Shree Krishna Hospital, Karamsad, Anand, Gujarat, India; Dept. of Neuro-Medicine, Pramukhswami Medical College, Karamsad, Anand, Gujarat 388325, India.
Dept. of Neurology, All India Institute of Medical Sciences, New Delhi 110029, India.
Epilepsy Behav. 2014 Mar;32:29-33. doi: 10.1016/j.yebeh.2013.11.025. Epub 2014 Jan 24.
The purpose of this study was to assess axis-I DSM-IV psychiatric disorders in patients at baseline and 3 months after surgery for medically refractory temporal lobe epilepsy.
The Mini International Neuropsychiatric Interview (MINI) and Quality of Life in Epilepsy Inventory-10 (QOLIE-10) were evaluated before and 3 months after surgery in 50 consecutive patients (21 females, 29 males) with medically refractory temporal lobe epilepsy (persistent seizures>2/month, despite treatment with ≥2 appropriate drugs in adequate doses for ≥2 years) who underwent surgery [anterior temporal lobectomy with amygdalo-hippocampectomy (for mesial temporal sclerosis in 40), electrocorticography-guided lesionectomy (for other lesions in 10)].
Twenty-six patients (52%) had an axis-I psychiatric disorder [26% depressive disorder, 28% anxiety disorder] at baseline, while 30 (60%) patients had an axis-I psychiatric disorder [28% depressive disorder, 28% anxiety disorder] at 3 months after surgery. Twenty percent developed a new psychiatric disorder, while 12% showed improvement postsurgery. Mean QOLIE-10 scores improved from 23.78 to 17.80 [24 (48%) patients showed ≥5-point improvement]. Thirty-four (68%) patients had no seizure, 6 (12%) had non-disabling seizures, while 2 (4%) had disabling seizures after surgery. High frequency of seizures prior to surgery (p<0.038) and seizure occurrence after surgery (p<0.055) predicted the presence of psychiatric disorders after surgery. No clinical characteristic could predict development of new psychiatric disorder after surgery.
Psychiatric dysfunction in the early postsurgery period is seen in nearly half of patients undergoing surgery for temporal lobe epilepsy, is mild in nature, and does not adversely affect quality of life but may cause significant clinical problems when it arises de novo postsurgery.
本研究旨在评估药物难治性颞叶癫痫患者在基线时和手术后 3 个月的 DSM-IV 轴 I 精神障碍。
50 例药物难治性颞叶癫痫患者（21 例女性，29 例男性）连续接受手术治疗[前颞叶切除术伴杏仁核-海马切除术（40 例为内侧颞叶硬化症，10 例为其他病变）]。在术前和术后 3 个月，使用迷你国际神经精神病访谈（MINI）和癫痫生活质量问卷-10（QOLIE-10）进行评估。
26 例（52%）患者在基线时有轴 I 精神障碍[26%为抑郁障碍，28%为焦虑障碍]，30 例（60%）患者在术后 3 个月时有轴 I 精神障碍[28%为抑郁障碍，28%为焦虑障碍]。20%的患者出现新的精神障碍，12%的患者术后有所改善。QOLIE-10 平均评分从 23.78 分提高到 17.80 分[24 例（48%）患者改善≥5 分]。34 例（68%）患者无癫痫发作，6 例（12%）患者有非致残性癫痫发作，2 例（4%）患者有致残性癫痫发作。术前癫痫发作频率高（p<0.038）和术后癫痫发作（p<0.055）预测术后精神障碍的发生。没有临床特征可以预测术后新发精神障碍的发生。
颞叶癫痫手术后早期出现精神功能障碍的患者近一半，其性质轻微，不会对生活质量产生不利影响，但当新出现时可能会引起显著的临床问题。
