Adachi Naoto, Akanuma Nozomi, Fenwick Peter, Ito Masumi, Okazaki Mitsutoshi, Ishida Shiro, Sekimoto Masanori, Kato Masaaki, Onuma Teiichi
National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan; Adachi Mental Clinic, Sapporo, Japan.
National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan; South London & Maudsley NHS Foundation Trust, London, UK.
Epilepsy Behav. 2018 Feb;79:234-238. doi: 10.1016/j.yebeh.2017.10.012. Epub 2017 Dec 15.
Despite a theoretical consensus that interictal psychosis (IIP) is related to various epilepsy-related factors, the impact of seizure activity on development of IIP remains inconclusive. This is the first controlled study using quantitative seizure-activity measures at the onset of IIP.
One hundred and eighty-one patients with epilepsy who exhibited first-episode IIP (IIP group) and 427 patients with epilepsy without psychotic episodes (control group) were enrolled. The control group was matched for age, epilepsy type, and duration of epilepsy. The two seizure-activity indices (seizure frequency at the time of onset of first-episode IIP and the number of seizures before the onset of IIP) were evaluated and compared between the IIP and control groups. Logistic regression analysis was used for extracting risk variables to develop first-episode IIP.
The sum of previous seizures was greater in the IIP than in control groups. This was particularly the case in the patients with partial epilepsies (PE). Higher seizure frequency in the patients with PE was associated with the development of first-episode IIP while no association was found in the whole cohort or in the patients with generalized epilepsies (GE). Subsequent multivariate analysis revealed the sum of previous seizures and family history of psychosis as risk variables to first-episode IIP.
The accumulation of seizure-related damages and family history of psychosis is associated with the onset of IIP episodes, particularly in the patients with PE. Seizure activity and individual vulnerability to psychosis are likely to be interacted for as the development of IIP in patients with epilepsy.
尽管在理论上已达成共识，即发作间期精神病（IIP）与多种癫痫相关因素有关，但癫痫发作活动对IIP发展的影响仍无定论。这是第一项在IIP发作时使用定量癫痫发作活动测量方法的对照研究。
招募了181例出现首次发作IIP的癫痫患者（IIP组）和427例无精神病发作的癫痫患者（对照组）。对照组在年龄、癫痫类型和癫痫病程方面进行了匹配。评估并比较了IIP组和对照组的两个癫痫发作活动指标（首次发作IIP时的癫痫发作频率以及IIP发作前的癫痫发作次数）。采用逻辑回归分析提取风险变量，以确定首次发作IIP的相关因素。
IIP组既往癫痫发作总数高于对照组。部分性癫痫（PE）患者尤其如此。PE患者较高的癫痫发作频率与首次发作IIP的发生有关，而在整个队列或全身性癫痫（GE）患者中未发现相关性。随后的多变量分析显示，既往癫痫发作总数和精神病家族史是首次发作IIP的风险变量。
癫痫发作相关损害的累积和精神病家族史与IIP发作有关，尤其是在PE患者中。癫痫发作活动和个体对精神病的易感性可能相互作用，共同影响癫痫患者IIP的发展。
