創傷後癲癇疾患神經認知及心理社會之研究

目的：創傷性腦損傷（Traumatic Brain Injury，TBI）具長期且慢性的影響，範圍從基礎神經認知功能缺損，到高階統複雜整合性執行功能與性格改變皆涵蓋其中。而創傷後癲癇疾患（Post-Traumatic Epilepsy，PTE）為 TBI 後嚴重併發症之一，PTE患者經TBI及癲癇的雙重打擊是否有更差的預後，目前研究結果不一致。故本研究欲採用神經認知功能測驗與主觀自陳問卷，欲了解 PTE 患者預後之表現，並進一步分析和 TBI 與無 TBI 之對照組之差異。方法：本研究分為健康組（control組）及疾病組（TBI組、PTE組），共110人。其中control組共40人皆來自社區，TBI組共48人、PTE組共22人皆來自南部教學醫院，欲比較三組受試者神經認知功能測驗及心理社會適應之差異。使用神經認知功能測驗，包含廣泛性神經認知功能篩檢測驗、執行功能兩個面向，測驗如下：蒙特利爾認知評估、社區型心智篩檢測驗、威斯康辛卡片分類測驗、倫敦塔、記憶廣度、叫色測驗；心理社會適應問卷，包含疾病適應、情緒適應兩個面向，問卷如下：腦震盪後症狀問卷、日常執行功能行為量表、照護層級評分量表、癲癇患者社會職業功能評估量表、流行病學研究中心憂鬱量表、台灣簡明版世界衛生組織生活品質問卷。以獨立樣本 t 檢定、卡方檢定、變異數分析、共變數進行統計分析。結果：人口學變項中，三組皆在性別、婚姻、年齡、教育程度中皆未達顯著差異。疾病變項中，三組在損傷原因、傷後持續時間及部分病灶類型達顯著差異。廣泛性神經認知功能篩檢測驗中，三組達顯著差異，且蒙特利爾認知評估分數在疾病組間亦達顯著；執行功能測驗中，三組在記憶廣度之順序、逆序背誦，叫色部分之叫字、叫色、顏色-字、預測顏色-字向度達顯著差異。疾病適應問卷中，三組在日常執行功能行為量表總分、計畫性、動機控制分測驗達顯著差異，另於照護層級評分量表之家務性活動、認知及情緒亦達顯著差異；情緒適應問卷中，台灣簡明版世界衛生組織生活品質問卷各向度皆達顯著。上述結果在控制傷後持續時間變項後皆未達顯著差異。結論：本研究結果顯示，TBI及PTE確實比健康組有較差的神經認知功能及心理社會適應之表現。在考量傷後持續時間後，神經認知功能和心理社會適應表現皆未觀察到差異。

Objectives: Traumatic brain injury (TBI) has long-term and chronic effects, ranging from basic neurocognitive function deficits to complex integrative executive functions and personality changes. Post-traumatic epilepsy (PTE) is one of the severe complications following TBI. Whether PTE patients have a worse prognosis due to the dual impacts of TBI and epilepsy remains inconsistent in current research findings. Therefore, this study aims to use neurocognitive tests and subjective self-report questionnaires to understand the prognosis of PTE patients and further analyze the differences compared to control groups with and without TBI.Methods: The study is divided into a healthy group (control group) and a disease group (TBI group, PTE group), with a total of 110 participants. The control group consists of 40 individuals from the community, the TBI group consists of 48 individuals, and the PTE group consists of 22 individuals, all from a teaching hospital in the southern region. The differences in neurocognitive function tests and psychosocial adaptation among the three groups were compared. Neurocognitive function tests include broad cognitive function screening and executive function. The tests are as follows: Montreal Cognitive Assessment (MoCA), Community Mental Status Examination (CMSE), Wisconsin Card Sorting Test (WCST), Tower of London (ToL), Digit Span, and Stroop tast. Psychosocial adaptation questionnaires include disease adaptation and emotional adaptation. The questionnaires are as follows: Post-Concussion Symptom Questionnaire (PCS), Daily Executive Behavior Scale (DEBS), Healthy of Care Required (HCR), Social and Occupational Functioning Scale for Epilepsy (SOFSE), Center for Epidemiological Studies Depression Scale (CESD), and World Health Organization Quality of Life-brief Taiwan version (WHOQoL- brief). Statistical analyses will be conducted using independent sample t-tests, chi-square tests, analysis of variance, and covariance analysis.Results: In the demographic variables, there were no significant differences among the three groups in terms of gender, marital status, age, and education level. In the disease variables, significant differences were observed among the three groups in terms of the causes of injury, the number of years since the injury, and some types of lesions. Significant differences were found among the three groups in the comprehensive neurocognitive function screening test, and the MoCA scores also showed significant differences between disease groups. In the executive function tests, significant differences were observed in the Digit Span (both forward and backward) and Stroop tast (word, color, color-word, and predicted color-word dimensions). In disease adaptation, significant differences were found among the three groups in the total scores, planning and motivational control of DEBS. Additionally, significant differences were observed in the Instrumental activities of daily living, cognitive and emotion of HCR. In emotional adaptation, significant differences were found in all dimensions of the WHOQoL- brief. The above results did not reach significant differences after controlling for the duration since the injury variable.Conclusions: The results of this study indicate that individuals in the TBI and PTE groups indeed exhibit poorer neurocognitive function and psychosocial adaptation compared to the healthy group. After considering the duration since the injury, no differences in neurocognitive function and psychosocial adaptation performance were observed.