The Departments of Medicine and Neurology, The Royal Melbourne Hospital, The University of Melbourne, Victoria, Australia.
The Departments of Medicine and Neurology, The Royal Melbourne Hospital, The University of Melbourne, Victoria, Australia; Department of Neuroscience, Central Clinical School, The Alfred Hospital, Monash University, Victoria, Australia; Melbourne School of Psychological Sciences, The University of Melbourne, Victoria, Australia.
Epilepsy Behav. 2021 Apr;117:107861. doi: 10.1016/j.yebeh.2021.107861. Epub 2021 Mar 6.
This cross-sectional study aimed to determine the effect of psychiatric comorbidity and neurocognitive deficits on the quality of life in a cohort of patients admitted for Video-EEG Monitoring (VEM) for investigation into a presumed seizure disorder.
Patients were recruited from an inpatient VEM unit between January 2009 and December 2016. All patients had formal neuropsychiatric assessment. All patients completed questionnaires assessing psychiatric symptomatology (SCL-90-R), Anxiety and Depression (HADS), quality of life (QOLIE-89), and cognition (NUCOG).
A total of 451 patients were enrolled. Upon discharge, 204 patients were diagnosed to have epilepsy, 118 psychogenic nonepileptic seizures (PNES), and 29 both epilepsy and PNES, while the diagnosis was uncertain diagnosis in 100. Diagnosis (p = .002), HADS Depression score (p < .001), SCL-90-R positive symptoms total (p < .001), and NUCOG total score (p < .001) were found to be significant predictors of QOLIE-89 total scores, together explaining 65.4% of variance in quality of life. Seizure frequency was not a significant predictor of quality of life (p = .082). Patients with PNES had significantly worse quality of life, and scored higher on measures of psychiatricsymptomatology, compared to patients with epilepsy alone. The prevalence of psychiatric comorbidity was significantly higher in patients with PNES (70.3%) or both PNES and epilepsy (62.1%) compared to patients with epilepsy alone (41.2%) (p < .001).
Psychiatric symptomatology, depression, and cognition were stronger determinants of quality of life than seizure frequency in this study population of patients with drug-resistant epilepsy and PNES. Patients with PNES with or without comorbid epilepsy had similar neuropsychiatric profiles.
本横断面研究旨在确定精神共病和神经认知缺陷对疑似癫痫发作障碍患者视频脑电图监测（VEM）队列生活质量的影响。
2009 年 1 月至 2016 年 12 月，我们从住院 VEM 病房招募患者。所有患者均进行了正式的神经精神评估。所有患者均完成了评估精神症状（SCL-90-R）、焦虑和抑郁（HADS）、生活质量（QOLIE-89）和认知（NUCOG）的问卷。
共纳入 451 例患者。出院时，204 例患者被诊断为癫痫，118 例为非癫痫性精神运动性发作（PNES），29 例为癫痫和 PNES 并存，100 例诊断为不确定。诊断（p=0.002）、HADS 抑郁评分（p<0.001）、SCL-90-R 阳性症状总分（p<0.001）和 NUCOG 总分（p<0.001）是 QOLIE-89 总分的显著预测因子，共解释了 65.4%的生活质量方差。发作频率不是生活质量的显著预测因子（p=0.082）。与单独患有癫痫的患者相比，PNES 患者的生活质量明显更差，且在精神症状测量方面得分更高。PNES（70.3%）或癫痫合并 PNES（62.1%）患者的精神共病患病率明显高于单独癫痫患者（41.2%）（p<0.001）。
在本研究人群中，药物难治性癫痫和 PNES 患者的生活质量决定因素比发作频率更强的是精神症状、抑郁和认知。患有 PNES 伴或不伴合并症的癫痫患者具有相似的神经精神特征。
