Sager Gunes, Vatansever Zeynep, Batu Utku, Çağ Yakup, Akin Yasemin
Department of Pediatric Neurology, Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, Turkey.
Department of Child and Adolescent Psychiatry Dr. Lutfi Kirdar City Hospital, Istanbul, Turkey.
Epilepsy Behav. 2021 Sep 29;124:108339. doi: 10.1016/j.yebeh.2021.108339.
Idiopathic/genetic generalized epilepsy (GGE) accounts for 15-20% of all epilepsy cases. Neuropsychiatric comorbidities and disorders, such as attention-deficit hyperactivity disorder (ADHD), academic failure, and poor social competence, are present at a higher rate in patients with epilepsy compared with the general population. In this study, we aimed to determine the frequency of neuropsychiatric comorbidities in GGE subgroups, and to reveal the risk factors in the patient group with neuropsychiatric comorbidities.
This hospital-based, cross-sectional study follows the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. Patients with seizure-controlled GGE were invited to a semi-structured interview at the hospital. Variables [photosensitivity, valproic acid (VPA) resistance, timing of the neuropsychiatric comorbidities Attention deficit and hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), and low academic performance), seizure control, and timing of the antiepileptic treatment] were statistically analyzed and evaluated in terms of their association with GGE subgroups [Generalized tonic-clonic seizures alone (EGTGS), juvenile myoclonic epilepsy (JME), and juvenile absence epilepsy (JAE)], RESULTS: Total 101 patients with GGE were included in the study and the mean age was 13.94 ± 1.66 years. A total of 12.9% (n = 13) of the patients had EGTGS, 49.5% (n = 50) had JME, and 37.6% (n = 38) had JAE. VPA resistance, photosensitivity, and the presence of neuropsychiatric symptoms before the starting of epilepsy were found to be risk factors in the GGE group with neuropsychiatric comorbidities compared with the group without neuropsychiatric comorbidities (p < 0.001). The subgroups of GGE did not show any relationship with psychiatric disorders, including ADHD, ODD, and low academic performance (neuropsychiatric comorbidities) (p > 0.005). No correlation was found between seizure control and decline in neuropsychiatric symptoms (p > 0.05).
In this study, the onset of psychiatric symptoms prior to the onset of epilepsy, photosensitivity, and VPA resistance were the most important factors affecting neuropsychiatric comorbidities. The JME, JAE, and EGTCS subgroups, early initiation of antiepileptic treatment, and seizure control were found to have no effect on poor psychosocial outcome and neuropsychiatric comorbidities.
特发性/遗传性全身性癫痫（GGE）占所有癫痫病例的15%至20%。与普通人群相比，癫痫患者中神经精神共病和障碍，如注意力缺陷多动障碍（ADHD）、学业失败和社交能力差的发生率更高。在本研究中，我们旨在确定GGE亚组中神经精神共病的发生率，并揭示患有神经精神共病的患者组中的危险因素。
本项基于医院的横断面研究遵循了加强流行病学观察性研究报告（STROBE）指南。癫痫发作得到控制的GGE患者被邀请到医院进行半结构化访谈。对变量[光敏性、丙戊酸（VPA）耐药性、神经精神共病的发生时间（注意力缺陷多动障碍（ADHD）、对立违抗障碍（ODD）和学业成绩低下）、癫痫控制情况以及抗癫痫治疗的时间]进行统计分析，并评估它们与GGE亚组[仅全身性强直阵挛发作（EGTGS）、青少年肌阵挛癫痫（JME）和青少年失神癫痫（JAE）]的相关性。
共有101例GGE患者纳入研究，平均年龄为13.94±1.66岁。共有12.9%（n = 13）的患者患有EGTGS，49.5%（n = 50）患有JME，37.6%（n = 38）患有JAE。与无神经精神共病的组相比，VPA耐药性、光敏性以及癫痫发作开始前存在神经精神症状被发现是患有神经精神共病的GGE组中的危险因素（p < 0.001）。GGE的亚组与包括ADHD、ODD和学业成绩低下（神经精神共病）在内的精神障碍没有任何关系（p > 0.005）。癫痫控制与神经精神症状的减轻之间未发现相关性（p > 0.05）。
在本研究中，癫痫发作前精神症状的出现、光敏性和VPA耐药性是影响神经精神共病的最重要因素。发现JME、JAE和EGTCS亚组、抗癫痫治疗的早期开始以及癫痫控制对不良心理社会结局和神经精神共病没有影响。
