Centro de Epilepsia de Santa Catarina (CEPESC), Hospital Universitário (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil; Serviço de Psiquiatria, Hospital Governador Celso Ramos (HGCR), Florianópolis, SC, Brazil; Centro de Neurociências Aplicadas (CeNAp), HU, UFSC, Florianópolis, SC, Brazil.
Centro de Epilepsia de Santa Catarina (CEPESC), Hospital Universitário (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil; Centro de Neurociências Aplicadas (CeNAp), HU, UFSC, Florianópolis, SC, Brazil; Serviço de Psiquiatria, HU-UFSC, Florianópolis, SC, Brazil.
J Affect Disord. 2019 Mar 1;246:452-457. doi: 10.1016/j.jad.2018.12.072. Epub 2018 Dec 24.
Mesial temporal lobe epilepsy with hippocampal sclerosis (MTLE-HS) is the most prevalent type of surgically remediable epilepsy and highly associated with psychiatric comorbidities. This study aimed to evaluate Hospital anxiety and depression scale-anxiety subscale (HADS-A) and The State-Trait Anxiety Inventory - Trait subscale (STAI-T) accuracy for detection of anxiety disorders in patients with drug-resistant MTLE-HS.
One hundred three consecutive patients with drug-resistant MTLE-HS were enrolled. Diagnosis was based on the anamnesis, neurological examination, video-electroencephalogram (VEEG) analyses, and magnetic resonance imaging (MRI). Psychiatric interviews were based on DSM-IV-TR criteria and ILAE Commission of Psychobiology classification as a gold standard; HADS-A and STAI-T were used as psychometric diagnostic tests, and receiver operating characteristic (ROC) curves were used to determine the optimal threshold scores.
The areas under the curve (AUCs) were higher than 0.7 (0.6-0.8) for both scales. The STAI-T cutoff point of ˃53 and the HADS-A cutoff point of ˃7 showed both around of 80% (44.4-97.7) sensitivity and 80% (66.9-86.9) and 60% (46.5-68.6) of specificity, respectively. In this sample the prevalence of anxiety disorders was 11.7% and both scales showed a high negative predictive value such as 96% (87.1-99.0) but low positive predictive value such as 30% (22.1-45.2) and 20% (15.0-27.2) respectively.
The small number of cases in the diagnostic population; the results are only applied to drug resistant MTLE-HS; the psychiatric diagnosis were not based on a structured psychiatric interview; possible observer bias in 7 illiterate patients; the antidepressant treatment was not controlled.
In MTLE-HS, STAI-T and HADS-A had a similar and low positive predictive value and high negative predictive value. The implications for the HADS-A and STAI-T usefulness for anxiety disorders screening in patients with other epilepsies types deserve further investigations. If replicated in other populations, these findings may have important relevance for the presurgical screening of anxiety disorders in MTLE-HS patients who are candidates to epilepsy surgery.
伴海马硬化的内侧颞叶癫痫（MTLE-HS）是最常见的可手术治疗的癫痫类型，与精神共病高度相关。本研究旨在评估汉密尔顿焦虑量表（HADS-A）和状态-特质焦虑量表（STAI-T）在检测耐药性 MTLE-HS 患者焦虑障碍方面的准确性。
纳入 103 例耐药性 MTLE-HS 连续患者。诊断基于病史、神经检查、视频脑电图（VEEG）分析和磁共振成像（MRI）。精神科访谈基于 DSM-IV-TR 标准和 ILAE 心理生物学分类作为金标准；HADS-A 和 STAI-T 作为心理诊断测试，使用受试者工作特征（ROC）曲线确定最佳截断分数。
两个量表的曲线下面积（AUC）均高于 0.7（0.6-0.8）。STAI-T 的截断值为＞53，HADS-A 的截断值为＞7，两者的敏感性均约为 80%（44.4-97.7），特异性均为 80%（66.9-86.9）和 60%（46.5-68.6）。在该样本中，焦虑障碍的患病率为 11.7%，两个量表均具有较高的阴性预测值（如 96%（87.1-99.0）），但阳性预测值较低，分别为 30%（22.1-45.2）和 20%（15.0-27.2）。
诊断人群中的病例数较少；结果仅适用于耐药性 MTLE-HS；精神科诊断并非基于结构化精神科访谈；7 名文盲患者可能存在观察者偏倚；未控制抗抑郁治疗。
在 MTLE-HS 中，STAI-T 和 HADS-A 的阳性预测值较低且相似，阴性预测值较高。HADS-A 和 STAI-T 在其他癫痫类型患者焦虑障碍筛查中的有用性值得进一步研究。如果在其他人群中得到复制，这些发现可能对 MTLE-HS 患者癫痫手术候选者焦虑障碍的术前筛查具有重要意义。
