Wrench J M, Wilson S J, Bladin P F, Reutens D C
School of Behavioural Science, University of Melbourne, Victoria, Australia.
J Neurol Neurosurg Psychiatry. 2009 May;80(5):539-44. doi: 10.1136/jnnp.2008.152165. Epub 2009 Feb 9.
Major depression is common after epilepsy surgery. It has previously been suggested that surgical removal of limbic system structures such as the hippocampus may contribute to this comorbidity. Recent magnetic resonance imaging studies have found smaller hippocampal volumes in depressed patients in comparison with controls.
The current study examined whether preoperative hippocampal volumes were associated with depression experienced after epilepsy surgery. Patients undergoing mesial (n = 26) and non-mesial (n = 16) temporal lobe resections were assessed preoperatively, and for 1 year postoperatively. Assessment included a clinical interview and the Beck Depression Inventory. Hippocampal volumes were measured on the preoperative T1-weighted magnetic resonance imaging scans of the patients and 41 neurologically normal controls.
A similar proportion of mesial and non-mesial temporal patients had a preoperative history of major depression. Postoperatively, 42% of mesial and 19% of non-mesial temporal patients were depressed. There was no relationship between hippocampal volume and preoperative depression in either group. Depression after surgery was associated with significantly smaller hippocampal volumes contralateral to the resection in the mesial temporal group (p = 0.005). This effect was seen in mesial temporal patients who developed de novo depression (p = 0.006). Hippocampal volume was unrelated to postoperative depression in the non-mesial group.
This study highlights the role of neurobiological factors in the development of postoperative depression. These initial findings have implications for understanding depression following epilepsy surgery as well as the pathogenesis of depression more generally.
癫痫手术后重度抑郁症很常见。此前有观点认为，手术切除海马体等边缘系统结构可能与这种共病有关。最近的磁共振成像研究发现，与对照组相比，抑郁症患者的海马体体积较小。
本研究探讨术前海马体体积是否与癫痫手术后出现的抑郁症有关。对接受内侧（n = 26）和非内侧（n = 16）颞叶切除术的患者在术前及术后1年进行评估。评估包括临床访谈和贝克抑郁量表。在患者术前的T1加权磁共振成像扫描以及41名神经功能正常的对照者中测量海马体体积。
内侧和非内侧颞叶患者中有类似比例的人有重度抑郁症的术前病史。术后，42%的内侧颞叶患者和19%的非内侧颞叶患者出现抑郁。两组中海马体体积与术前抑郁症均无关联。内侧颞叶组中，手术后的抑郁症与切除对侧的海马体体积显著减小有关（p = 0.005）。这种效应在新发抑郁症的内侧颞叶患者中也可见（p = 0.006）。非内侧颞叶组中海马体体积与术后抑郁症无关。
本研究强调了神经生物学因素在术后抑郁症发生中的作用。这些初步发现对理解癫痫手术后的抑郁症以及更普遍的抑郁症发病机制具有启示意义。
