Narayanan Jaishree, Simon Kelly Claire, Choi Janet, Dobrin Sofia, Rubin Susan, Taber Jesse, Wang Charles, Pham Anna, Chesis Richard, Hadsell Bryce, Epshteyn Alexander, Wilk Gary, Tideman Samuel, Meyers Steven, Frigerio Roberta, Maraganore Demetrius
NorthShore Neurological Institute, NorthShore University HealthSystem, Evanston, IL, USA.
Health Information Technology, NorthShore University HealthSystem, Evanston, IL, USA.
J Epilepsy Res. 2019 Dec 31;9(2):103-110. doi: 10.14581/jer.19018. eCollection 2019 Dec.
Epilepsy patients are more likely to experience depressive symptoms and cognitive impairment compared to individuals in the general population. As the reasons for this are not definitively known, we sought to determine what factors correlate most strongly with cognition and a screening test for depression in epilepsy patients.
Our study population included 379 adult patients diagnosed with epilepsy or seizure in our neurology clinic. We collected detailed demographic and clinical data during patient visits using structured clinical documentation support tools that we have built within our commercial electronic medical records system (Epic), including a depression score (Neurological Disorders Depression Inventory for Epilepsy, NDDIE) and cognition score test measures (specifically in this study, Mini-Mental State Examination [MMSE]). Medication, age, gender, body mass index, duration of epilepsy, seizure frequency, current number of anti-epileptic medications, years of education were assessed in relation to baseline score as well as change in score from initial visit to first annual follow-up.
Of the analyzed factors, two statistically significant associations were found after correction for multiple testing. Male gender and lower anti-seizure medication count were associated with better mood, as assessed by NDDIE score, at initial visit. Specifically, male gender was associated with a 1.3 decrease in NDDIE and for each additional anti-seizure medication, there was an associated 1.2 increase in NDDIE.
However, these factors were not associated with change in NDDIE score from initial to first annual follow-up visit. These findings, although interesting, are preliminary. Additionally, these findings were based on a homogenous (mainly Caucasian) clinic-based population and detailed information on previous medication use was lacking. Further work is needed to replicate these findings and to understand any mechanisms that may explain these associations.
与普通人群相比，癫痫患者更易出现抑郁症状和认知障碍。由于其原因尚不明确，我们试图确定哪些因素与癫痫患者的认知及抑郁筛查测试关联最为密切。
我们的研究对象包括在我们神经科诊所被诊断为癫痫或发作性疾病的379名成年患者。在患者就诊期间，我们使用在商业电子病历系统（Epic）中构建的结构化临床文档支持工具收集详细的人口统计学和临床数据，包括抑郁评分（癫痫神经疾病抑郁量表，NDDIE）和认知评分测试指标（在本研究中具体为简易精神状态检查表[MMSE]）。评估了药物治疗、年龄、性别、体重指数、癫痫病程、发作频率、当前抗癫痫药物数量、受教育年限与基线评分以及从初次就诊到首次年度随访评分变化之间的关系。
在对多个测试进行校正后，在所分析的因素中发现了两个具有统计学意义的关联。初次就诊时，通过NDDIE评分评估，男性和较低的抗癫痫药物数量与较好的情绪相关。具体而言，男性与NDDIE评分降低1.3相关，每增加一种抗癫痫药物，NDDIE评分增加1.2。
然而，这些因素与从初次就诊到首次年度随访期间NDDIE评分的变化无关。这些发现虽然有趣，但只是初步的。此外，这些发现基于一个同质的（主要是白种人）基于诊所的人群，且缺乏关于既往用药的详细信息。需要进一步开展工作来重复这些发现，并了解可能解释这些关联的任何机制。
