Josephson Colin B, Patten Scott B, Bulloch Andrew, Williams Jeanne V A, Lavorato Dina, Fiest Kirsten M, Secco Mary, Jette Nathalie
Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
Epilepsia. 2017 May;58(5):764-771. doi: 10.1111/epi.13723. Epub 2017 Mar 27.
The aim of this study was to examine the impact of seizures on persons living with epilepsy in a national, community-based setting.
The data source was the Survey of Living with Neurological Conditions in Canada (SLNCC), a cohort derived from a national population-based survey of noninstitutionalized persons aged 15 or more years. Participants had to be on a seizure drug or to have had a seizure in the past 5 years to meet the definition of active epilepsy. The respondents were further stratified by seizure status: the seizure group experienced ≥1 seizure in the past 5 years versus the no seizure group who were seizure-free in the past ≥5 years regardless of medication status. Weighted overall and stratified prevalence estimates and odds ratios were used to estimate associations.
The SLNCC included 713 persons with epilepsy with a mean age of 45.4 (standard deviation 18.0) years. Fewer people in the seizure group (42.7%) reported being much better than a year ago versus those in the no seizure group (70.1%). Of those with seizures, 32.1% (95% confidence interval [95% CI] 18.8-45.3) had symptoms suggestive of major depression (as per the Patient Health Questionnaire-9) compared to 7.7% (95% CI 3.4-11.9) of those without seizures. Driving, educational, and work opportunities were also significantly limited, whereas stigma was significantly greater in those with seizures.
This community-based study emphasizes the need for seizure freedom to improve clinical and psychosocial outcomes in persons with epilepsy. Seizure freedom has an important influence on overall health, as those with at least one seizure over the prior 5 years had an increased risk of mood disorders, worse quality of life, and faced significantly more stigma.
本研究旨在探讨在全国范围内基于社区的环境中，癫痫发作对癫痫患者的影响。
数据来源为加拿大神经疾病生活状况调查（SLNCC），该队列来自对15岁及以上非机构化人群进行的全国性基于人群的调查。参与者必须正在服用抗癫痫药物或在过去5年内有过癫痫发作，才能符合活动性癫痫的定义。受访者进一步按癫痫发作状态分层：癫痫发作组在过去5年内经历过≥1次癫痫发作，而无癫痫发作组在过去≥5年内无癫痫发作，无论其用药情况如何。使用加权总体和分层患病率估计值及比值比来估计关联。
SLNCC纳入了713名癫痫患者，平均年龄为45.4岁（标准差18.0）。癫痫发作组中报告比一年前好多了的人（42.7%）少于无癫痫发作组（70.1%）。在有癫痫发作的人中，32.1%（95%置信区间[95%CI]18.8 - 45.3）有提示重度抑郁的症状（根据患者健康问卷-9），而无癫痫发作的人中这一比例为7.7%（95%CI 3.4 - 11.9）。驾驶、教育和工作机会也受到显著限制，而癫痫发作患者的耻辱感明显更强。
这项基于社区的研究强调了实现无癫痫发作对于改善癫痫患者临床和心理社会结局的必要性。无癫痫发作对整体健康有重要影响，因为在过去5年中至少有一次癫痫发作的患者患情绪障碍的风险增加、生活质量更差，并且面临的耻辱感明显更多。
