Study The Changes Of Neuropsychology After Surgical Intervention In Patients With NTLE And Relation Of Results In Stereo-EEG Monitoring With Their Prognosis

Objective:To understand the changes of Neuropsychology after surgical intervention in patients with NTLE, comparing different treatments, hippocampal atrophy, lateral, ways of surgery and postoperative results, analysis changes of neuropsychological aspects:intelligence, memory, mental disorders and emotion recognition; investigate the correlation between results in long-term video EEG monitoring and Neuropsychological Prognosis.Method:Analyse retrospectively 65 cases of NTLE since September 2011 to March 2015 in our hospital, which enrolled 55 cases,10 cases not enrolled because of losing contact, losing interview, and so on. In the 55 patients enrolled,34 males (61.8%), female 21 (38.2%), male to female ratio was 1.6:1. Age of onset is 12-63 years, mean age 25.56±14.23Y, median age 21 years, the average age of men and women were 26.36±14.45Y and 24.26±14.12Y. Information collected depends on factors related to clinical history:the form of onset is divided into simple partial seizures, complex partial seizures, secondary generalized seizures, automatism, somatosensory and special sensory symptoms, psychiatric symptoms and autonomic symptoms; lesions of temporal lobe are divided into lesions and no lesions, NTLE with lesion alone and NTLE with dual pathology (involving neocortex lesion and hippocampal sclerosis). According epileptic network-wide in the long-term video EEG monitoring, divided into focal, hemispheric and bilateral; According seizure frequency, divided into IEDs> 10% and IEDs≤10% two groups. Patients with surgical selection were divided into non-operated group, excision of neocortex lesion group and the anterior temporal lobe resection. The study period is from the beginning of surgery to the end of follow-up. In Neuropsychology, intelligence, memory, NBI and emotion recognition were detected using a fixed scale score and classification.Strictly in accordance with the standard of surgical patients with NTLE to choose patients, patients with NTLE after surgery need conventional antiepileptic drugs for a year, depending on the specific situation to adjust the dose, type and time.Qualitative medical data Was extracted from medical files, using a defined protocol, and assembled in a database(Excel 2007, Windows software). Statistical analyses were performed using SPSS statistical software(Version 17.0; SPSS Inc.,Chicago, IL, USA).Descriptive analysis Was performed using means±standard deviation, medians, and percentages. All the variables were analyzed with regard to their importance using the univariate analysis for the changes of Neuropsychology after surgical intervention in patients with NTLE. The P value<0.05 Was selected as significant.Comparative analysis of data use t-test and ANOVA to test. In order to simplify the analysis of figures, we retained after two decimal places, neuropsychological monitoring data base on common specifications to be given simplified.Frequency Domain in EEG depend on correlation analyses, concordance analyses and clustering analyses.For maintaining a homogenous sample and thus faithfully evaluating the prognostic factors we have used several rigid inclusion and exclusion criteria for the static analysis.Result:1. The impact of hippocampus changes on neuropsychological changes in patients with NTLE after surgical intervention1.1 Lesion alone groupPostoperative patients with hippocampal atrophy did not find statistically significant for intelligence, NBI and emotional recognition, after surgery, the left NTLE with learning condition memory dysfunction was significantly (p=0.001), delayed condition memory function (p=0.002) is also significantly, indicating that the left postoperative NTLE with hippocampal atrophy are factors of memory impairment.1.2 No lesion groupNo lesion group selected the ATL procedure, hippocampus has been removed, and won’t determine the impact of hippocampus changes on neuropsychological changes.1.3 Dual pathologyNTLE-HS in this group, only three cases, after the left ATL, intelligence, memory and emotion recognition has declined, indicating that the left ATL will make cognitive decline significantly, while cognitive decline of the right side of excision is not obvious.2. The impact of different treatments on neuropsychological changes in patients with NTLE after surgical interventionSurgery did not affect the patient’s changes of mental, NBI and emotion recognition, learning condition memory function in right postoperative NTLE compared with the preoperative improved significantly, indicating that the right of surgical excision and ATL always can improve learning condition memory function.3. The impact of different ways of surgery on neuropsychological changes in patients with NTLE after surgical interventionChanges in psychology of NTLE resection have no statistical differences, learning condition memory function improved rapidly, while improving of the delayed condition memory function is relatively slow. After the left ATL, memory function and emotion recognition has significantly decreased, after the right ATL, NBI was significantly increased, and there is statistically significant, indicating that the right side after ATL is more likely to produce mental disorders disease.4. The impact of Engel classification on neuropsychological changes in patients with NTLE after surgical interventionIntelligence, NBI and emotion recognition with El sub-class of NTLE after surgery are not statistically significant.postoperative Engel1A compared to other sub-level, learning condition memory function improved significantly, there are significant differences, and regardless of lateral.5. The correlation between results in long-term video EEG monitoring and Neuropsychological Prognosis.the learning condition memory function of IEDs>10% decreased, it had significantly statistical difference; learning condition memory function with hemispheric IEDs decreased significantly, similarly had statistical significance; learning condition and delayed condition memory function with bilateral IEDs decreased apparently and are statistically significant.In resting state, the decline of δ power have good consistency with delayed condition memory dysfunction, the more obviously 8 power decline, the more serious delayed condition memory dysfunction is; the decline of β and y power have good consistency with neurobehavioral decline, the more obviously β and y power decline, the more serious mental disorders is; the decline of β power have good consistency with emotion recognition dysfunction, the more obviously P power decline, the more serious emotion recognition dysfunction is. In resting state EEG, changes of frequency-domain information in part band may become well-predictor of postoperative psychological changes with NTLE.Conclusion:1. postoperative intelligence with NTLE change slightly, essentially unaffected;2. Changes in memory function with NTLE are associated with hippocampal atrophy, lateral, ways of surgery and postoperative results, learning condition memory function compared to delayed condition is more susceptible to become progressive disorder, but compared to the delayed condition memory function, it also improve faster;3. In dual pathology with NTLE, cognitive function of left ATL decrease more significantly than the right side, and cognitive function after right resection maintain stability;4. The right of surgical excision and ATL can improve learning condition memory function, but delayed condition not improve obviously;5. Postoperative memory function and social cognition with left ATL decline more obviously than the right side, postoperative mental disorders with right ATL are more apparent;6. Compared to other sub-grade, learning condition memory function with Engel 1A comparing with delayed condition memory function improved significantly, regardless of lateral;7. The learning condition memory function of IEDs>10% decreased obviously, Comparing with delayed condition;8. learning condition memory function with hemispheric and bilateral IEDs decreased significantly, delayed condition memory function with bilateral IEDs also decreased apparently;9. In resting state EEG, changes of frequency-domain information in each band may become well-predictor of postoperative psychological changes with NTLE.