From the Department of Neurology (H.H.), Yale University School of Medicine, New Haven, CT; New York University School of Medicine (K.B., O.D.); Department of Psychology (L.Y.A.), New York University, New York; Yale University School of Public Health (X.C., J.D.), New Haven, CT; Ann & Robert H. Lurie Children's Hospital of Chicago (A.T.B.), Epilepsy Center; Department of Pediatrics (A.T.B.), Northwestern Memorial Feinberg School of Medicine, Chicago, IL; University of California at Los Angeles (B.G.V.); Thomas Jefferson University Medical School (M.R.S.), Philadelphia, PA; Montefiore Medical Center (S.S.), Albert Einstein College of Medicine, New York; University of Rochester School of Medicine (J.T.L.), NY; Minnesota Comprehensive Epilepsy Program (T.S.W.), St. Paul, MN; and Columbia University Medical School (C.W.B.), New York, NY.
Neurology. 2014 Mar 11;82(10):887-94. doi: 10.1212/WNL.0000000000000183. Epub 2014 Jan 31.
We examined the complex relationship between depression, anxiety, and seizure control and quality of life (QOL) outcomes after epilepsy surgery.
Seven epilepsy centers enrolled 373 patients and completed a comprehensive diagnostic workup and psychiatric and follow-up QOL evaluation. Subjects were evaluated before surgery and then at 3, 6, 12, 24, 48, and 60 months after surgery. Standardized assessments included the Quality of Life in Epilepsy Inventory-89, Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI). A mixed-model repeated-measures analysis was used to analyze associations of depression, anxiety, seizure outcome, and seizure history with overall QOL score and QOL subscores (cognitive distress, physical health, mental health, epilepsy-targeted) prospectively.
The groups with excellent and good seizure control showed a significant positive effect on the overall QOL compared to the groups with fair and poor seizure control. The BDI and BAI scores were both highly and negatively associated with overall QOL; increases in BDI and BAI scores were associated with decreased overall QOL score.
Depression and anxiety are strongly and independently associated with worse QOL after epilepsy surgery. Interestingly, even partial seizure control, controlling for depression and anxiety levels, improved QOL. Management of mood and anxiety is a critical component to postsurgical care.
我们研究了抑郁、焦虑与癫痫手术后的癫痫控制和生活质量（QOL）结果之间的复杂关系。
7 家癫痫中心纳入了 373 名患者，并完成了全面的诊断评估和精神病学及随访 QOL 评估。受试者在手术前和手术后 3、6、12、24、48 和 60 个月进行评估。标准化评估包括癫痫生活质量量表-89、贝克抑郁量表（BDI）和贝克焦虑量表（BAI）。采用混合模型重复测量分析前瞻性分析抑郁、焦虑、癫痫发作结果和癫痫发作史与总体 QOL 评分和 QOL 子评分（认知困扰、身体健康、心理健康、针对癫痫）之间的关联。
与癫痫控制不佳和中等的患者相比，癫痫控制良好和优秀的患者的总体 QOL 具有显著的积极影响。BDI 和 BAI 评分均与总体 QOL 呈高度负相关；BDI 和 BAI 评分升高与总体 QOL 评分降低相关。
抑郁和焦虑与癫痫手术后的 QOL 明显较差密切相关。有趣的是，即使控制了抑郁和焦虑水平，部分癫痫控制也能改善 QOL。管理情绪和焦虑是术后护理的重要组成部分。
