Temporal lob epilepsi cerrahisi öncesinde ve sonrasında dikkat, bellek ve yürütücü işlevlerdeki değişimin retrospektif olarak incelenmesi
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2022
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Bu çalışmanın amacı temporal lob epilepsi cerrahisi geçirmiş hastalarda cerrahi sonrasında, dikkat, bellek, yürütücü işlevleri ve depresyon düzeylerinde meydana gelen değişimi incelemekti. Cerrahpaşa Tıp Fakültesi'nde 2010-2020 yılları arasında epilepsi cerrahisi geçirmiş olan hasta dosyaları incelemeye alınmıştır. Dâhil etme kriterlerine uygun 91 hasta dosyasına ulaşılmıştır. Bu hasta dosyaları öncelikle cerrahi sonrası 1. NPT değerlendirmeleri 6-11. aylarda yapılanlar (64 hasta) ve cerrahi sonrası 1. NPT değerlendirmeleri 12-24. aylarda yapılanlar (19 hasta) olarak iki farklı gruba ayrılmıştır. Doksan bir hastadan 30'unun cerrahi sonrasında, takip amaçlı olarak, farklı zamanlarda iki kez NPT değerlendirmesi yapıldığı görülmüştür. Post-op döneme ait iki NPT dosyası olan bu 30 kişilik hasta grubu ile üçüncü bir grup oluşturularak bilişsel işlevlerde ve depresyon düzeyinde zaman içinde oluşan değişimlerin incelenmesi amaçlanmıştır. Tanımlanan her üç grup kendi içinde sol taraflı cerrahi geçirenler ve sağ taraflı cerrahi geçirenler olarak alt gruplara ayrılmıştır. Ayrıca, nöbetsizliğin bilişsel işlevler üzerindeki etkisini inceleyebilmek için toplam hasta grubu (91 hasta), cerrahi sonrasında nöbetleri azalarak devam edenler (ENGEL II ve üzeri) ve cerrahi sonrasında nöbetleri sonlananlar (ENGEL I) olarak iki gruba ayrılıp incelenmiştir. Veri toplama araçları olarak, dikkat işlevlerini değerlendirmek için Sayı Menzili testi, yürütücü işlevleri değerlendirmek için Stroop Testi TBAG Formu ile birlikte Sözel Akıcılık testi ve İz Sürme testleri, sözel bellek işlevlerini değerlendirmek için California İşitsel Sözel Öğrenme Testi (CVLT) ve görsel bellek işlevlerini değerlendirmek için Wechsler Bellek Ölçeği Görsel Üretim Alt Testi ve sosyodemografik veri formu kullanılmıştır. Her gruptaki katılımcının cerrahi sonrasındaki bilişsel işlev performansları ve depresyon düzeyleri, cerrahi öncesindeki durumlarıyla karşılaştırılmıştır. Bulgularda, bazı grupların cerrahi öncesi ve sonrasındaki dikkat, yürütücü işlev, bellek işlevleri ve depresyon düzeyleri arasında anlamlı farklılıklar tespit edilmiştir. Dikkat işlevleriyle ilgili olarak, nöbetleri sonlanan ve boylamsal takibi yapılan grubun, cerrahi sonrasında Geri Sayı Menzili sayı performanslarında, kısa ve uzun dönemde iyileşme olduğu tespit edilmiştir. Yürütücü işlevlerle ilgili olarak, boylamsal takibi yapılanlarda hem sağ taraflı hem de sol taraflı cerrahi geçirenlerde, İz Sürme A Testi performansının iyileştiği gözlenmiştir. Ayrıca nöbetleri sonlanan grupta Stroop Testi hata puanlarının cerrahi öncesi göre anlamlı olarak düştüğü saptanmıştır. Bununla beraber sol taraflı cerrahi geçirenlerde cerrahi sonrası 1-2 yıl içinde semantik akıcılık becerilerinin cerrahi öncesine göre anlamlı olarak iyileştiği belirlenmiştir. Ek olarak, nöbetleri sonlanan grubunun cerrahi sonrasındaki semantik ve leksikal akıcılık becerilerinin cerrahi öncesine göre anlamlı olarak iyileştiği bulunmuştur. Sözel bellek işlevleriyle ilgili olarak, sol taraflı cerrahi geçirenlerde cerrahi sonrası ilk bir yıl içinde sözel öğrenme puanları anlamlı olarak düştüğü, buna karşın sağ taraflı cerrahi geçirenlerde anlamlı olarak yükseldiği görülmüştür. Cerrahi sonrasında nöbetleri devam eden grubun kısa süreli sözel bellek puanlarında, anlamlı bir düşüş olduğu tespit edilmiştir. Benzer şekilde sol taraflı cerrahi geçirenlerde ve nöbetleri devam eden grupta kısa süreli sözle bellek işlevlerinde cerrahi öncesine göre anlamlı bir düşüş olduğu saptanmıştır. Cerrahi sonrası ilk bir yıl içinde sol taraflı cerrahi geçirenlerde uzun süreli sözel bellek performanslarının cerrahi öncesine göre anlamlı olarak düştüğü, sağ taraflı cerrahi geçirenlerde ise anlamlı olarak yükseldiği gözlenmiştir. Görsel bellek işlevleriyle ilgili olarak, gecikmeli görsel bellek puanlarının nöbetleri sonlanan ve azalarak devam eden gruplarda anlamlı bir olarak yükseldiği bulunmuştur. Depresyon puanlarının ise sağ taraflı cerrahi geçirenlerde hem ilk bir yıl içinde hem de takip eden yıl içinde anlamlı olarak düştüğü; sol taraflı cerrahi geçirenlerde ise anlamlı bir farklılık olmadığı tespit edilmiştir. Nöbetleri sonlanan grupta ise depresyon puanlarının anlamlı olarak düştüğü görülmüştür. Boylamsal incelenen grupta ise depresyon düzeylerinde zaman içinde anlamlı bir düşüş saptanmıştır. Sonuç olarak, cerrahi sonrasında çalışma belleği ve dikkati sürdürme becerilerinde zaman içinde iyileşmeler olduğu ve nöbetlerin sonlanmasının dikkat işlevlerini olumlu şekilde etkilediği görülmüştür. Yürütücü işlevlerle ilgili olarak özellikle sol taraflı cerrahi geçirenlerde zaman içinde iyileşmeler meydana gelebildiği ve nöbetlerin durdurulmasının yürütücü işlevleri olumlu yönde etkilediği saptanmıştır. Sözel bellek işlevleriyle ilgili olarak sol taraflı cerrahi geçirenlerde ve nöbetleri devam edenlerde zayıflama olduğu, görsel bellek işlevlerinde ise nöbet sıklığının azalmasının olumlu bir etken olduğu ortaya koyulmuştur. Son olarak, nöbetlerin sonlanmasının genel olarak depresyon düzeyini azaltıcı bir etken olduğu ve sağ taraflı cerrahi geçirenlerde depresyon düzeyinin iyileştiği tespit edilmiştir.
The current study aimed to search post-surgical changes in attention, memory and executive functions in chronic temporal lobe epilepsy patients who underwent epilepsy surgery. The files of patients who underwent epilepsy surgery in Cerrahpaşa School of Medicine between 2010 and 2020 were analyzed retrospectively. Among those, patients who had an epilepsy diagnosis for more than one year, who were between the ages of 18 to 65, who were literate, and whom had received pre-operative and post-operative neuropsychological testing (NPT) were included into the study. A total of 91 patient files were reached whom met all the inclusion criteria. Patients were firstly classified as the ones who were applied NPT between post-operative 6th to 11th months (64 patients), and then between 12th and 24th months (19 patients). Among 91 patients, 30 patients who had two consecutive post-op NPTs were classified as the third group in order to examine alterations in cognitive functions and depression levels within time (longitudinal follow-up group). All three groups were further grouped in themselves as left-sided and right-sided surgeries. Moreover, in order to examine the effect of being seizure-free on cognitive functions and depression, 91 patients were classified into two groups; the ones who still had seizures after surgery ( ENGEL II and above) and the ones whose seizures were completely terminated ( ENGEL I). Measurement tools were as follows: a sociodemographic information form, Digit Span Test, Stroop Test TBAG Form, Verbal Fluency Test, Trail Making Test, California Verbal Learning Test (CVLT), Wechsler Adult Intelligence Scale Visual Reproduction Subtest, and Beck Depression Inventory. For Digit Span Test, digit backward scores were improved after surgery in seizure-free group and in longitudinal follow-up group both in short-term and long-term follow-ups. In longitudinal follow-up group, both left-sided and right-sided temporal lobe surgery group's scores on Trail Making A Test performance was improved. Stroop test error scores were significantly decreased after surgery in the seizure-free group. In the left-sided surgery group, semantic fluency scores improved significantly in one to two years after surgery. In seizure-free group, semantic and lexical fluency scores improved significantly after surgery. In the left-sided surgery group, verbal learning scores decreased significantly in post-operative first year while there was a significant increase of verbal learning scores in the right-sided surgery group. There was a significant decline in verbal short-term memory scores of patients who had seizures after surgery. Verbal short-term memory scores of the left-sided surgery group decreased significantly as well. Also, verbal short-term memory scores of patients who had seizures after surgery decreased significantly. In left-sided surgery group, verbal long-term memory scores were significantly decreased in the first post-operative year while there was a significant increase in the right-sided surgery group. On the other hand, visual long-term memory performances were significantly improved both in seizure-free group and in patients whose seizure frequency decreased, yet, not terminated. Depression scores were found to be significantly reduced in the right-sided surgery group both in the first post-operative year and in the following. However, left-sided surgery group did not experience any significant difference regarding depression after surgery. In the seizure-free group, depression scores were decreased significantly. Also, depression scores of the longitudinal follow-up group's decreased significantly in time. In conclusion, working memory and attention functions were improved after surgery in time. Also, termination of the seizures were help to improve the functions related to attention. Concerning executive functions, particularly, patients with left-sided surgery and patients who were seizure-free after surgery were experienced improvement in executive functions. Verbal memory scores of patients in the left-sided surgery group decreased after surgery. Also, verbal memory scores of patients who had seizures decreased. Seizure-free status and right sided surgery was shown to reduce the depression level.
The current study aimed to search post-surgical changes in attention, memory and executive functions in chronic temporal lobe epilepsy patients who underwent epilepsy surgery. The files of patients who underwent epilepsy surgery in Cerrahpaşa School of Medicine between 2010 and 2020 were analyzed retrospectively. Among those, patients who had an epilepsy diagnosis for more than one year, who were between the ages of 18 to 65, who were literate, and whom had received pre-operative and post-operative neuropsychological testing (NPT) were included into the study. A total of 91 patient files were reached whom met all the inclusion criteria. Patients were firstly classified as the ones who were applied NPT between post-operative 6th to 11th months (64 patients), and then between 12th and 24th months (19 patients). Among 91 patients, 30 patients who had two consecutive post-op NPTs were classified as the third group in order to examine alterations in cognitive functions and depression levels within time (longitudinal follow-up group). All three groups were further grouped in themselves as left-sided and right-sided surgeries. Moreover, in order to examine the effect of being seizure-free on cognitive functions and depression, 91 patients were classified into two groups; the ones who still had seizures after surgery ( ENGEL II and above) and the ones whose seizures were completely terminated ( ENGEL I). Measurement tools were as follows: a sociodemographic information form, Digit Span Test, Stroop Test TBAG Form, Verbal Fluency Test, Trail Making Test, California Verbal Learning Test (CVLT), Wechsler Adult Intelligence Scale Visual Reproduction Subtest, and Beck Depression Inventory. For Digit Span Test, digit backward scores were improved after surgery in seizure-free group and in longitudinal follow-up group both in short-term and long-term follow-ups. In longitudinal follow-up group, both left-sided and right-sided temporal lobe surgery group's scores on Trail Making A Test performance was improved. Stroop test error scores were significantly decreased after surgery in the seizure-free group. In the left-sided surgery group, semantic fluency scores improved significantly in one to two years after surgery. In seizure-free group, semantic and lexical fluency scores improved significantly after surgery. In the left-sided surgery group, verbal learning scores decreased significantly in post-operative first year while there was a significant increase of verbal learning scores in the right-sided surgery group. There was a significant decline in verbal short-term memory scores of patients who had seizures after surgery. Verbal short-term memory scores of the left-sided surgery group decreased significantly as well. Also, verbal short-term memory scores of patients who had seizures after surgery decreased significantly. In left-sided surgery group, verbal long-term memory scores were significantly decreased in the first post-operative year while there was a significant increase in the right-sided surgery group. On the other hand, visual long-term memory performances were significantly improved both in seizure-free group and in patients whose seizure frequency decreased, yet, not terminated. Depression scores were found to be significantly reduced in the right-sided surgery group both in the first post-operative year and in the following. However, left-sided surgery group did not experience any significant difference regarding depression after surgery. In the seizure-free group, depression scores were decreased significantly. Also, depression scores of the longitudinal follow-up group's decreased significantly in time. In conclusion, working memory and attention functions were improved after surgery in time. Also, termination of the seizures were help to improve the functions related to attention. Concerning executive functions, particularly, patients with left-sided surgery and patients who were seizure-free after surgery were experienced improvement in executive functions. Verbal memory scores of patients in the left-sided surgery group decreased after surgery. Also, verbal memory scores of patients who had seizures decreased. Seizure-free status and right sided surgery was shown to reduce the depression level.
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Psikoloji, Psychology, Klinik psikoloji, Clinical psychology