Department of Psychiatry and Psychotherapy, Evangelical Clinic Bethel, Bielefeld, Germany.
Epilepsy Center Bethel, Krankenhaus Mara, Bielefeld, Germany.
Epilepsia. 2017 Jun;58(6):983-993. doi: 10.1111/epi.13736. Epub 2017 Apr 5.
To examine whether psychiatric comorbidity is a predictor of long-term seizure outcome following temporal lobe epilepsy surgery.
A sample of 434 adult patients who received temporal lobe resection to treat epilepsy between 1991 and 2009 and were psychiatrically assessed before surgery were followed for 2 years to assess seizure outcome. Stepwise multivariate logistic regression analyses were used to assess the impact of psychiatric variables on complete seizure freedom (Engel class IA), and freedom from disabling seizures (Engel class I). Lifetime histories of three psychiatric syndromes (PS: psychosis; depression; other) and five personality disorders (PD: DSM-IV Clusters A, B, and C; organic personality disorder; other) were considered as predictors, complemented by age at onset, duration of epilepsy, type of lesion (mesiotemporal sclerosis vs. other), and year of surgery.
Seizure-freedom rates were significantly higher (p < 0.001) in patients with no history of PS or PD (N = 138; Engel class IA: 61.6%; Engel class I: 87.7%) than in those with any PS or PD (N = 296; Engel class IA: 39.5%; Engel class I: 58.8%). Particularly low seizure-freedom rates were found in patients with a diagnosis of psychosis (N = 32, Engel class IA: 21.9%; Engel class I: 40.6%), organic PD (N = 48, Engel class IA: 25.0%; Engel class I: 35.4%) or a double diagnosis of PS plus PD (N = 97; Engel class IA: 27.8%; Engel class I: 45.5%). No other variables emerged as significant risk factors in multivariate logistic regression analyses.
Patients with and without psychiatric comorbidities can benefit from temporal lobe epilepsy surgery; however, psychiatric comorbidities are negatively associated with postoperative seizure-freedom rates. Surgical outcome is related to the type and extent of preoperative psychiatric morbidity, which underscores the prognostic value of presurgical psychiatric evaluation. The data support the argument that there are common pathogenetic mechanisms underlying both epilepsy and psychiatric conditions.
探讨精神共病是否是颞叶癫痫手术后长期癫痫发作结局的预测因素。
本研究纳入了 1991 年至 2009 年间接受颞叶切除术治疗癫痫的 434 例成年患者，这些患者在术前接受了精神评估，并随访 2 年以评估癫痫发作结局。采用逐步多元逻辑回归分析来评估精神变量对完全无癫痫发作（Engel 分级 IA）和无致残性癫痫发作（Engel 分级 I）的影响。将三种精神综合征（PS：精神病；抑郁；其他）和五种人格障碍（PD：DSM-IV 聚类 A、B 和 C；器质性人格障碍；其他）的终生病史作为预测因子，同时考虑发病年龄、癫痫持续时间、病变类型（颞叶内侧硬化症与其他）和手术年份。
无 PS 或 PD 病史的患者（N=138）的无癫痫发作率显著高于有 PS 或 PD 病史的患者（N=296）（p<0.001）（Engel 分级 IA：61.6%；Engel 分级 I：87.7% vs. Engel 分级 IA：39.5%；Engel 分级 I：58.8%）。精神病诊断（N=32，Engel 分级 IA：21.9%；Engel 分级 I：40.6%）、器质性 PD（N=48，Engel 分级 IA：25.0%；Engel 分级 I：35.4%）或 PS 合并 PD 双重诊断（N=97，Engel 分级 IA：27.8%；Engel 分级 I：45.5%）的患者的无癫痫发作率尤其低。多元逻辑回归分析未发现其他有意义的危险因素。
有和无精神共病的患者均可从颞叶癫痫手术中获益；然而，精神共病与术后无癫痫发作率呈负相关。手术结局与术前精神疾病的类型和严重程度有关，这突出了术前精神评估的预后价值。这些数据支持这样一种观点，即癫痫和精神疾病之间存在共同的发病机制。
