de Araújo Filho Gerardo Maria, Lin Katia, Lin Jaime, Peruchi Mirella M, Caboclo Luís Otávio S F, Guaranha Mirian S B, Guilhoto Laura M F F, Carrete Henrique, Yacubian Elza Márcia T
Department of Neurology, Universidade Federal de São Paulo/UNIFESP, São Paulo, Brazil.
Epilepsia. 2009 May;50(5):1201-9. doi: 10.1111/j.1528-1167.2009.02021.x. Epub 2009 Mar 11.
Personality traits characterized by emotional instability and immaturity, unsteadiness, lack of discipline, hedonism, frequent and rapid mood changes, and indifference toward one's disease have been associated with patients who have juvenile myoclonic epilepsy (JME). Literature data demonstrate worse seizure control and more psychosocial dysfunctions among patients with JME who have those traits. In this controlled study we performed a correlation analysis of psychiatric scores with magnetic resonance spectroscopy (MRS) values across JME patients, aiming to verify the existence of a possible relation between frontal lobe dysfunction and the prevalence of personality disorders (PDs) in JME.
Sixteen JME patients with cluster B PDs, 41 JME patients without any psychiatric disorder, and 30 healthy controls were submitted to a psychiatric evaluation and to a quantitative multivoxel MRS of thalamus; insula; cingulate gyrus; striatum; and frontal, parietal, and occipital lobes. Groups were homogeneous according to age, gender, and manual dominance. Psychiatric evaluation was performed through the Scheduled Clinical Interview for DSM-IV, Axis I and II (SCID I and II, respectively).
A significant reduction of N-acetyl-aspartate over creatinine (NAA/Cr) ratio was observed mainly in the left frontal lobe in the JME and PD group. In addition, a significant increase in the glutamate-glutamine over creatinine GLX/Cr ratio was also observed in this referred region in the same group.
These data support the hypothesis that PDs in JME could represent neuronal dysfunction and possibly a more severe form of this epileptic syndrome.
情绪不稳定、不成熟、摇摆不定、缺乏自律、享乐主义、频繁且快速的情绪变化以及对自身疾病漠不关心等人格特质与青少年肌阵挛性癫痫（JME）患者相关。文献数据表明，具有这些特质的JME患者癫痫发作控制较差，心理社会功能障碍更多。在这项对照研究中，我们对JME患者的精神科评分与磁共振波谱（MRS）值进行了相关性分析，旨在验证额叶功能障碍与JME中人格障碍（PDs）患病率之间可能存在的关系。
16名患有B簇人格障碍的JME患者、41名无任何精神疾病的JME患者以及30名健康对照者接受了精神科评估和丘脑、岛叶、扣带回、纹状体以及额叶、顶叶和枕叶的定量多体素MRS检查。根据年龄、性别和利手情况，各组具有同质性。通过《精神疾病诊断与统计手册》第四版轴I和轴II的定式临床访谈（分别为SCID I和II）进行精神科评估。
主要在JME和人格障碍组的左侧额叶观察到N - 乙酰天门冬氨酸与肌酐（NAA/Cr）比值显著降低。此外，在同一组的该区域还观察到谷氨酸 - 谷氨酰胺与肌酐（GLX/Cr）比值显著升高。
这些数据支持了这样一种假设，即JME中的人格障碍可能代表神经元功能障碍，并且可能是这种癫痫综合征的一种更严重形式。
