Neurosciences and Mental Health Program, The Hospital for Sick Children, Toronto, ON, Canada; Department of Psychology, The Hospital for Sick Children, Toronto, ON, Canada.
Neurosciences and Mental Health Program, The Hospital for Sick Children, Toronto, ON, Canada; Division of Neurology, The Hospital for Sick Children, Toronto, ON, Canada; Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada.
Epilepsy Behav. 2021 Jan;114(Pt A):107585. doi: 10.1016/j.yebeh.2020.107585. Epub 2020 Dec 1.
To examine longitudinal changes and predictors of depression and anxiety 2 years following resective epilepsy surgery, compared to no surgery, in children with drug-resistant epilepsy (DRE).
This multicenter cohort study involved 128 children and adolescents with DRE (48 surgical, 80 nonsurgical; 8-18 years) who completed self-report measures of depression and anxiety at baseline and follow-up (6-month, 1-year, 2-year). Child demographic (age, sex, IQ) and seizure (age at onset, duration, frequency, site and side) variables were collected.
Linear mixed-effects models controlling for age at enrolment found a time by treatment by seizure outcome interaction for depression. A negative linear trend across time (reduction in symptoms) was found for surgical patients, irrespective of seizure outcome. In contrast, the linear trend differed depending on seizure outcome in nonsurgical patients; a negative trend was found for those with continued seizures, whereas a positive trend (increase in symptoms) was found for those who achieved seizure freedom. Only a main effect of time was found for anxiety indicating a reduction in symptoms across patient groups. Multivariate regressions failed to find baseline predictors of depression or anxiety at 2-year follow-up in surgical patients. Older age, not baseline anxiety or depression, predicted greater symptoms of anxiety and depression at 2-year follow-up in nonsurgical patients.
Children with DRE reported improvement in anxiety and depression, irrespective of whether they achieve seizure control, across the 2 years following surgery. In contrast, children with DRE who did not undergo surgery, but achieved seizure freedom, reported worsening of depressive symptoms, which may indicate difficulty adjusting to life without seizures and highlight the potential need for ongoing medical and psychosocial follow-up and support.
与未手术组相比，在耐药性癫痫（DRE）儿童中，检查手术后 2 年抑郁和焦虑的纵向变化及其预测因素。
这项多中心队列研究纳入了 128 名 DRE 儿童和青少年（手术组 48 例，非手术组 80 例；年龄 8-18 岁），他们在基线和随访（6 个月、1 年、2 年）时完成了抑郁和焦虑的自我报告测量。收集了儿童人口统计学（年龄、性别、智商）和癫痫发作（发病年龄、持续时间、频率、部位和侧别）变量。
线性混合效应模型控制了入组时的年龄，发现抑郁的治疗时间与癫痫结局存在交互作用。手术组无论癫痫结局如何，均表现出随时间的线性下降趋势（症状减轻）。相比之下，非手术组的线性趋势取决于癫痫结局，持续发作的患者呈下降趋势，而无发作的患者呈上升趋势（症状加重）。仅发现焦虑的时间存在主要效应，表明所有患者群体的症状均有所减轻。多变量回归未能在手术患者中发现 2 年随访时抑郁或焦虑的基线预测因子。非手术患者中，年龄较大而非基线焦虑或抑郁预测着 2 年随访时焦虑和抑郁症状更严重。
无论是否控制癫痫，DRE 儿童在手术后的 2 年内都报告了焦虑和抑郁的改善。相比之下，未手术但癫痫无发作的 DRE 儿童报告了抑郁症状的恶化，这可能表明他们难以适应无癫痫发作的生活，突出了对持续的医疗和心理社会随访和支持的潜在需求。
