Epilepsy Center Mara, Bielefeld, Germany.
Epilepsia. 2013 Mar;54 Suppl 1:46-52. doi: 10.1111/epi.12105.
We describe the physical, psychological, and social complications and adaptation demands after epilepsy surgery and the risks of the development of psychiatric disorders when adequate stress processing fails. Practical strategies that can be followed in the prevention and treatment of postsurgical psychiatric complications are reviewed. The postoperative period is divided in three phases: (1) the early postoperative phase of stress processing until discharge from hospital; (2) the coping phase during the first months after discharge; and (3) the reorientation phase. The early postoperative course is often dominated by physical problems that hamper success in convalescence. They may initiate early psychiatric disturbances especially in patients with preoperative psychiatric comorbidity. The second phase after discharge from hospital is the typical time in which various psychiatric disorders may develop (either de novo or exacerbations of known disorders). At this time it is mandatory to keep in contact with patients, to start psychiatric treatments if necessary, and to assess for suicidal risk. The course of the third phase of reorientation depends on seizure outcome and on psychiatric state. Seizure-free persons without psychiatric comorbidities start to forget their epilepsy; those with less successful outcome conditions may need further support, especially for vocational integration. Epilepsy surgery brings about an overall strong improvement of psychiatric morbidity and quality of patients' life. Nevertheless, the first postoperative year is a fragile period that includes multiple physical, psychological, and social adaptation tasks. Patients with a history of psychiatric disorders are at a special risk of failing to cope with those health-related demands, but also for nonpsychiatric patients the months after epilepsy surgery are often stressful and exhausting. Professional help must be available during the postoperative coping time.
我们描述了癫痫手术后的身体、心理和社会并发症以及适应需求，以及当适当的压力处理失败时精神障碍发展的风险。回顾了可以在预防和治疗手术后精神并发症中遵循的实用策略。术后期间分为三个阶段：（1）应激处理的早期术后阶段，直至出院；（2）出院后第一个月的应对阶段；（3）重新定位阶段。术后早期阶段通常由身体问题主导，这些问题会阻碍康复成功。它们可能会引发早期精神障碍，尤其是在术前有精神共病的患者中。出院后的第二个阶段是各种精神障碍可能发展的典型时期（无论是新发的还是已知疾病的恶化）。此时，必须与患者保持联系，如果需要，开始进行精神治疗，并评估自杀风险。重新定位阶段的过程取决于癫痫发作的结果和精神状态。无精神共病的无癫痫发作的患者开始忘记他们的癫痫；那些结局较差的患者可能需要进一步的支持，特别是在职业融入方面。癫痫手术带来了整体上精神发病率和患者生活质量的显著改善。然而，术后的第一年是一个脆弱的时期，包括多个身体、心理和社会适应任务。有精神病史的患者在应对这些与健康相关的需求方面面临特殊的风险，但即使是非精神科患者，癫痫手术后的几个月通常也是压力大且疲惫的。术后应对期间必须提供专业帮助。
