Schmitz Bettina
Department of Neurology, Epilepsy Research Group, Charité, Humboldt University, Berlin, Germany.
Epilepsia. 2005;46 Suppl 4:45-9. doi: 10.1111/j.1528-1167.2005.463009.x.
Depression has a major impact on quality of life in patients with epilepsy and is also the main risk factor for the increased suicide rate in epilepsy. The frequency of depressive disorders depends on the severity of epilepsy and the localization of the epileptogenic focus, with a prevalence of <or=50% in patients with intractable temporal lobe epilepsy. The diagnosis of depression in epilepsy may be difficult because symptoms of depression may be fluctuating, and some symptoms, such as memory complaints, may be misinterpreted as being a consequence of drug treatment or the epilepsy per se. Affective disorders in epilepsy may differ from those seen in patients without epilepsy. A possibility exists that patients with epilepsy will develop a specific interictal dysphoric syndrome related to limbic system dysfunction. Recent epidemiologic studies suggest a bidirectional relation between depression and epilepsy. Depression does not necessarily occur after the onset of epilepsy; the sequence may as well be the other way round, suggesting a common underlying mechanism for both disorders. Classic bipolar disorder type I is rarely seen in epilepsy, and manic episodes occur almost exclusively in the setting of postictal psychosis or after epilepsy surgery. This article explores the clinical manifestations of depressive and manic disorders in epilepsy and the differences from bipolar disorder.
抑郁症对癫痫患者的生活质量有重大影响，也是癫痫患者自杀率升高的主要危险因素。抑郁障碍的发生率取决于癫痫的严重程度和致痫灶的位置，在难治性颞叶癫痫患者中的患病率≤50%。癫痫患者的抑郁症诊断可能困难，因为抑郁症状可能波动，而且一些症状，如记忆障碍，可能被误解为药物治疗或癫痫本身的结果。癫痫患者的情感障碍可能与无癫痫患者的不同。癫痫患者有可能会出现与边缘系统功能障碍相关的特定发作间期烦躁综合征。最近的流行病学研究表明抑郁症与癫痫之间存在双向关系。抑郁症不一定在癫痫发作后出现；顺序也可能相反，这表明两种疾病有共同的潜在机制。经典的I型双相情感障碍在癫痫中很少见，躁狂发作几乎只发生在癫痫发作后精神病或癫痫手术后的情况下。本文探讨癫痫中抑郁和躁狂障碍的临床表现以及与双相情感障碍的差异。
