摘要目的:探讨颞叶癫痫患者发作间期双侧颞区不同步放电对患者认知功能的影响。方法:收集2021年6月至2023年12月就诊于复旦大学附属中山医院、被明确诊断为颞叶癫痫的患者162例。根据患者发作间期的脑电图表现，将颞叶癫痫患者分为双侧颞区不同步放电患者（51例）和单侧颞区放电患者（111例；其中右侧颞区单侧放电患者48例，左侧颞区单侧放电患者63例）。所有患者均完善简易精神状态检查量表（MMSE）、蒙特利尔认知评估量表（MoCA）、数字广度测试（DS）、言语流畅性测试（VFT）、Stroop色词测验-第三部分（CWT-C）、连线测验-B（TMT-B）、符号数字模式测验（SDMT）、听觉词语学习测验（AVLT）、Rey-Osterrieth复杂图形测验（ROCF）、相似性测试。比较双侧颞区不同步放电组和单侧颞区放电组患者各认知功能评分的不同，并用单因素和多因素Logistic回归模型法分析双侧颞区不同步放电的危险因素。采用Spearman相关分析法评估认知功能和临床指标的相关性。结果:双侧颞区不同步放电的颞叶癫痫组患者较单侧颞区放电的颞叶癫痫组CWT-C完成时间［67（55，103）s与59（50，71）s， Z=-2.904， P=0.004］、TMT-B完成时间［159（108，219）s与129（95，180）s， Z=-2.361， P=0.018］更长，MMSE评分［28（26，29）分与29（28，30）分， Z=3.098， P=0.002］、MoCA评分［23（19，28）分与27（23，28）分， Z=3.175， P=0.001］、VFT-蔬菜水果个数［15（13，19）个与18（15，21）个， Z=2.402， P=0.016］、SDMT完成数目［41（30，53）个与51（40，60）个， Z=3.089， P=0.002］、AVLT1+2+3评分［（16.843±6.482）分与（19.162±5.526）分， t=-2.347， P=0.020］、AVLT6评分［6（3，10）分与8（5，10）分， Z=3.275， P=0.001］、ROCF2评分［15（8，22）分与20（12，25）分， Z=2.870， P=0.004］、ROCF3评分［14（8，22）分与20（11，25）分， Z=2.634， P=0.008］、相似性测试评分［13（8，18）分与16（12，20）分， Z=2.387， P=0.017］均更低或更少。AVLT6评分减低（ OR=1.546，95% CI 1.150~2.078， P=0.004）、TMT-B完成时间延长（ OR=1.013，95% CI 1.001~1.025， P=0.035）是颞叶癫痫患者存在双侧颞区不同步放电的独立危险因素。 结论:与单侧颞区放电的颞叶癫痫患者相比，双侧颞区不同步放电的颞叶癫痫患者存在执行功能、记忆力、语言功能等全方位认知功能维度的下降。语言记忆中的线索回忆能力下降、执行功能中的连线测验时间延长是双侧颞区不同步放电的独立认知受损危险因素。

abstractsObjective:To investigate the cognitive functions of temporal lobe epilepsy (TLE) patients with bilateral asynchronous interictal discharges.Methods:A total of 162 TLE patients who were treated at Zhongshan Hospital, Fudan University, from June 2021 to December 2023 were collected. According to the interictal scalp electroencephalogram, TLE patients were classified to the TLE with bilateral temporal asynchronous interictal epileptiform discharges ( n=51) and TLE with unilateral temporal epileptiform discharges ( n=111). Unilateral TLE patients were divided into TLE with right ( n=48) and left ( n=63) temporal epileptiform discharges. The Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), Digital Span (DS), Verbal Fluency Test (VFT), the third part of Color Word Test (CWT-C), Trail Making Test-B (TMT-B), Symbol Digit Modalities Test (SDMT), Auditory Verbal Learning Test (AVLT), Rey-Osterrieth Complex Figure (ROCF), and Similarity Comprehension Test were performed for the participants. The differences of cognitive functions between patients with bilateral and unilateral temporal discharges were compared. Univariate and multivariate Logistic regression models were used to analyze the risk factors for patients with bilateral temporal asynchronous discharges. Spearman analysis was used to explore the correlation between cognitive function and clinical indicators. Results:In the group of TLE patients with bilateral asynchronous discharges compared to those with unilateral discharges, the completion time of CWT-C [67 (55, 103) s vs 59 (50, 71) s, Z=-2.904, P=0.004], TMT-B [159 (108, 219) s vs 129 (95, 180) s, Z=-2.361, P=0.018] was longer. Additionally, TLE patients with bilateral asynchronous discharges got lower scores of MMSE [28 (26, 29) vs 29 (28, 30), Z=3.098, P=0.002], MoCA [23 (19, 28) vs 27 (23, 28), Z=3.175, P=0.001], AVLT1+2+3 [16.843±6.482 vs 19.162±5.526, t=-2.347, P=0.020], AVLT6 [6 (3, 10) vs 8 (5, 10), Z=3.275, P=0.001], ROCF2 [15 (8, 22) vs 20 (12, 25), Z=2.870, P=0.004], ROCF3 [14 (8, 22) vs 20 (11, 25), Z=2.634, P=0.008], and Similarity Test [13 (8, 18) vs 16 (12, 20), Z=2.387, P=0.017] as well as lower VFT-vegetable and fruit count [15 (13, 19) vs 18 (15, 21), Z=2.402, P=0.016] and SDMT completion count [41 (30, 53) vs 51 (40, 60), Z=3.089, P=0.002]. The multivariate Logistic regression analysis showed that the decrease in AVLT6 scores ( OR=1.546, 95% CI 1.150-2.078, P=0.004) and longer TMT-B time ( OR=1.013, 95% CI 1.001-1.025, P=0.035) were independent risk factors for TLE patients with bilateral asynchronous discharges. Conclusions:Compared to the patients with TLE characterized by unilateral temporal lobe discharges, those with asynchronous discharges in bilateral temporal lobes show statistically significant declines in all domains of cognitive functions, including executive function, memory, and language abilities. Decreased cue recall ability in language memory and prolonged trail-making test in executive function are independent cognitive impairment risk factors for bilateral temporal asynchronous discharges.