| Epilepsy is a common neurological disorder.Statistics showed that the morbidity rate of epilepsy in China was about 7.0‰.So there are about 9 million patients affected by epilepsy in China.Epilepsy carries a substantial burden of illness, which is reflected in poor quality of life(QOL), psychosocial function and higher care resource use. The influence of epilepsy on patients'lives may be quite destructive and impaired QOL. Seizure, cognitive, emotional and behavioral status, social function, self-esteem, stigma seem to be crucial to QOL. It has been gradually recognized that seizure control is only one aspect of comprehensive management on epilepsy. It is widely pointed out that the purpose of treating epilepsy is not necessarily seizure eradiation rather the aim should be at obtaining maximal improvement of patients'quality of life.Temporal lobe epilepsy is the most common epilepsy syndrome in adults, accouting for more than 30% of partial epilepsy. About half of temporal lobe epilepsy is medically intractable. Temporal lobe epilepsy is a heterogeneous disorder with complex genetics in which putative susceptibility genes and environmental factors are believed to contribute to the etiologic and phenotype of the diseases.According to the focus of seizure origin, temporal lobe epilepsy is subclassificated as mesial temporal lobe epilepsy and lateral lobe epilepsy. Mesial temporal lobe epilepsy is regarded as the most common medically intractable epilepsy and early surgery may not only reduce seizure,but also improve cognitive and prognosis outcome. The study consists of the following four parts.Part 1 The assessment of sub-classification of temporal lobe epilepsy and analysis of it's clinical and etiological characteristics Objective:To analyse and study the sub-classification and etiological characteristics of temporal lobe epilepsy(TLE).Methods:There 278 patients with TLE were included in our study.The sub-classification was based on clincal data and electroencephalographic recording.The etiology for TLE was mainly concluded from both clinical history and neuroimaging investigations.Results:There 252 patients in our study were subclassified as mesial temporal lobe epilepsy(MTLE), in which51.2% patitents had auras such as epigastric sensation and 60.3 % patients had automatismas mainly performed as oroalimentary automatismas. The electroencephalography recording for MTLE showed the presence of interictal epileptic paroxysms discharges over the anterior or mid-anterior temporal areas. The main etiological factors related to MTLE were hippocampal sclerosis , intracranial infection, tumor ,cerebrovascular disease and trauma.While 15 patients in our study were subclassified as lateral temporal lobe epilepsy(LTLE). Auras such as acousma were found in all of them. The electroencephalography recording showed the presence of interictal epileptic paroxysms discharges over the posterior or mid-posterior temporal areas and the main etiological factors were tumor ,trauma and atrophy in the LTLE group.There 11 patients from our study could not be subclassified neither as MTLE nor as LTLE.Conclusions:Temporal lobe epilepsy is a common epileptic syndrome with a variety of clinical manifestations and etiology.In our study,most of the cases diagnosed as TLE could be subclassified either as MTLE or as LTLE through clinical data and some noninvasive investigations,While the subclassification for TLE would paly a very important role in the selection of therapy methods.Part2 Association analysis of polymorphisms of Apolipoprotein E gene with nonlesional temporal lobe epilepsy in Chinese Han populationObjective:To evaluate the hypothetical link between Apolipoprotein E(ApoE) polymorphisms and nonlesional mesial temporal lobe epilepsy and whether the presence of ApoEε4 allele has an impact on clinical characteristics such as onset age and duration of epilepsy. Methods:The study group consisted of 94 nonlesional mesial temporal lobe epilepsy patients and 102 healthy controls. ApoE polymorphisms were determined from blood samples by PCR-sequence-based typing method.Results: There were no difference between MTLE patients and controls in either genotypic orε4 allelic frequencies of ApoE(P>0.05). ApoEε4 allele had no impact on the clinical characteristics of MTLE,such as onset age and duration of epilepsy,seizure frequency, hippocampal sclerosis and history of febrile convulsion.Conclusions:This study has found no association between ApoE polymorphisms and patients with nonlesional mesial temporal lobe epilepsy in a group of Chinese Han patients.Part3 The study on quality of life and relevant factors in patients with temporal lobe epilepsyObjective:To evaluate the quality of life (QOL) status in patients with temporal lobe epilepsy and the impact of sociodemographic factors, clinical seizure factors, depression and anxiety on QOL.Methods:In total, 93 patients with temporal lobe epilepsy and 100 matched healthy controls who met the entry criteria were included in our study. All of them completed the QOL-31, SDS and SAS for self evaluation of quality of life and mood. The factors that may be relevant to QOL were also analyzed.Results:The scores on QOL-31 in patients with temporal lobe epilepsy were significantly lower than in healthy controls (P<0.001). The scores on SDS and SAS in temporal lobe epilepsy patients were significantly higher than in healthy controls (P<0.001). Multiple linear regression was used to examine the relationship between QOL and sociodemographic factors, clinical seizure factors, and level of depression and anxiety. It showed that depression, seizure severity, anxiety and duration of epilepsy were the main relevant factors that impact QOL.Conclusions:Quality of life in patients with temporal lobe epilepsy is worse than healthy controls. Recognition and treatment of comorbid psychiatric symptoms such as depression and anxiety is an important consideration in improving quality of life in patients with temporal lobe epilepsy. And selection of reasonable treatment strategy to achieve good seizure control is another important one.Part4 The study on cognitive function and relevant factors in patients with temporal lobe epilepsyObjective:To evaluate the cognitive function status in patients with temporal lobe epilepsy and the impact of sociodemographic factors, clinical seizure factors and epileptiform discharge on cognition.Methods:In total, 129 patients with temporal lobe epilepsy and 90 matched healthy controls who met the entry criteria were included in our study. All of them were assessed with WAIS-RC and Chinese clinical memory test.The factors that may be relevant to cognitive function were also analyzed.Results:The scores of tests including FIQ,VIQ,PIQ and MQ in patients with temporal lobe epilepsy were significantly lower than in healthy controls(P<0.001). There was significant difference between different education groups. The higher the education level was,the higher IQ and MQ scores were. There was significant difference between different seizure frequency groups. The more frequent seizure was,the lower IQ and MQ scores were. There was significant difference between different epileptiform discharge groups. The more severe of epileptiform discharge was,the lower IQ and MQ scores were. Multiple linear regression was used to examine the association between IQ, MQ and sociodemographic factors, clinical seizure factors, and epileptiform discharge. It showed that seizure frequency and epileptiform discharge were the main relevant factors that impact cognitive function.Conclusions:Cognition deficits are common in patients with temporal lobe epilepsy. Recognition and treatment of comorbid cognition deficits is an important consideration in improving quality of life in patients with temporal lobe epilepsy. Selection of reasonable treatment strategy to achieve good seizure control is another important one.
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