Rocamora Rodrigo, Ley Miguel, Molins Albert, Toledo Manuel, Sansa Gemma, Bertol Vicente, Becerra Juan-Luis, Carreño Mar, Mauri José-Ángel
Epilepsy Unit, Department of Neurology, Hospital del Mar, Barcelona, Spain.
Department of Neurology, Hospital Trueta, Girona, Spain.
Epilepsy Behav. 2018 Feb;79:87-92. doi: 10.1016/j.yebeh.2017.10.032. Epub 2017 Dec 16.
Depression is the main psychiatric comorbidity in epilepsy with an estimated prevalence between 20% and 55% and one of the main determinants of quality of life. The aim of this study was to investigate the effect of lacosamide (LCM) on mood and anxiety symptoms in patients with focal onset seizures (FOS). The secondary objective was to evaluate if the potential modifications in variables were related to seizure control or to the intrinsic effect of LCM.
We performed a prospective multicenter study in 8 tertiary epilepsy centers in adults with FOS in which LCM was initiated as add-on therapy. Patients' mood and quality of life were evaluated through questionnaires and scales such as the Beck Depression Inventory-II (BDI-II), the State-Trait Anxiety Inventory (STAI-S/T), the Hospital Anxiety and Depression Scale (HADS), and the Quality of Life in Epilepsy-10 (QOLIE-10). Initiation of psychotropic medication was not allowed during the observation period. Patients with diagnosis of major depression or bipolar disorder were excluded. Evaluations were scheduled before LCM treatment, at 3 and 6months.
Forty-nine patients were included (51% female) with an average age of 39.5years (range 18-65). At the start of treatment with LCM, 65.3% of the patients were on treatment with one antiepileptic drug (AED). Based on BDI-II, 38.8% of patients had depressive symptoms and 46.9% according to HADS Depression (HADS-D), 63.3% of patients presented pathological levels of anxiety (STAI-S/T), and 44.9% according to HADS Anxiety (HADS-A). Quality of Life in Epilepsy-10 showed that 57.1% of patients had a relevant reduction in their quality of life. After LCM, the score on the BDI-II depression scale decreased significantly (p<0.001). Based on the STAI and HADS-anxiety scales, patients who had a pathological anxiety at baseline, significantly improved. The QOLIE-10 improved significantly over the observation period (p<0.001). At 6months, 28.3% of patients were seizure-free (67.4% were responders). The improvements on depression and anxiety scores were not statistically related to seizure control.
Lacosamide seems to have a positive effect on depressive and anxiety symptoms. Although the efficacy of LCM in seizure control was demonstrated, the antidepressant and anxiolytic effect on mood and anxiety seems to be an independent factor.
抑郁症是癫痫中主要的精神共病，估计患病率在20%至55%之间，是生活质量的主要决定因素之一。本研究的目的是调查拉考沙胺（LCM）对局灶性发作（FOS）患者情绪和焦虑症状的影响。次要目的是评估变量的潜在变化是否与癫痫控制或LCM的内在作用有关。
我们在8个三级癫痫中心对成年FOS患者进行了一项前瞻性多中心研究，其中LCM作为附加疗法开始使用。通过问卷和量表评估患者的情绪和生活质量，如贝克抑郁量表第二版（BDI-II）、状态-特质焦虑量表（STAI-S/T）、医院焦虑抑郁量表（HADS）和癫痫生活质量量表-10（QOLIE-10）。观察期内不允许开始使用精神药物。排除诊断为重度抑郁症或双相情感障碍的患者。评估安排在LCM治疗前、3个月和6个月时进行。
纳入49例患者（51%为女性），平均年龄39.5岁（范围18 - 65岁）。在开始使用LCM治疗时，65.3%的患者正在使用一种抗癫痫药物（AED）。根据BDI-II，38.8%的患者有抑郁症状，根据HADS抑郁量表（HADS-D）为46.9%，63.3%的患者存在病理性焦虑水平（STAI-S/T），根据HADS焦虑量表（HADS-A）为44.9%。癫痫生活质量量表-10显示57.1%的患者生活质量有显著下降。使用LCM后，BDI-II抑郁量表得分显著降低（p<0.001）。根据STAI和HADS焦虑量表，基线时存在病理性焦虑的患者有显著改善。在观察期内，QOLIE-10显著改善（p<0.001）。在6个月时，28.3%的患者无癫痫发作（67.4%为反应者）。抑郁和焦虑评分的改善与癫痫控制无统计学关联。
拉考沙胺似乎对抑郁和焦虑症状有积极作用。虽然证明了LCM在癫痫控制方面的疗效，但对情绪和焦虑的抗抑郁和抗焦虑作用似乎是一个独立因素。
