皮质兴奋性影响特发性全身性癫痫（IGEs）患者的情绪状态。
Cortical excitability affects mood state in patients with idiopathic generalized epilepsies (IGEs).
作者信息
Bolden Lauren B, Griffis Joseph C, Nenert Rodolphe, Allendorfer Jane B, Szaflarski Jerzy P
机构信息
Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA; Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA; UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, USA.
Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA; Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA; UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, USA.
出版信息
Epilepsy Behav. 2019 Jan;90:84-89. doi: 10.1016/j.yebeh.2018.11.001. Epub 2018 Dec 2.
Previously, we demonstrated an association between cortical hyperexcitability and mood disturbance in healthy adults. Studies have documented hyperexcitability in patients with idiopathic generalized epilepsies (IGEs; long-interval intracortical inhibition [LICI]) and high prevalence of mood comorbidities. This study aimed to investigate the influences of cortical excitability and seizure control on mood state in patients with IGEs. Single and paired-pulse transcranial magnetic stimulation (TMS) was applied to 30 patients with IGEs (16 controlled IGEs [cIGEs], 14 with treatment-resistant IGEs [trIGEs]), and 22 healthy controls (HCs) to assess cortical excitability with LICI. The Profile of Mood Sates (POMS) questionnaire was used to assess total mood disturbance (TMD), as well as, six mood domains: Depression, Confusion, Anger, Anxiety, Fatigue, and Vigor. To assess the effects of seizure control (HC vs. cIGEs vs. trIGEs) and LICI response (inhibitory vs. excitatory) on TMD, a two-way multivariate analysis of variance (MANOVA) was performed. Analyses revealed a significant main effect of long-interval intracortical inhibition (LICI) response on TMD (F(1, 46) = 4.69, p = 0.04), but not seizure control (F(2, 46) = 0.288, p = 0.75). Excitatory responders endorsed significantly higher TMD scores, indicating greater mood disturbance, than inhibitory responders (MD = -2.12; T (50) = -2.47, p = 0.04). Also, excitatory responders endorsed more items than inhibitory responders on the Depression (MD = -2.12; T (50) = -2.47, p = 0.04) and Fatigue (MD = -3.42; T (50) = -2.96, p = 0.03) subscales of the POMS. These findings provide further evidence of a relationship between hyperexcitability and mood disturbance, and indicate that cortical excitability may have greater influence on mood state than seizure control in patients with IGEs. Results also support theories for the underlying role of gamma-aminobutyric acid (GABA) network dysfunction in the etiology of depression. To better understand the clinical relevance and causal nature of these relationships, further investigation is warranted.
此前，我们证明了健康成年人的皮质兴奋性过高与情绪障碍之间存在关联。研究记录了特发性全身性癫痫（IGEs；长间隔皮质内抑制[LICI]）患者存在兴奋性过高现象，且情绪共病的患病率很高。本研究旨在调查皮质兴奋性和癫痫控制对IGEs患者情绪状态的影响。对30例IGEs患者（16例癫痫得到控制的IGEs患者[cIGEs]，14例难治性IGEs患者[trIGEs]）和22名健康对照者（HCs）进行单脉冲和配对脉冲经颅磁刺激（TMS），以通过LICI评估皮质兴奋性。使用情绪状态剖面图（POMS）问卷评估总体情绪障碍（TMD）以及六个情绪领域：抑郁、困惑、愤怒、焦虑、疲劳和活力。为了评估癫痫控制（HCs与cIGEs与trIGEs）和LICI反应（抑制性与兴奋性）对TMD的影响，进行了双向多变量方差分析（MANOVA）。分析显示，长间隔皮质内抑制（LICI）反应对TMD有显著的主效应（F(1, 46) = 4.69，p = 0.04），但癫痫控制对其无显著影响（F(2, 46) = 0.288，p = 0.75）。与抑制性反应者相比，兴奋性反应者的TMD得分显著更高，表明情绪障碍更严重（平均差[MD] = -2.12；T(50) = -2.47，p = 0.04）。此外，在POMS的抑郁（MD = -2.12；T(50) = -2.47，p = 0.04）和疲劳（MD = -3.42；T(50) = -2.96，p = 0.03）子量表上，兴奋性反应者认可的项目比抑制性反应者更多。这些发现进一步证明了兴奋性过高与情绪障碍之间的关系，并表明在IGEs患者中，皮质兴奋性对情绪状态的影响可能比癫痫控制更大。研究结果也支持γ-氨基丁酸（GABA）网络功能障碍在抑郁症病因中起潜在作用的理论。为了更好地理解这些关系的临床相关性和因果性质，有必要进行进一步研究。
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