组之间的癫痫发作结果没有显著差异,但考虑到样本量和95%置信限,ATL对SAH具有潜在的临床重要益处;术后1年的生活质量和情绪症状有显著改善,与手术类型无关。

这项随机对照试验表明,蛛网膜下腔出血产生更好的,显着的,改善听觉命名结果,但并没有减少视觉命名损失。这表明,为了优化听觉命名结果,保留内侧颞叶癫痫患者的颞叶新皮质是有价值的,特别是因为听觉命名是一种与视觉命名相比具有更高生态效度的测量方法。虽然几乎一半的患者在视觉命名方面的下降超过了RCI,但大约五分之一的患者在视觉命名方面有所改善,八分之一的患者在视觉命名方面的改善超过了RCI。

 

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    2021-01-23 paperyu
  7. [GetPortalCommentsPageByObjectIdResponse(id=1775547, encodeId=ada71e755478d, content=<a href='/topic/show?id=937d46650bf' target=_blank style='color:#2F92EE;'>#对照#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=46650, encryptionId=937d46650bf, topicName=对照)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8ae138776909, createdName=amyloid, createdTime=Mon Mar 29 04:59:05 CST 2021, time=2021-03-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1922971, encodeId=ea1019229e187, content=<a href='/topic/show?id=78f794e800a' target=_blank style='color:#2F92EE;'>#选择性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=94780, encryptionId=78f794e800a, topicName=选择性)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a0802500050, createdName=肉我只吃一口, createdTime=Mon Jun 28 04:59:05 CST 2021, time=2021-06-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1987290, encodeId=492b198e29042, content=<a href='/topic/show?id=bac5466546c' target=_blank style='color:#2F92EE;'>#对照试验#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=46654, encryptionId=bac5466546c, topicName=对照试验)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ad9f79, createdName=般若傻瓜, createdTime=Fri Nov 12 07:59:05 CST 2021, time=2021-11-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1877370, encodeId=87a518e737002, content=<a href='/topic/show?id=67c5319121e' target=_blank style='color:#2F92EE;'>#切除术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=31912, encryptionId=67c5319121e, topicName=切除术)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=9d8a96, createdName=doctorzheng, createdTime=Sat Sep 04 16:59:05 CST 2021, time=2021-09-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1296258, encodeId=16941296258c6, content=<a href='/topic/show?id=7591984530b' target=_blank style='color:#2F92EE;'>#随机对照试验#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=98453, encryptionId=7591984530b, topicName=随机对照试验)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=373b263, createdName=lisa438, createdTime=Sat Jan 23 14:59:05 CST 2021, time=2021-01-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1540395, encodeId=438e15403952b, content=<a href='/topic/show?id=48d6614666b' target=_blank style='color:#2F92EE;'>#杏仁核#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=61466, encryptionId=48d6614666b, topicName=杏仁核)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=53c913230719, createdName=paperyu, createdTime=Sat Jan 23 14:59:05 CST 2021, time=2021-01-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=918916, encodeId=1034918916a8, content=认真学习了?, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210122/ce2afd37c8ee477585364ea0ace651a7/acf7a88cfd184c1f9a24a04925048b4f.jpg, createdBy=078c5454872, createdName=ms7000000709511634, createdTime=Fri Jan 22 08:43:34 CST 2021, time=2021-01-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1038990, encodeId=e3a01038990cc, content=高质量研究,读起来真爽,谢谢梅斯, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=肿瘤克星, createdTime=Fri Jan 22 02:59:05 CST 2021, time=2021-01-22, status=1, ipAttribution=)]
    2021-01-22 ms7000000709511634

    认真学习了?

    0

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    2021-01-22 肿瘤克星

    高质量研究,读起来真爽,谢谢梅斯

    0

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