Jayalakshmi Sita, Padmaja Gaddamanugu, Vooturi Sudhindra, Bogaraju Anand, Surath Mohandas
Department of Neurology, Krishna Institute of Medical Sciences, Minister Road, Secunderabad-03, Andhra Pradesh, India.
Department of Neurology, Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad, Andhra Pradesh, India.
Epilepsy Behav. 2014 Aug;37:7-10. doi: 10.1016/j.yebeh.2014.05.020. Epub 2014 Jun 18.
Psychiatric disorders (PDs) are frequently observed in patients with juvenile myoclonic epilepsy (JME). In this study, we aimed to assess factors associated with PDs in patients with JME.
Retrospective analysis of data of 90 consecutive patients with JME was performed. Assessment of DSM-IV Axis I clinical disorders was done using Structured Clinical Interview for Axis I. Diagnosis of PDs is made when the score exceeds the threshold provided by the DSM-IV. We also applied the Global Assessment of Functioning (GAF) scale which is part of the multiaxial evaluation of the DSM-IV (Axis-V). Using seizure frequency score at presentation, we classified subjects into controlled and uncontrolled groups.
In the current cohort, 29 (32.2%) patients were diagnosed with PDs. Fewer patients with PDs had family support (48.3% vs. 83.6%; p=0.001). Lifetime prevalence of PDs was higher among patients with current PDs (96.6% vs. 18.0%; p<0.0001). Subthreshold illness was not different between the groups (17.2% vs. 27.9%; p=0.204). Mean GAF was higher in patients without PDs than in patients with PDs (89.19±6.92 vs. 64.22±9.76; p<0.0001). Patients with PDs had lower seizure control (7.8% vs. 73.1%; p<0.0001) compared with patients without PDs. Logistic regression analysis for factors associated with diagnosis of PDs revealed that none of the factors significantly affected the odds of seizure control. Patients with lack of family support had poor seizure control (0% vs. 36.9%; p<0.0001); 51.7% of patients with JME with PDs reported lack of family support. Patients with family support had lower lifetime prevalence of PDs (30.8% vs. 76.0%; p<0.0001), whereas patients with JME without family support had lower levels of education (8.0% vs. 35.4%; p=0.009).
Lack of family support is associated with poor seizure control and higher incidence of PDs in patients with JME. Lack of family support increases neither the odds of PDs nor seizure control.
青少年肌阵挛癫痫（JME）患者中经常观察到精神障碍（PDs）。在本研究中，我们旨在评估JME患者中与PDs相关的因素。
对90例连续的JME患者的数据进行回顾性分析。使用轴I型障碍的结构化临床访谈对DSM-IV轴I临床障碍进行评估。当分数超过DSM-IV提供的阈值时诊断为PDs。我们还应用了功能总体评定量表（GAF），它是DSM-IV多轴评估（轴V）的一部分。根据就诊时的癫痫发作频率评分，将受试者分为控制组和未控制组。
在当前队列中，29例（32.2%）患者被诊断为PDs。有PDs的患者获得家庭支持的较少（48.3%对83.6%；p=0.001）。当前患有PDs的患者中PDs的终生患病率更高（96.6%对18.0%；p<0.0001）。两组之间阈下疾病无差异（17.2%对27.9%；p=0.204）。无PDs的患者的平均GAF高于有PDs的患者（89.19±6.92对64.22±9.76；p<0.0001）。与无PDs的患者相比，有PDs的患者癫痫控制较差（7.8%对73.1%；p<0.0001）。对与PDs诊断相关因素的逻辑回归分析显示，没有一个因素显著影响癫痫控制的几率。缺乏家庭支持的患者癫痫控制较差（0%对36.9%；p<0.0001）；51.7%的患有PDs的JME患者报告缺乏家庭支持。有家庭支持的患者PDs的终生患病率较低（30.8%对76.0%；p<0.0001），而没有家庭支持的JME患者教育水平较低（8.0%对35.4%；p=0.009）。
缺乏家庭支持与JME患者癫痫控制不佳和PDs发病率较高相关。缺乏家庭支持既不会增加PDs的几率，也不会影响癫痫控制。
