Lee Sang-Ahm, Choi Eun Ju, Jeon Ji-Ye, Han Su-Hyun, Kim Hyun-Woo, Lee Gha-Hyun, Ryu Han Uk, Im Kayeong, Yang Ha-Rin
Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Epilepsy Res. 2022 Jan;179:106825. doi: 10.1016/j.eplepsyres.2021.106825. Epub 2021 Nov 23.
Clinical research regarding impulsivity in patients with epilepsy is limited. The present study investigated the associations between impulsivity and seizure-related factors or suicidality in patients with epilepsy, independent of depression and anxiety.
The multicenter study included 146 subjects (63% men). We utilized the Barratt Impulsiveness Scale-11 (BIS-11), Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and suicidality module of the Mini International Neuropsychiatric Interview (MINI). Stepwise regression analyses and an analysis of covariance with interaction terms were performed.
The mean BIS-11 score was 59.3 (SD = 10.7). Psychiatric pathologies, including suicidality, were reported in relatively large proportions of patients, including PHQ-9 score ≥ 10 in 29 (19.9%) patients, GAD-7 score ≥ 7 in 35 (24.0%) patients, and MINI suicidality score ≥ 6 in 15 (10.3%) patients. Stepwise linear regression revealed that BIS-11 score was positively associated with the PHQ-9 scores (p < 0.001), antiseizure medication polytherapy (p < 0.001), use of lamotrigine (p = 0.009), and recurrence of generalized or focal to bilateral tonic clonic seizures (p = 0.010). The coefficient of determination for the model was 0.397. Generalized or focal to bilateral tonic clonic seizure recurrence tended to be positively associated with total BIS-11 scores in men but not in women. In subscale analyses, somewhat different variables were associated with different BIS-11subscales. A trend for a positive association between BIS-11 score and suicidality was found (p = 0.066).
This study identified a positive association between clinical seizure severity and impulsivity, and found that this association tended to be sex-specific, occurring only in males. Impulsivity could potentially be weakly associated with suicidality in patients with epilepsy.
关于癫痫患者冲动性的临床研究有限。本研究调查了癫痫患者冲动性与癫痫相关因素或自杀倾向之间的关联，且独立于抑郁和焦虑因素。
这项多中心研究纳入了146名受试者（63%为男性）。我们使用了巴雷特冲动性量表-11（BIS-11）、患者健康问卷-9（PHQ-9）、广泛性焦虑障碍量表-7（GAD-7）以及迷你国际神经精神病学访谈（MINI）的自杀倾向模块。进行了逐步回归分析以及带有交互项的协方差分析。
BIS-11量表的平均得分为59.3（标准差 = 10.7）。相当比例的患者报告了包括自杀倾向在内的精神病理学问题，其中29名（19.9%）患者的PHQ-9得分≥10，35名（24.0%）患者的GAD-7得分≥7，15名（10.3%）患者的MINI自杀倾向得分≥6。逐步线性回归显示，BIS-11得分与PHQ-9得分呈正相关（p < 0.001）、与抗癫痫药物联合治疗呈正相关（p < 0.001）、与使用拉莫三嗪呈正相关（p = 0.009）以及与全面性发作或局灶性发作继发全面性强直阵挛发作的复发呈正相关（p = 0.010）。该模型的决定系数为0.397。全面性发作或局灶性发作继发全面性强直阵挛发作的复发在男性中往往与BIS-11总分呈正相关，而在女性中并非如此。在分量表分析中，不同的变量与不同的BIS-11分量表相关。发现BIS-11得分与自杀倾向之间存在正相关趋势（p = 0.066）。
本研究确定了临床癫痫严重程度与冲动性之间存在正相关，并发现这种关联具有性别特异性，仅在男性中出现。冲动性可能与癫痫患者的自杀倾向存在微弱关联。
