Kanner Andres M, Mazarati Andrey, Koepp Matthias
Department of Neurology, University of Miami, Miller School of Medicine, 1120 NW, 14th Street, Room 1324, Miami, FL, 33136, USA,
Neurotherapeutics. 2014 Apr;11(2):358-72. doi: 10.1007/s13311-014-0271-4.
The last decade has witnessed a significant shift on our understanding of the relationship between psychiatric disorders and epilepsy. While traditionally psychiatric disorders were considered as a complication of the underlying seizure disorder, new epidemiologic data, supported by clinical and experimental research, have suggested the existence of a bidirectional relation between the two types of conditions: not only are patients with epilepsy at greater risk of experiencing a psychiatric disorder, but patients with primary psychiatric disorders are at greater risk of developing epilepsy. Do these data suggest that some of the pathogenic mechanisms operant in psychiatric comorbidities play a role in epileptogenesis? The aim of this article is to review the epidemiologic data that demonstrate that primary psychiatric disorders are more frequent in people who develop epilepsy, before the onset of the seizure disorder than among controls. The next question looks at the available data of pathogenic mechanisms of primary mood disorders and their potential for facilitating the development and/or exacerbation in the severity of epileptic seizures. Finally, we review data derived from experimental studies in animal models of depression and epilepsy that support a potential role of pathogenic mechanisms of mood disorders in the development of epileptic seizures and epileptogenesis. The data presented in this article do not yet establish conclusive evidence of a pathogenic role of psychiatric comorbidities in epileptogenesis, but raise important research questions that need to be investigated in experimental, clinical, and population-based epidemiologic research studies.
在过去十年中，我们对精神障碍与癫痫之间关系的理解发生了重大转变。传统上，精神障碍被视为潜在癫痫发作疾病的一种并发症，但新的流行病学数据，在临床和实验研究的支持下，表明这两种疾病之间存在双向关系：不仅癫痫患者患精神障碍的风险更高，而且原发性精神障碍患者患癫痫的风险也更高。这些数据是否表明在精神共病中起作用的一些致病机制在癫痫发生中也起作用？本文的目的是回顾流行病学数据，这些数据表明，在癫痫发作疾病发作前，原发性精神障碍在患癫痫的人群中比在对照组中更常见。接下来的问题是研究原发性情绪障碍的致病机制的现有数据，以及它们在促进癫痫发作的发展和/或加重癫痫发作严重程度方面的潜力。最后，我们回顾了来自抑郁症和癫痫动物模型实验研究的数据，这些数据支持情绪障碍致病机制在癫痫发作发展和癫痫发生中的潜在作用。本文所呈现的数据尚未确凿证明精神共病在癫痫发生中具有致病作用，但提出了重要的研究问题，需要在实验、临床和基于人群的流行病学研究中进行调查。
