Williams Roberson Shawniqua, Rehman Rizwana, Bucurescu Gabriel
Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Southeast Epilepsy Center of Excellence, Durham VA Medical Center, Durham, North Carolina, USA.
Neurology (ECronicon). 2019 Dec;11(12). Epub 2019 Nov 7.
Veterans and patients with epilepsy are at higher risk of suicide than the general population. Some studies suggest that antiepileptic drugs (AEDs) further increase the risk of suicide. The nature of the relationship between suicidality and epilepsy treatment needs clarification. We examined this relationship in a cohort of veterans with seizures.
We performed a retrospective chart analysis of patients at the Philadelphia VA Medical Center with a diagnosis of seizure disorder between January 2000 and April 2007. Patients with suicidal ideation and/or suicidal behaviors were analyzed with respect to the following risk factors: age, history of traumatic brain injury (TBI), substance abuse and AED prescription.
526 charts were reviewed, 385 of which met inclusion criteria. Patients with substance abuse were more likely to have suicidal ideation (adjusted odds ratio 3.37, 95% CI 1.84 -6.18). Risk decreased with age (adjusted odds ratio 0.94, 95% CI 0.92 - 0.97 for each year). There was no statistically significant relationship between suicidality and AED use or history of TBI.
In our population, AEDs were not associated with increased risk of suicidality, whereas substance abuse was associated with a substantial risk increase. The interactions among seizures, suicidality, substance abuse and other neuropsychiatric diseases are complex. Large-scale studies in patients with seizures are needed to understand the impact of individual drugs and other contributing factors. Providers should be cautious not to withhold potentially beneficial treatment, however patients with risk factors such as history of substance abuse should be followed closely after AED initiation or adjustment.
退伍军人和癫痫患者自杀风险高于普通人群。一些研究表明，抗癫痫药物（AEDs）会进一步增加自杀风险。自杀倾向与癫痫治疗之间关系的本质需要阐明。我们在一组有癫痫发作的退伍军人队列中研究了这种关系。
我们对2000年1月至2007年4月间在费城退伍军人事务医疗中心被诊断患有癫痫症的患者进行了回顾性病历分析。对有自杀意念和/或自杀行为的患者分析了以下风险因素：年龄、创伤性脑损伤（TBI）史、药物滥用和AED处方。
共审查了526份病历，其中385份符合纳入标准。药物滥用患者更有可能有自杀意念（调整后的优势比为3.37，95%置信区间为1.84 - 6.18）。风险随年龄降低（每年调整后的优势比为0.94，95%置信区间为0.92 - 0.97）。自杀倾向与AED使用或TBI史之间无统计学显著关系。
在我们的研究人群中，AEDs与自杀倾向风险增加无关，而药物滥用与风险大幅增加有关。癫痫发作、自杀倾向、药物滥用和其他神经精神疾病之间的相互作用很复杂。需要对癫痫患者进行大规模研究，以了解个体药物和其他促成因素的影响。医疗服务提供者应谨慎，不要拒绝给予可能有益的治疗，然而，对于有药物滥用史等风险因素的患者，在开始使用AED或调整AED后应密切随访。
