Performance de memória ao longo de mais de uma década em pacientes livres de crises após a cirurgia de lobo temporal associada à esclerose hipocampal

• Ano de defesa: 2016
• Autor(a) principal: Gomes, Roberta de Figueiredo
• Orientador(a): Palmini, André Luis Fernandes
• Tipo de documento: Tese
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Pontifícia Universidade Católica do Rio Grande do Sul
• Programa de Pós-Graduação: Programa de Pós-Graduação em Medicina e Ciências da Saúde
• Departamento: Escola de Medicina
• País: Brasil
• Palavras-chave em Português: EPILEPSIA; ESCLEROSE; MEMÓRIA; NEUROCIÊNCIA; NEUROPSICOLOGIA; MEDICINA
• Área do conhecimento CNPq: CIENCIAS DA SAUDE::MEDICINA
• Link de acesso: http://tede2.pucrs.br/tede2/handle/tede/7199

Objective: Describe the dynamics of memory evolution between the preoperative period, the first years after operation and the very long term, 10 or more years later, and to determine variables relate to such trajectory. Patients and methods: We studied material-specific memory function in 54 patients with unilateral TLE (34 left) with pathology-verified HS, who were rendered seizure-free for 10 or more years following selective amygdalohippocampectomy (SAH) or anterior temporal lobectomy (ATL). Standard neuropsychological tests were applied before operation (T1), 1 to 4 years after surgery (T2), and again 10 years or more after operation (T3). Performance was analyzed according to 2 distinct criteria and logistic regression evaluated variables associated with memory function at each point in time. Results: Patients operated in the right hemisphere performed significantly better than those operated on the left in verbal memory and learning tests at T2 (p=0,002; 0,002) and T3 (p=0,013; 0,008). Despite a material-specific battery, around half the patients with left HS have normal preoperative verbal memory and learning. These associated with significant worsening in the first years (T2) and in the long term (T3), compared to those already dysfunctional preoperatively (p<0.015 and p<0.001 for verbal memory; p=0.029 and p=0.045 for verbal learning). However, 70% and 50% of patients with normal preoperative performance respectively in verbal memory and learning sustained normal function in the first years, although the majority worsened in the long term. Likewise, roughly 30% of patients with dysfunctional scores preoperatively significantly improved performance in verbal memory and learning in the first years, but most worsened again in the long term. Furthermore, those with normal scores at T2 worsened significantly more in the long term than those with abnormal scores in the first years. Interestingly, 15% of patients reversed from a dysfunctional to a normal performance in verbal learning between the first years and the long term. Performance in visual memory followed the same trend of significant worsening in the long term for patients who improved or sustained normal performance between T1 and T2. For patients operated in the right hemisphere, performance in verbal memory and learning did not statistically differ between the three time points, irrespective of functional status at T1 and T2. However, only the minority of those who improved between T1 and T2 sustained improvement in the long term. On the other hand, performance in visual memory was sustained in the long term for most patients who improved in the first years. Risk of worsening for delayed verbal memory or verbal learning between preoperative status (T1) and the first postoperative years (T2) was significantly increased by normal preoperative scores, younger age, surgery in the left hemisphere and low schooling levels. On its turn, functional worsening between the first post-operative years (T2) and the long-term (T3) in all memory domains was significantly associated with normal preoperative scores and low schooling levels. Worsening for verbal learning or delayed visual memory was also associated with surgery in the left hemisphere and nonselective surgical technique. Depression and anxiety scores did not impact in memory function in the long term, whereas preserved visual memory associated with better quality of life. Conclusions: These findings shed a new light into the trajectory of memory functions following surgery for TLE/HS. They specifically highlight that despite a sclerotic hippocampus, materialspecific memory functions are often preserved before operation and often remain normal or revert to normal in the first few postoperative years, suggesting active reorganization or plasticity. However, normal function is rarely sustained in the long term, indicating the possibility that disease progression surpasses plasticity over the years.