Department of Psychiatry and Behavioral Sciences, Children's National Medical Center, George Washington University School of Medicine, Washington, District of Columbia 20010, USA.
Epilepsia. 2013 Jun;54(6):1074-82. doi: 10.1111/epi.12205. Epub 2013 May 10.
Children and adolescents with epilepsy have an overrepresentation of psychiatric illness. However, few studies in pediatrics have characterized specific psychiatric conditions associated with seizure localization. In addition, degree to which psychiatric illness may be more prominent in children refractory to standard medical treatment for epilepsy is not known. The aim of this study was to assess psychiatric symptoms in children with medically refractory epilepsy and ascertain whether symptoms were associated with specific localization.
Case records were reviewed for 40 children with medically refractory epilepsy at the time of their referral for presurgical evaluation. Patients received a clinical psychiatric evaluation and parents completed the Child Behavioral Checklist (CBCL). Seizure localization was verified by pediatric epileptologists, and suitability for surgical procedures was verified by neurosurgical specialists. Groups were compared based on localization of seizure foci, either in the temporal lobe or predominantly extratemporal.
The majority of the sample had psychiatric diagnoses and behavior problems, well beyond the level reported in chronic epilepsy populations. In addition, children with temporal lobe seizure foci had more CBCL behavioral problem categories rated in the clinically significant range, and also were more likely to have clinical diagnoses of depression.
Routine psychiatric evaluation prior to epilepsy surgery may be important for pediatric patients with medically refractory epilepsy. Psychiatric illness, particularly depression, may be especially prominent for those with temporal lobe seizure foci.
患有癫痫的儿童和青少年存在精神疾病发病率过高的情况。然而，儿科领域的研究很少描述与癫痫灶定位相关的特定精神状况。此外，在癫痫标准治疗无效的儿童中，精神疾病是否更为突出也不得而知。本研究旨在评估癫痫药物难治性儿童的精神症状，并确定症状是否与特定的定位相关。
对 40 名癫痫药物难治性儿童的病例记录进行了回顾性研究，这些儿童在接受手术评估时接受了临床精神评估，其父母完成了儿童行为检查表（CBCL）。儿科癫痫专家证实了癫痫发作的定位，神经外科专家证实了手术的适用性。根据癫痫灶的定位，将患者分为颞叶或主要为颞叶外的两组进行比较。
大多数患者都有精神障碍和行为问题，其严重程度远远超过慢性癫痫患者群体。此外，有颞叶癫痫灶的儿童在更多的 CBCL 行为问题类别中被评为临床显著水平，且更有可能被诊断为抑郁症。
癫痫手术前进行常规精神评估可能对癫痫药物难治性的儿科患者很重要。对于有颞叶癫痫灶的患者，精神疾病，尤其是抑郁症，可能更为突出。
