Yale University School of Medicine, Department of Neurology, 950 Campbell Ave., West Haven, CT 06516-2700, USA.
Neurology. 2011 Nov 29;77(22):1972-6. doi: 10.1212/WNL.0b013e31823a0c90. Epub 2011 Nov 16.
This study explored the association between long-term epilepsy surgery outcome and changes in depressive symptoms.
Adults were enrolled between 1996 and 2001 in a multicenter prospective study to evaluate outcomes of resective epilepsy surgery. The extent of depressive symptoms and depression case status (none, mild, or moderate/severe) were assessed using the Beck Depression Inventory (BDI) preoperatively and 3, 12, 24, 48, and 60 months postoperatively. A mixed-model repeated-measures analysis was performed, adjusting for covariates of seizure location, gender, age, race, education, and seizure control.
Of the total 373 subjects, 256 were evaluated at baseline and 5 years after surgery. At baseline, 164 (64.1%) were not depressed, 34 (13.3%) were mildly depressed, and 58 (22.7%) had moderate to severe depression. After 5 years, 198 (77.3%) were not depressed, 20 (7.8%) were mildly depressed, and 38 (14.8%) were moderately to severely depressed. Five years after surgery, the reduction in mean change from baseline in BDI score was greater in subjects with excellent seizure control than in the fair and poor seizure control groups (p = 0.0006 and p = 0.02 respectively). Those with good seizure control had a greater reduction in BDI score than the poor seizure control group (p = 0.02) and borderline significant reduction compared with the fair seizure control group (p = 0.055).
Although study participants had initial improvement in depressive symptoms, on average, after resective surgery, only patients with good or excellent seizure control had sustained long-term improvement in mood.
本研究旨在探讨长期癫痫手术后与抑郁症状变化的关系。
1996 年至 2001 年期间，纳入一项多中心前瞻性研究以评估切除性癫痫手术的结果。使用贝克抑郁量表（BDI）术前及术后 3、12、24、48 和 60 个月评估抑郁症状严重程度和抑郁病例状况（无、轻度或中重度）。采用混合模型重复测量分析，调整了癫痫部位、性别、年龄、种族、教育程度和癫痫控制等协变量。
在 373 例患者中，256 例在基线和手术后 5 年时进行了评估。基线时，164 例（64.1%）无抑郁，34 例（13.3%）轻度抑郁，58 例（22.7%）中重度抑郁。5 年后，198 例（77.3%）无抑郁，20 例（7.8%）轻度抑郁，38 例（14.8%）中重度抑郁。手术后 5 年，与癫痫控制不佳和一般的组相比，癫痫控制良好的患者的 BDI 评分从基线的平均变化降低幅度更大（p = 0.0006 和 p = 0.02 分别）。与癫痫控制不佳的患者相比，癫痫控制良好的患者 BDI 评分降低幅度更大（p = 0.02），与癫痫控制一般的患者相比降低幅度具有边缘显著差异（p = 0.055）。
尽管研究参与者在切除性手术后最初改善了抑郁症状，但平均而言，只有癫痫控制良好或极佳的患者在情绪方面具有长期持续的改善。
