de Araujo Filho Gerardo Maria, Furlan Ana Eliza Romano, Ribeiro Ana Elisa Sa Antunes, Marques Lucia Helena Neves
Department of Psychiatry and Medical Psychology, Faculdade de Medicina de São José do Rio Preto (FAMERP), São Paulo, Brazil.
Department of Psychiatry and Medical Psychology, Faculdade de Medicina de São José do Rio Preto (FAMERP), São Paulo, Brazil.
Epilepsy Behav. 2015 Apr;45:35-8. doi: 10.1016/j.yebeh.2015.02.026. Epub 2015 Mar 21.
Given the high frequency of psychiatric disorders (PDs) observed among patients with epilepsy, studies have highlighted the necessity of psychiatric evaluation for these patients, especially for those with refractory temporal lobe epilepsy with mesial temporal sclerosis (TLE-MTS) who are surgical candidates. Current evidence highlights the safety of video-electroencephalography (VEEG) as a means of investigation in patients with TLE-MTS and PDs. However, the presence of such disorders has still been seen as a contraindication for presurgical evaluation with VEEG in some epilepsy centers mainly because of the risk of negative behavioral events. The present retrospective cohort study performed in a Brazilian tertiary epilepsy center aimed to identify whether the presence of a PD remains a contraindication for presurgical VEEG. Clinical, sociodemographic, and psychiatric data from 41 patients who underwent VEEG as part of their presurgical evaluation were compared to data from 32 patients with refractory TLE-MTS who had not undergone VEEG. Psychiatric diagnoses were determined using the DSM-IV and ILAE criteria. Psychiatric disorders were diagnosed in 34 patients (46.6%). Major depressive disorder was the most frequent PD and was observed in 22 patients (30.1%). Anxiety disorders were observed in 14 patients (19.2%). Of the 41 patients (56.2%) who underwent presurgical VEEG, only 12 (29.2%) were found to have a PD during the presurgical psychiatric evaluation compared to 22 of the 32 (68.7%) who did not undergo VEEG (p=0.001; RR=2.35). The present findings suggest that the presence of a PD alone should not be a contraindication for VEEG monitoring and epilepsy surgery.
鉴于癫痫患者中观察到的精神障碍（PDs）发生率较高，研究强调了对这些患者进行精神评估的必要性，特别是对于那些患有难治性颞叶癫痫伴内侧颞叶硬化（TLE-MTS）且考虑手术治疗的患者。目前的证据表明，视频脑电图（VEEG）作为TLE-MTS和PDs患者的一种检查手段是安全的。然而，在一些癫痫中心，此类障碍的存在仍被视为VEEG术前评估的禁忌证，主要是因为存在负面行为事件的风险。本项在巴西一家三级癫痫中心进行的回顾性队列研究旨在确定PD的存在是否仍然是VEEG术前评估的禁忌证。将41例接受VEEG作为术前评估一部分的患者的临床、社会人口学和精神数据与32例未接受VEEG的难治性TLE-MTS患者的数据进行比较。使用《精神疾病诊断与统计手册》第四版（DSM-IV）和国际抗癫痫联盟（ILAE）标准确定精神疾病诊断。34例患者（46.6%）被诊断患有精神障碍。重度抑郁症是最常见的PD，22例患者（30.1%）出现该病症。14例患者（19.2%）出现焦虑症。在接受术前VEEG的41例患者（56.2%）中，只有12例（29.2%）在术前精神评估中被发现患有PD，而在未接受VEEG的32例患者中有22例（68.7%）（p=0.001；相对危险度=2.35）。目前的研究结果表明，仅PD的存在不应成为VEEG监测和癫痫手术的禁忌证。
