Rocamora Rodrigo, Chavarría Beatriz, Pérez Eva, Pérez-Enríquez Carmen, Barguilla Ainara, Panadés-de Oliveira Luisa, Principe Alessandro, Zucca Riccardo
Epilepsy Monitoring Unit, Department of Neurology, Hospital del Mar, Barcelona, Spain.
Hospital del Mar Medical Research Institute, Barcelona, Spain.
Front Neurol. 2021 Oct 28;12:761239. doi: 10.3389/fneur.2021.761239. eCollection 2021.
The overall combined prevalence of anxiety and depression in patients with epilepsy has been estimated at 20.2 and 22.9%, respectively, and is considered more severe in drug-refractory epilepsy. Patients admitted to epilepsy monitoring units constitute a particular group. Also, patients with psychogenic non-epileptic seizures can reach more than 20% of all admissions. This study aims to characterize these symptoms in a large cohort of patients admitted for evaluation in a tertiary epilepsy center. The study was conducted among 493 consecutive patients (age: 38.78 ± 12.7, 57% females) admitted for long-term video EEG from January 2013 to February 2021. Demographic, clinical, and mood disorder patients' data were collected. Anxiety and depression symptoms were assessed through the Hospital Anxiety Depression Scale (HADS-A and HADS-D), the State Trait Anxiety Inventory (STAI), and Beck Depression Inventory (BDI-II). Quality of life was determined using the QOLIE-10. Patients were divided into three groups: patients with epilepsy ( = 395), psychogenic non-epileptic seizures (PNES) ( = 56), and combined ( = 33). A univariate and multivariate regression analysis was performed for variables associated with quality of life. Of 493 patients, 45.0% had structural etiology, and considering epilepsy classification, 43.6% were of temporal lobe origin. In addition, 32.45% of patients had a previous psychiatric history, 49.9% of patients had depressive symptoms in BDI, and 30.9% according to HADS-D; 56.42 and 52.63% of patients presented pathological anxiety scores in STAI-T and STAI-S, respectively; and 44.78% according to HADS-A. PNES and combined groups revealed a higher incidence of pathologic BDI scores (64.29 and 78.79%, < 0.001) as well as pathologic HADS-A scores ( = 0.001). Anxiety and depression pathologic results are more prevalent in females, HADS-A (females = 50.7%, males = 36.8%; = 0.0027) and BDI > 13 (females = 56.6%, males = 41.0%; = 0.0006). QOLIE-10 showed that 71% of the patients had their quality of life affected with significantly higher scores in the combined group than in the epilepsy and PNES groups ( = 0.0015). Subjective anxiety, depression, and reduced quality of life are highly prevalent in patients with refractory epilepsy. These symptoms are more evident when PNES are associated with epilepsy and more severe among female patients. Most of the cases were not previously diagnosed. These factors should be considered in everyday clinical practice, and specific approaches might be adapted depending on the patient's profile.
癫痫患者中焦虑和抑郁的总体合并患病率估计分别为20.2%和22.9%，并且在药物难治性癫痫中被认为更为严重。入住癫痫监测病房的患者构成一个特殊群体。此外，心因性非癫痫发作患者可占所有入院患者的20%以上。本研究旨在对在一家三级癫痫中心接受评估的一大群患者的这些症状进行特征描述。该研究在2013年1月至2021年2月期间连续入住的493例患者（年龄：38.78±12.7岁，57%为女性）中进行，这些患者因长期视频脑电图监测而入院。收集了人口统计学、临床和情绪障碍患者的数据。通过医院焦虑抑郁量表（HADS - A和HADS - D）、状态特质焦虑量表（STAI）和贝克抑郁量表（BDI - II）评估焦虑和抑郁症状。使用QOLIE - 10确定生活质量。患者分为三组：癫痫患者（n = 395）、心因性非癫痫发作（PNES）患者（n = 56）和合并组（n = 33）。对与生活质量相关的变量进行了单因素和多因素回归分析。在493例患者中，45.0%有结构性病因，考虑癫痫分类，43.6%为颞叶起源。此外，32.45%的患者有既往精神病史，49.9%的患者在BDI中有抑郁症状，根据HADS - D为30.9%；分别有56.42%和52.63%的患者在STAI - T和STAI - S中呈现病理性焦虑评分；根据HADS - A为44.78%。PNES组和合并组显示病理性BDI评分的发生率更高（分别为64.29%和78.79%，P < 0.001）以及病理性HADS - A评分（P = 0.001）。焦虑和抑郁的病理性结果在女性中更为普遍，HADS - A（女性 = 50.7%，男性 = 36.8%；P = 0.0027）和BDI > 13（女性 = 56.6%，男性 = 41.0%；P = 0.0006）。QOLIE - 10显示71%的患者生活质量受到影响，合并组的得分显著高于癫痫组和PNES组（P = 0.0015）。主观焦虑、抑郁和生活质量下降在难治性癫痫患者中非常普遍。当PNES与癫痫相关时，这些症状更明显，并且在女性患者中更严重。大多数病例之前未被诊断。在日常临床实践中应考虑这些因素，并且可能需要根据患者情况采用特定方法。
