Kanner Andres M
Rush Medical College, Rush University Medical Center, Chicago, Illinois 60612, USA.
Dialogues Clin Neurosci. 2008;10(1):39-45. doi: 10.31887/DCNS.2008.10.1/amkanner.
Mood disorders are the most frequent psychiatric comorbidity in epilepsy, and in particular in temporal lobe epilepsy For a long time, depressive disorders were considered to be the expression of a reactive process to the obstacles of a life with epilepsy. Data obtained in the last two decades, however, have demonstrated biochemical, neuropathological, and neurophysiologic changes mediating the development of mood disorders, which in fact can be tested in animal models. Furthermore, there is also evidence that mood disorders and epilepsy have a complex relationship which is bidirectional; that is, not only are patients with epilepsy at greater risk of developing depression, but patients with depression have a higher risk of developing epilepsy. Such a relationship can only be explained by the existence of common pathogenic mechanisms that are operant in both conditions. These include changes in neurotransmitters, such as serotonin, norepinephrine, glutamate, and y-aminobutyric acid. Such a bidirectional relationship also appears to have important clinical consequences. Indeed, patients with a history of mood disorders are twice as likely to develop pharmacoresistant epilepsy as those without such a history. These data are reviewed in this article.
情绪障碍是癫痫中最常见的精神共病，尤其是在颞叶癫痫中。长期以来，抑郁症被认为是对癫痫患者生活中各种障碍的一种反应性过程的表现。然而，过去二十年获得的数据表明，存在介导情绪障碍发生发展的生化、神经病理和神经生理变化，这些变化实际上可以在动物模型中得到验证。此外，也有证据表明情绪障碍与癫痫之间存在复杂的双向关系；也就是说，不仅癫痫患者患抑郁症的风险更高，抑郁症患者患癫痫的风险也更高。这种关系只能通过在这两种情况下都起作用的共同致病机制来解释。这些机制包括神经递质的变化，如血清素、去甲肾上腺素、谷氨酸和γ-氨基丁酸。这种双向关系似乎也具有重要的临床意义。事实上，有情绪障碍病史的患者发生药物难治性癫痫的可能性是没有这种病史患者的两倍。本文对这些数据进行了综述。
